Diseases Of The Testicle
DISEASES OF THE TESTICLE AND RELATED STRUCTURES
This discussion deals with disorders of the scrotal contents, i.e. the testicles, spermatic structures and related anatomic areas. Cancers and other tumors, infections including epididymitis, and hormonal imbalances are dealt with in other specific sections such as those on cancer, infections, and endocrinology.
ANY MASS, LUMP, OR OTHER CHANGE IN THE SCROTUM OR TESTICLE AREA SHOULD BE IMMEDIATELY EVALUATED BY A PHYSICIAN, SINCE CANCERS OF THIS AREA ARE NOT RARE. UNTIL PROVEN OTHERWISE, ANY SUCH ABNORMALITY SHOULD BE CONSIDERED POTENTIALLY SERIOUS UNTIL A PHYSICIAN RULES THIS OUT.
VARICOCOELE
A varicocoele is the equivalent of a varicose vein in the vessels surrounding and draining the testicle and related structures within the scrotum. Generally it is of unknown cause, although rarely the vein becomes dilated because it is being blocked by an unsuspected tumor; the vast majority are not of this nature. Interestingly over 97% of cases occur on the left side, due to the anatomy of the veins in the area.
Most cases are first noted in patients who become aware of a bulging fullness or a mass near the testicle. It has been unglamourously described as resembling a “bag of worms” in consistency. There is usually little or no discomfort associated unless the size of the veins becomes so large as to put mechanical pressure on the surrounding structures. The disorder routinely decreases the sperm production on the involved side, and even on the other side as well; it is thus an occasional cause of male infertility. Most cases can be diagnosed on examination.
When treatment is judged necessary, a fairly simple surgical procedure is curative.
TORSION OF THE TESTICLE
One of the more painful conditions known to man, testicular torsion occurs when the supporting structures of the testicle are formed in such a way as to allow the testis to twist into a position which strangulates off the supplying blood vessels;
when swelling takes place from this, the twisting may become irreversible and a torsion is said to have occurred. There may be no obvious precipitating factor, or the patient may recall some unusual movement or strain. Young men are affected far more often than those over 40.
Symptoms consist of sudden onset of severe and progressive pain in the testicle, which because of its visceral nature may be accompanied by nausea and vomiting. Left untreated, this can result in gangrene of the testicle. Diagnosis is suggested by the history, but care must be taken not to confuse this with conditions such as infections or tumors which have suddenly hemorrhaged. An experienced examiner, usually a urologist, can often feel the reversed position of the detailed anatomy of the testis, and make a rapid diagnosis. As a relative urologic emergency, surgery is important before too much time has elapsed and the testis is sacrificed due to lack of blood supply.
HYDROCOELE & SPERMATOCOELE
A hydrocoele is a fluid-fille mass within the scrotum which is generally painless and very slow growing. It seems to occur from a mild congenital abnormality which leaves certain structures within the scrotum open to the accumulation of fluid, instead of being closed off from the surrounding structures. Spermatocoeles are also cyst-lik masses which arise from the sperm carrying tubules of the testicle and adjoining epididymis, and are filled with sperm containing fluids.
Diagnosis revolves on the characteristic feel of the cysts, and their exact anatomic location, i.e. outside of the testicle itself. In addition, these cysts are somewhat translucent to a bright light source, and this can sometimes be helpful in diagnosis.
These cysts are generally progressive if only slowly, and should be surgically repaired at a convenient time by a urologist or a general surgeon. Any sudden change in the mass would require more urgent evaluation, as would any diagnostic uncertainty.
Cancers and tumors of this area are discussed in the cancer section of HealthNet. Another disorder which can sometimes present as a mass near the testicle is an inguinal hernia, which can be read about in the “Common Surgical Problems” section.
ORCHITIS
Orchitis refers to infection of the testicle with micro organisms. It is not common, but cases can be most confusing. The commonest cause is the mumps virus; usually it only occurs in men who get mumps as adults or teenagers, and is less common in children. Painful swelling of the testis is the main symptom, and the end result may be scarring, shrinkage and loss of sperm production on the involved side.
Diagnosis usually is made from the presence of typical mumps symptoms elsewhere, such as swelling of the salivary glands. If there is even the slightest question about the origin of such swelling, urologic consultation is warranted.
DISORDERS OF THE PENIS
HYPOSPADIUS
This is a common congenital condition in which the urethral opening normally at the tip of the penis is instead located along the shaft of the penis on its bottom aspect. Depending on its exact position, this may present absolutely no problem for the patient, or else sexual functioning and urination may be interfered with. When such problems are present, repair can be accomplished through surgical procedures.
PHIMOSIS
The foreskin of the uncircumcised male forms a sort of band around the shaft of the penis. If injury, local infection, or swelling from almost any cause occurs and progresses, the band can act like a tourniquet. When this happens, the return of blood from the end portions of the penis are cut off, and further swelling can occur. This condition is known as phimosis.
Diagnosis is obvious from examination. Treatment should be prompt, and consists of somewhat forceful withdrawing of the foreskin when possible, even if anesthesia is necessary. More often, the foreskin must be cut and removed to prevent recurrences, in effect a circumcision. Preventive measures include proper hygiene of the foreskin and underlying penis, and early attention when the patient first finds that retracting the foreskin is not easily done.
Peyronie’s Disease
This rather unusual disease is the formation of a contracture or shortening of one of the major tendons attaching the shaft of the penis to the supporting pelvic area. In the normal state, the patient may be unaware of this. During erection of the penis, the patient may note pain as the tendon is stretched beyond its usual length, and the penis may point to the side of the contracture. Embarrassing though it may be, this can cause considerable dysfunction of a sexual nature, and often warrants treatment. The cause is unknown.
Treatment is basically surgical if reassurance of its benign nature is not sufficient to relieve the patients symptoms. Some authorities advise the use of high doses of PABA (para-amino benzoic acid) which is said to reduce scar formation, but scientific evidence of its effectiveness is poor.