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Testicular disease

Testicular disease. 19 th May 2011 Jonathan Chua. Undescended testes. More common in premature babies Spontaneous descent ~ 3 months (most) ~99% descended at the end of first year ~1% will need surgical correction. Undescended testes. Differentials Retractile testes Absent testes

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Testicular disease

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  1. Testicular disease 19th May 2011 Jonathan Chua

  2. Undescended testes • More common in premature babies • Spontaneous descent ~ 3 months (most) • ~99% descended at the end of first year • ~1% will need surgical correction

  3. Undescended testes • Differentials • Retractile testes • Absent testes • Ectopic testes

  4. Undescended testes • Management • Wait • Orchidopexy • Preserve fertility • Reduce risk of torsion • Reduce risk of malignant change (but intrinsically higher risk)

  5. Testicular torsion • History • Sudden onset scrotal pain • May radiate to lower abdo • May have preceding short-duration scrotal pain • Associated nausea & vomiting • Exam • Testis may appear normal • Exclude other causes • One may lie higher than the other due to cord shortening

  6. Testicular torsion • Differentials • Torsion of the testicular appendage • Acute epididymitis

  7. Testicular torsion • Investigations • Doppler • Exploration required for suspected torsion • Preserve testis if potentially viable • Contralateral testis should also be fixed due to risk of torsion

  8. Testicular cancer • Germ cell vs Stromal tumors • Germ cell tumors more common • More common in patients with abnormal testicular descent

  9. Testicular cancer • Hx • Painless swelling • Vague testicular discomfort • Symptoms of metastatic disease • Hx of abnormal testicular descent

  10. Testicular cancer • Exam • Hard, irregular, non-tender mass • Partial or whole testis • Investigations • Bloods: AFP, HCG (repeat post-op) • Scrotal U/S • Staging: CXR, CT Abdo/Pelvis

  11. Testicular disease • Management • Orchidectomy • Depends on type of tumor • Seminoma is highly radiosensitive • Non-seminoma germ cell tumors are highly chemosensitive • Prognosis • Overall >90% cure rate • Node-negative disease ~100% 5-year survival

  12. To sum up • Undescended testes • Management usually after 12 months of age • Orchidopexy to preserve fertility and ? reduce risk of malignancy • Overall higher risk of testicular malignancy

  13. To sum up • Think about testicular torsion in males with lower abdo/scrotal pain • Surgical exploration is required if testicular torsion is suspected • Testicular tumors aren’t the worst cancer • Suspect it in a patient with a new hard irregular lump • Orchidectomy • Further Mx depends on type of tumor • Overall good prognosis

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