Common Scrotal and Testicular Problems
Section snippets
Testicular torsion
Testicular torsion is a twisting of the testis, blocking blood flow from the spermatic cord and causing acute scrotal pain. Malformations that allow scrotal rotation increase the risk of torsion. The most common is when the tunica vaginalis wraps improperly around the spermatic cord and does not allow the testis to attach to the posterior scrotum.1 Other predisposing factors include increase in testicular volume, testicular tumor, testicles with horizontal lie, a history of cryptorchidism, and
Acute epididymitis
Epididymitis is inflammation of the epididymis, the tightly coiled tube that connects the testicle with the vas deferens. Epididymitis is the most common cause of acute scrotal pain in all age groups, although most cases occur in men 14 to 35 years of age. In the acute phase, symptoms are present for less than 6 weeks.7
Most cases are infectious, caused by bacteria that reflux from the vas deferens to the epididymis. In sexually active men younger than 35 years, Chlamydia trachomatis and
Torsion of the testicular and epididymal appendages
The testicular and epididymal appendages are part of the scrotal anatomy and subject to torsion; this is the most common cause of acute scrotum in prepubertal children. Because appendageal torsion can mimic testicular torsion, it should be considered in all patients presenting with sudden onset of scrotal pain.
The pain is usually localized to a specific area in the testis. These patients lack any signs or symptoms of urinary tract infection or sexually transmitted disease. In these patients,
Chronic scrotal pain
Chronic scrotal pain is pain lasting longer than 3 months, which interferes with daily activity and affects quality of life.9 This condition occurs in 15% to 19% of postvasectomy patients, but in the general population the incidence is unknown. Causes are many and varied, and include prior or ongoing infection (including epididymitis, prostatitis, and orchitis), vasectomy or other previous inguinal surgery, referred pain from the back or abdomen, inguinal hernia, tumor, prior trauma or
Cryptorchidism
Cryptorchidism is a developmental defect whereby the testis fails to descend completely into the scrotum. Undescended testes can be found anywhere from their origin near the inferior pole of the kidney to just outside the external inguinal ring. A normally descended testis can also retract to become cryptorchid later in childhood. Cryptorchid testes can be palpable or nonpalpable,19 with palpable testes accounting for 70% to 80% of cases.
Cryptorchidism is actually a group of abnormalities, with
Hydrocele
A hydrocele is a fluid collection between the layers of the tunica vaginalis. A communicating hydrocele occurs when a patent processus vaginalis allows fluid to pass from the peritoneal space into the scrotum, whereas a noncommunicating or simple hydrocele has no such connection. The incidence of neonatal hydroceles is as high as 4.7%,51 while only about 1% of adult males have hydroceles.
Congenital hydroceles are present at birth or within the first year of life, and are typically caused by an
Spermatocele
Spermatoceles (epididymal cysts) are benign cystic collections of fluid that arise from the epididymis, usually at the superior pole of the testis. Spermatoceles are typically smooth, painless masses, found incidentally by the patient or on routine physical examination, that transilluminate. Spermatoceles require no treatment unless they are significantly painful, and they require no further workup in most cases. Scrotal ultrasound can be used if the diagnosis is in question. If treatment is
Varicocele
A varicocele is a dilation of the testicular vein and pampiniform plexus within the scrotum. Varicoceles are one of the most commonly identified scrotal abnormalities, found in 15% of adult men and in 40% of men with infertility. Varicoceles are thought to be the most common cause of male infertility worldwide.56 Due to discrepancies in venous drainage, 90% of varicoceles occur on the left side. The cause is poorly understood. Most develop in adolescence, so physiologic changes in testosterone
Testicular cancer
Although testicular cancer is a rare cancer, accounting for only about 1% of all male cancers, it is the leading cause of cancer in men between the ages of 15 and 35 years, with an average age at diagnosis of 34. The annual incidence of 4 cases per 100,000 men is rising and has nearly doubled in the past 40 years. Germ cell testicular tumors (seminomas and nonseminomas) are the most common, whereas sex cord-stromal tumors account for only 4% of testicular tumors69 and are not further addressed
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Cited by (52)
Testicular torsion induced by epididymo-orchitis: A case report
2021, International Journal of Surgery Case ReportsCitation Excerpt :Infectious causes below the age of 35 are N. gonorrhoeae and C. trachomatis and E. coli in the older age group specifically in those with obstructive uropathies [15,16]. On the other hand, the exact cause of torsion is unknown however predisposing factors include bell clapper deformity, increase in testicular volume, testicular tumor, horizontal lie testicle, trauma, long spermatic cords [17]. Therefore, increase in testicular volume in EO as seen in our case due to inflammatory reactions can predispose an individual to develop testicular torsion.
Remote ischemic conditioning in a rat model of testicular torsion: does it offer testicular protection?
2019, Journal of Pediatric UrologyCitation Excerpt :Testicular torsion is a urological emergency and a leading cause of testicular loss in adolescents, with about 65% of cases presenting between 12 and 18 years of age [1,2]. It occurs in about 1 in 4000 males per year before the age of 25 years [3–6]. It is a real surgical emergency in which the testicle twists around its own spermatic cord, thus compromising its blood supply with secondary hemorrhage and edema.
Natural History and Conservative Treatment Outcomes for Hydroceles: A Retrospective Review of One Center's Experience
2018, UrologyCitation Excerpt :We searched for relevant cases in a computerized database using the diagnostic code for hydrocele (ICD code: N43) and the surgical codes for hydrocele (SUT codes: 621.510 and 621.520). A questionnaire was prepared to review the epidemiological factors for hydroceles as cited in the literature2-7 and possible outcomes of hydroceles during follow-up or treatment. The medical records of 355 patients were reviewed, and the parents of 274 patients (77%) answered our telephone call and agreed to give detailed information.
Exploring men's preferred strategies for learning about testicular disorders inclusive of testicular cancer: A qualitative descriptive study
2017, European Journal of Oncology NursingCitation Excerpt :The location, anatomy, and physiology of the testes can put men at risk for a number of diseases ranging from painless and benign to incapacitating and malignant (Wampler, 2010).
Evaluation of Adult Acute Scrotum in the Emergency Room: Clinical Characteristics, Diagnosis, Management, and Costs
2016, UrologyCitation Excerpt :Moreover, the percentage of patients with infectious pathologies and requested urine culture was quite low: only 7.4% of epididymitis cases, 17.6% of orchitis cases, 20% of abscesses, and 23.4% of orchiepididymitis cases. Although the results of urine culture tend to be negative in the absence of urinary symptoms, a urine culture should be performed on all patients suspected of having any type of testicular or epididymal infection.5 As can be observed in Figure 1B, there were significant differences both when the groups were separated by age and when they were classified by pathology.
Sclerotherapy in the Treatment of Hydroceles: A Comprehensive Review of the Efficacy, Types of Sclerosants, and Comparative Outcomes Against Hydrocelectomy
2024, Canadian Association of Radiologists Journal