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Medical picture of testicles: Testicular Cancer: Medical Illustrations | Cancer.Net

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Testes – Anatomy Pictures and Information

The testes (singular: testis), commonly known as the testicles, are a pair of ovoid glandular organs that are central to the function of the male reproductive system. The testes are responsible for the production of sperm cells and the male sex hormone testosterone. The testes produce as many as 12 trillion sperm in a male’s lifetime, about 400 million of which are released in a single ejaculation.

Located in the hollow sac of the scrotum, each testis is about 1.5 to 2 inches long along its long axis and around 1 inch in diameter. Continue Scrolling To Read More Below…

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Continued From Above…
The testes are connected to the vital organs of the ventral body cavity via the spermatic cords. Nerves, blood vessels, and lymphatic vessels travel through the spermatic cords to support the testes. The vas deferens also passes through the spermatic cord carrying sperm out of the testes toward the prostate and urethra. The cremaster muscle wraps around the exterior of the spermatic cord to lift the testes closer to the body or permit them to descend.

The testes are wrapped by the tunica vaginalis, an extension of the peritoneum of the abdomen, and the tunica albuginea, a tough, protective sheath of dense irregular connective tissue. Each testis is divided by invaginations of the tunica albuginea that divide it into several hundred small segments called lobules. Each lobule contains several tightly coiled tubes called seminiferous tubules.

The walls of the seminiferous tubules contain the germ cells, Sertoli cells, and Leydig cells that give the testes their function. Millions of germ cell in the walls of the seminiferous tubules multiply and differentiate to produce spermatocytes from the onset of puberty until death. The spermatocytes develop into spermatids and eventually spermatozoa, or sperm cells. The immature sperm cells are supported and protected by Sertoli cells as they travel the length of the seminiferous tubules and slowly mature. Leydig cells at the ends of the seminiferous tubules produce the male hormone testosterone that produces the secondary sex characteristics associated with males.

Each sperm produced by the testes takes about seventy-two days to mature and its maturity is overseen by a complex interaction of hormones. The scrotum has a built-in thermostat that keeps the testes and sperm at the correct temperature. It may be surprising that the testes should lie in such a vulnerable place outside the body, but it is too hot for them inside. Spermatogenesis requires a temperature that is three to five degrees Fahrenheit below body temperature. If it becomes too cool on the outside, the cremaster muscle will contract to bring the testes closer the body for warmth.

Clinical pictures: Male genital problems

Epididymal cyst

The epididymal cyst is probably the most common lump seen in male patients. These cysts vary in size from a pea to a peach. This young man, like most, was very worried, having become aware of the swelling while he was in the shower. He was certain that he had a testicular cancer. The swelling was separate from the testicle and clearly benign. An ultrasound scan confirmed the diagnosis and no further action was required.


Penile candida

This man presented with a very painful foreskin. It was extremely uncomfortable every time he developed an erection because the skin split. Topical antifungal cream was effective in controlling the infection and helping the skin to heal. He was advised to ensure that his partner also treated herself, to ensure that he did not become reinfected.


Fixed drug eruption

This patient developed a rash on his glans. Other than its alarming appearance, it was asymptomatic. He had recently been prescribed the COX-2 inhibitor etoricoxib for gout. A dermatologist considered this might be the cause because no other likely culprits were apparent. Withdrawal of the drug was followed by resolution of the rash, which did not reappear. The patient has subsequently taken colchicine for his acute gout.


Orchitis

This man required catheterisation following surgery. A few days later, he developed a very tender, swollen testicle, due to acute orchitis. He was quite unwell, with a pyrexia. He was treated with a combination of amoxicillin and metronidazole, covering aerobic and anaerobic organisms. He improved over a few days, but it took several weeks for the testicle to become normal.


Penile ulcer

This 75-year-old man had endstage renal failure requiring haemodialysis. He also developed a penile ulcer. It was thought to be due to herpes simplex and related to his immune-suppressed state. Viral and bacterial swabs were negative on culture and antiviral therapy was not effective. The ulcer eventually healed on its own, although the patient’s general health continued to deteriorate and he died a little while later.


Fordyce spots

Teenagers can be very concerned about the appearance of these spots. They are caused by sebaceous gland hyperplasia and may also be seen in the mouth. They often cause anxiety and are mistaken for warts or other STIs. They are very common and of no significance. Reassurance and explanation are normally all that is required.


Bruising

This man sustained a ‘groin strain’ playing rugby. The actual injury is probably due to a tear in the adductor muscles. This was moderately severe and would probably be graded two on a scale of one to three. He was alarmed to find this rather dramatic bruising. Advice to rest and use a combination of ice and warmth helped to heal the injury and he was playing rugby again in three weeks.


 

Orchidopexy

This 44-year-old man had a long history of problems with his testicles. The left side had been operated on in childhood to repair the scrotum. He had for some years been troubled by discomfort from the right testicle because it often rode upwards out of the correct position in the scrotum. The testicle was normal and his fertility had not been impaired. He underwent orchidopexy to fix the testicle into the scrotum once and for all.


  • Dr Marazzi is a GP in East Horsley, Surrey

Testicular Ultrasound | Michigan Medicine

Test Overview

A testicular ultrasound (sonogram) is a test that uses reflected sound waves to show a picture of the testicles and scrotum. The test can show the long, tightly coiled tube that lies behind each testicle and collects sperm (epididymis). And it can show the tube (vas deferens) that connects the testicles to the prostate gland. The ultrasound does not use X-rays or other types of radiation.

A small handheld device called a transducer is passed back and forth over the scrotum. The device sends the sound waves to the computer, which turns them into a picture. This picture is shown on a video screen. The picture produced by ultrasound is called a sonogram, echogram, or scan. Pictures or videos of the ultrasound images may be saved.

Why It Is Done

Testicular ultrasound is done to:

  • Check a mass or pain in the testicles.
  • Find or check on an infection or swelling of the testicles or epididymis.
  • Check for twisting of the spermatic cord. This problem cuts off blood supply to the testicles (testicular torsion).
  • Check to see if testicular cancer has come back.
  • Find an undescended testicle.
  • Check for fluid in the scrotum (hydrocele), fluid in the epididymis (spermatocele), blood in the scrotum (hematocele), or pus in the scrotum (pyocele).
  • Guide a biopsy needle for a testicular biopsy. This may be done when testing for infertility.
  • Check an injury to the genital area.

How To Prepare

In general, there’s nothing you have to do before this test, unless your doctor tells you to.

How It Is Done

A testicular ultrasound is done at a doctor’s office or hospital.

Before the test, you’ll need to take off all your clothes from the waist down. You will put on a gown. You’ll be asked to lie on your back on a padded table. Folded towels will be used to cover the penis and lift the scrotum. A gel (such as K-Y Jelly) will be spread on your scrotum. This is used for the transducer, which is pressed against your skin and moved across your scrotum many times.

You will need to lie very still during the ultrasound scan. You may be asked to take a breath and hold it for several seconds during the scan.

When the test is finished, the gel is removed from your skin. You may be asked to wait until the radiologist has reviewed the test. He or she may want to do more ultrasound views.

How long the test takes

The test takes about 20 minutes.

How It Feels

Most people don’t feel pain during the test. If your scrotum hurts already from an injury or illness, the slight pressure from the transducer may be somewhat painful. You will not hear or feel the sound waves.

Risks

There are no known risks from having this test.

Results

Testicular ultrasound

Normal:

The testicles are normal in shape and size. They are in the normal position.

There is no sign of a noncancerous (benign) or cancerous (malignant) lump in the testicles.

There is no sign of infection or swelling of the testicles or epididymitis.

There is no twisting of the spermatic cord. This twisting (testicular torsion) cuts off blood supply to the testicles.

There is no sign of fluid in the scrotum (hydrocele), blood in the scrotum (hematocele), fluid in the epididymis (spermatocele), or pus in the scrotum (pyocele).

Abnormal:

There is a lump in the testicle or there are signs of testicular cancer.

There are signs of infection or swelling of the testicles or epididymis.

The spermatic cord is twisted. This problem cuts off blood supply to the testicles (testicular torsion).

No testicle or only one testicle is present in the scrotal sac.

Fluid (hydrocele), blood (hematocele), or pus (pyocele) is present in the scrotum or fluid is present in the epididymis (spermatocele).

There is a hernia in the scrotum.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Martin J. Gabica MD – Family Medicine
Howard Schaff MD – Diagnostic Radiology

Current as of: September 23, 2020

Author:
Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Martin J. Gabica MD – Family Medicine & Howard Schaff MD – Diagnostic Radiology

Testicle injuries and conditions – Better Health Channel

There are various non-cancerous conditions that can affect the testicles. The testicles are also prone to injury because they are not protected by muscle or bone. It is important to seek prompt medical attention for any testicular complaint.

Testicle anatomy

Testicles are also known as testes (one is a testis) or ‘balls’. They are two small, oval-shaped male sex glands that produce sex hormones and sperm. Each testicle is housed in a fibrous outer covering called the tunica albuginea, which is contained within a sac of skin called the scrotum. 

Sperm production needs a temperature that is around 2 °C lower than the body, which is why the testicles are located outside the body in the scrotum.

Testicular torsion

The spermatic cord attaches the testicle to the body. Testicular torsion occurs when the spermatic cord twists and cuts off the blood supply to the testicle. This condition can occur at any age, but tends to be more common between the onset of puberty and the mid-20s. It requires urgent medical attention.

Hard physical activity can cause this twisting of the cord. In most cases, however, it is caused by abnormalities in a male’s anatomy (body structure and organs) that make it easier for the testicle to twist or rotate around the cord.

Symptoms of testicular torsion

Symptoms of testicular torsion include:

  • severe pain
  • scrotal swelling
  • nausea and vomiting.

These symptoms can often be confused with an infection of the testicles. An infection should not be considered until torsion has been ruled out.

Urgent medical attention is needed to save the testicle when torsion is diagnosed. Surgery must untwist the spermatic cord and restore blood flow to the testicle. A doctor uses physical examination and ultrasound scans to make the diagnosis. Sometimes, a doctor can only make a conclusive diagnosis at the time of surgical exploration.

The survival rate of the affected testicle is poor unless surgery is performed within four to six hours of the injury. Unnecessary investigations should not take place if torsion is suspected, as delays to surgery can affect the viability of the testis. If the blood supply has been disrupted for too long, the testis may not be viable or salvageable, and may need to be removed.

In many cases, the surgeon will also secure the spermatic cord on the unaffected side, to prevent future torsion of the other testicle. If the torted (twisted) testicle has to be removed, then a surgeon can put a prosthesis or silicone testis into the scrotum for cosmetic reasons (usually at a later date).

Torsion of the appendix testicle

The appendix testicle is a small tissue structure located at the upper third of the testicle. It doesn’t appear to have any particular function. Torsion of the appendix testicle means that the structure has twisted and cut off its blood supply.

This condition is easily confused with testicular torsion because the symptoms are so similar. However, the onset of pain is slower and the condition often presents with a noticeable blue dot on the surface of the scrotum. This blue dot is the darkened appendix testicle. Surgery is needed to correct the problem, but the testicle is not at risk.

Testicular cancer

Testicular cancer is an abnormal growth or tumour that appears as a hard and usually painless lump in either testicle. In most cases, testicular cancer can be cured if the person seeks medical treatment early. Surgical removal of the affected testicle (orchidectomy) is usually the first treatment for all testicular cancer.

Other testicular conditions

Other conditions that can affect the testicles include:

  • epididymitis – the epididymis is a collection of small tubes located at the back of each testicle. It collects and stores sperm. Epididymitis is infection and inflammation of these tubes. Causes include urinary tract infections and sexually transmissible infections (STIs). Treatment is usually antibiotics
  • epididymo-orchitis – this is infection of the epididymis, testicle or both, causing inflammation and pain. Treatment is usually antibiotics
  • varicocele or varicose veins – 10 to 15 per cent of men have a varicocele, occurring where veins draw blood from the testicle. When a man stands up, blood in the veins has to move against gravity to return to the heart. Valves in the veins help this process. If the valves don’t work, blood pools in the veins. This swells the veins and gives the appearance of ‘varicose veins’. Varicoceles usually don’t need treatment, unless the varicocele is severe enough to cause discomfort or impair fertility. The links between varicocele and infertility are not fully understood and research is ongoing. Treatment may include surgery or radiological techniques that can block the affected testicular veins, and redirect the blood flow into unaffected veins
  • haematocele – this is a blood clot caused by trauma or injury to the testicles or scrotum. In some cases, the body is able to reabsorb the blood. If not, the person will need surgery to remove the clot
  • hydrocele – this is an abnormal build-up of fluid that causes the affected testicle to swell. In some cases, the body can reabsorb the fluid. Even though the condition is painless, the hydrocele may become so large that the person will need surgery to remove it
  • spermatocele – this is an abnormal build-up of sperm-filled fluid next to the epididymis, which feels like a separate lump on the testicle. This is harmless, but can be removed surgically if it becomes large or bothersome. It is more common after a vasectomy
  • undescended testicles – either one or both testicles are missing from the scrotum and are lodged inside the lower abdomen. Premature and low-weight newborn boys are most prone to undescended testicles. This condition is a known risk factor for testicular cancer and strongly related to infertility. Unless the testicle is brought down into the scrotum by 12 months of age, there is a high risk of damage to sperm production in later life.

Trauma to the testicles

Testicles are easily injured because they are not protected by muscle or bone. The main types of possible injuries include:

  • penetrating (for example, a bite or stab wound)
  • impact from a moving object (for example, a kick to the testicles)
  • impact from hitting an immovable object (for example, a fall onto a hard surface).

The result of such trauma could be ruptured blood vessels or tearing of the testicle. 

A doctor can assess injuries to the testicles by physical examination and ultrasound. If the testicles seem normal, the doctor may prescribe pain-relieving medication. Even without an ultrasound, a surgeon may choose to explore the testicle, particularly in cases of possible testicular torsion.

Surgery is usually performed under a general anaesthetic. Significant injury to the testicles may require surgical exploration and repair or, potentially, removal of the affected testis. A man’s fertility is not affected if he still has one functioning testicle.

Reducing the risk of testicular problems

Suggestions on how to reduce the risk of testicular problems include:

  • Take all reasonable precautions to prevent accidents. For example, drive safely and always wear a seatbelt.
  • Protect yourself from sexually transmissible infections (STIs) by wearing a condom.
  • Always use protective equipment such as a jockstrap or hard cup while playing sports.
  • If you injure your testicles, always seek urgent medical advice.
  • Perform testicular self-examination (TSE) regularly to become familiar with the look, feel and shape of your testicles so you will notice any abnormalities. See your doctor for further information on how to perform TSE.
  • Always see your doctor if you experience any scrotal or testicular pain or unusual symptoms, or if you find a lump or swelling.

Where to get help

Ultrasound Imaging of the Scrotum

Ultrasound imaging of the scrotum uses sound waves to produce pictures of a male’s testicles and surrounding tissues. It is the primary method used to help evaluate disorders of the testicles, epididymis (tubes immediately next to the testicles that collect sperm) and scrotum. Ultrasound is safe, noninvasive, and does not use ionizing radiation.

This procedure requires little to no special preparation. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown.

What is Ultrasound Imaging of the Scrotum?

Ultrasound imaging of the scrotum provides pictures of a male’s testicles and the surrounding tissues.

Ultrasound is safe and painless. It produces pictures of the inside of the body using sound waves. Ultrasound imaging is also called ultrasound scanning or sonography. It uses a small probe called a transducer and gel placed directly on the skin. High-frequency sound waves travel from the probe through the gel into the body. The probe collects the sounds that bounce back. A computer uses those sound waves to create an image. Ultrasound exams do not use radiation (as used in x-rays). Because images are captured in real-time, they can show the structure and movement of the body’s internal organs. They can also show blood flowing through blood vessels.

Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions.

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What are some common uses of the procedure?

Ultrasound imaging of the scrotum is the primary imaging method used to evaluate disorders of the testicles, epididymis (tubes immediately next to the testicles that collect sperm made by the testicle) and scrotum.

This study is typically used to:

  • determine whether a mass in the scrotum felt by the patient or doctor is cystic or solid and its location.
  • diagnose results of trauma to the scrotal area.
  • diagnose causes of testicular pain or swelling such as inflammation or torsion.
  • evaluate the cause of infertility such as varicocele.
  • look for the location of undescended testis.

A sudden onset of pain in the scrotum should be taken very seriously. A common cause of scrotal pain is epididymitis, an inflammation of the epididymis. It is treatable with antibiotics. If left untreated, this condition can lead to an abscess or loss of blood flow to the testicles.

Ultrasound can often detect an absent or undescended testicle as well. It is estimated that approximately three percent of full-term baby boys have an undescended testicle. The testicle normally migrates from the abdomen down a short passage called the inguinal canal and then into the usual position in the scrotal sac before birth. If not present in the scrotal sac, the testicle may have stopped in the inguinal region, in which case the ultrasound examination will often see it. If the testicle has not left the abdominal cavity, it may not be seen by sonography. If a testicle is not detected, a urologist may be consulted in order to decide whether additional imaging such as an MRI is needed to determine its location. If the testicle is found to be in the inguinal region, it may be moved into the scrotum. If left in the abdomen too long, the testicle may become cancerous and may need to be removed.

Ultrasound can identify testicular torsion, the twisting of the spermatic cord that contains the vessels that supply blood to the testicle. Testicular torsion is caused by abnormally loose attachments of tissues that are formed during fetal development. Torsion commonly appears during adolescence, and less often in the neonatal period, and is very painful. Torsion requires immediate surgery to avoid permanent damage to the testicle.

Ultrasound also can be used to locate and evaluate masses (lumps or tumors) in the testicle or elsewhere in the scrotum. Collections of fluid and abnormalities of the blood vessels may appear as masses and can be assessed by ultrasound. Masses both outside and within the testicles may be benign or malignant and should be evaluated as soon as they are detected.

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How should I prepare?

Wear comfortable, loose-fitting clothing. You may need to remove all clothing and jewelry in the area to be examined.

You may be asked to wear a gown during the procedure.

No other preparation is required.

If your son is undergoing the examination, explain the procedure to him. In most cases, you will be able to accompany him into the examination room for support and reassurance.

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What does the equipment look like?

Ultrasound scanners consist of a computer console, video display screen and an attached transducer. The transducer is a small hand-held device that resembles a microphone. Some exams may use different transducers (with different capabilities) during a single exam. The transducer sends out inaudible, high-frequency sound waves into the body and then listens for the returning echoes. The principles are similar to sonar used by boats and submarines.

The technologist applies a small amount of gel to the area under examination and places the transducer there. The gel allows sound waves to travel back and forth between the transducer and the area under examination. The ultrasound image is immediately visible on a video display screen that looks like a computer monitor. The computer creates the image based on the loudness (amplitude), pitch (frequency) and time it takes for the ultrasound signal to return to the transducer. It also takes into account what type of body structure and/or tissue the sound is traveling through.

In order to perform a scrotal sonogram, most commonly a linear small parts transducer is used.

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How does the procedure work?

Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as the object’s size, shape and consistency. This includes whether the object is solid or filled with fluid.

In medicine, ultrasound is used to detect changes in the appearance of organs, tissues, and vessels and to detect abnormal masses, such as tumors.

In an ultrasound exam, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it sends small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive receiver in the transducer records tiny changes in the sound’s pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images. Short video loops of the images may also be saved.

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How is the procedure performed?

For most ultrasound exams, you will lie face-up on an exam table that can be tilted or moved. Patients may be turned to either side to improve the quality of the images.

After you are positioned on the examination table, the radiologist (a physician specifically trained to supervise and interpret radiology examinations) or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured.

There is usually no discomfort from pressure as the transducer is pressed against the area being examined. However, if scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.

Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry quickly. The ultrasound gel does not usually stain or discolor clothing.

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What will I experience during and after the procedure?

Most ultrasound exams are painless, fast and easily tolerated.

Ultrasound imaging of the scrotum is usually completed within 15 to 30 minutes, though sometimes more time is necessary.

If you are accompanying your son during the procedure, ask him to lie still so the sound waves can produce the proper images.

Babies undergoing the examination might cry, but this should not interfere with the procedure.

When the exam is complete, you may be asked to dress and wait while the ultrasound images are reviewed.

After an ultrasound examination, you should be able to resume your normal activities immediately.

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Who interprets the results and how do I get them?

A radiologist, a doctor trained to supervise and interpret radiology exams, will analyze the images. The radiologist will send a signed report to the doctor who requested the exam. Your doctor will then share the results with you. In some cases, the radiologist may discuss results with you after the exam.

Follow-up exams may be needed. If so, your doctor will explain why. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed.

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What are the benefits vs. risks?

Benefits

  • Most ultrasound scanning is noninvasive (no needles or injections).
  • Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful.
  • Ultrasound is widely available, easy-to-use and less expensive than most other imaging methods.
  • Ultrasound imaging is extremely safe and does not use radiation.
  • Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images.
  • Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration.

Risks

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What are the limitations of Scrotal Ultrasound Imaging?

Ultrasound of the scrotum is helpful for finding abnormalities such as masses in the scrotum or testicles. However, it does not always permit an exact diagnosis (i.e., the exact type of tissue a mass is composed of, especially when the mass is solid). Blood flow images of the testicles are not always reliable in determining the presence or absence of blood supply to a testicle that has twisted. When searching for an absent testicle, ultrasound may not be able to find it if it is located in the abdomen because gas filled bowel loops may block the view.

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This page was reviewed on April, 21, 2020

SCROTOX – Before & After Pictures

Aesthetic treatments of the scrotum, including Scrotox are gaining popularity among Great Seattle area men. We offer Scrotox procedure for male patients who prefer a lower hanging and more relaxed scrotum for cosmetic reasons.

IMH Doctors

Innovative Men’s Clinics
Innovative Doctor’s Group

What is Scrotox?

The latest trend in extreme grooming has crossed over from Europe and is becoming quite popular stateside. In fact, doctors are expecting this new procedure to become significantly more popular in 2017. Informally called Scrotox, the procedure involves injecting Botox into the scrota.

WHY WOULD SOMEONE INJECT BOTOX INTO THEIR SCROTA?

Scrotox – Testicular Botox has many purported benefits. One reported benefit is as a treatment for excessive sweating but the primary benefit seems to be that it smooths out the wrinkles on their testes and makes them look bigger. And then there is this – apparently, there are those who have reported that it has improved their sex life. Yup – the buzz is that it increases sensitivity in the boys downstairs… and that… has people talking.

Scrotox Before and After Picture

The clinical pictures below show the results that can be achieved with Scrotox. Results may vary among patients.

As well as smoothing the skin, Scrotox allows the testicles to hang down further and appear bigger.

So how does this all go down?

The procedure is painless and involves applying a topical cream to numb the area. Then there are several small injections made with a fine needle into the testicle skin (but not into the sack itself). The downtime is virtually non-existent and the result is a smoother and larger appearance.

Botox is injected in the scrotal skin (NOT in the testicles), mostly into the dartos muscle. A strong topical anesthetic cream is applied to the scrotum, so injections are painless.

People that have done the procedure have said they tried it because they heard others talk about improved appearance and increased sensitivity. Whether or not curiosity is what brings them in… The end result seems to be bringing them back.

Are there drawbacks?

One Dr warned that if you were trying to have children, there is a possibility that it could temporarily lower your sperm count. Your testicles expand and contract as a means of regulating heat. Scrotox causes your testicles to hang lower and appear more full but this may have a temporary effect on temperature regulation which, in turn, can impact your sperm count.

How long does it last?

Much like regular BOTOX injections, the results will typically last for around 4 months. “The results don’t happen immediately”, one man was quoted as saying “but later that week I noticed my scrotum was more relaxed.” The same patient was also kind enough to elaborate on our questions about sensitivity. “The sex was great!” he said.

SCROTOX PROCEDURE

The procedure usually takes about 45 minutes. IMH’s doctors perform Scrotox at either one of our offices in Seattle, Bellevue, Lynnwood or Federal Way. Schedule an appointment today.

SCHEDULE AN APPT.

Testis | anatomy | Britannica

Testis, plural testes, also called testicle, in animals, the organ that produces sperm, the male reproductive cell, and androgens, the male hormones. In humans the testes occur as a pair of oval-shaped organs. They are contained within the scrotal sac, which is located directly behind the penis and in front of the anus.

Human male testis, epididymis, and ductus deferens.

Encyclopædia Britannica, Inc.

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Exploring the Human Body Quiz

This quiz will test what you know about the parts of the human body and how they work—or don’t. You’ll need to be a master of medical terminology to get a high score.

Anatomy of the testes

In humans each testis weighs about 25 grams (0.875 ounce) and is 4–5 cm (1.6–2.0 inches) long and 2–3 cm (0.8–1.2 inches) in diameter. Each is covered by a fibrous capsule called the tunica albuginea and is divided by partitions of fibrous tissue from the tunica albuginea into 200 to 400 wedge-shaped sections, or lobes. Within each lobe are 3 to 10 coiled tubules, called seminiferous tubules, which produce the sperm cells. The partitions between the lobes and the seminiferous tubules both converge in one area near the anal side of each testis to form what is called the mediastinum testis.

The testes contain germ cells that differentiate into mature spermatozoa, supporting cells called Sertoli cells, and testosterone-producing cells called Leydig (interstitial) cells. The germ cells migrate to the fetal testes from the embryonic yolk sac. The Sertoli cells, which are interspersed between the germinal epithelial cells within the seminiferous tubules, are analogous to the granulosa cells in the ovary, and the Leydig cells, which are located beneath the tunica albuginea, in the septal walls, and between the tubules, are analogous to the hormone-secreting interstitial cells of the ovary. The Leydig cells are irregularly shaped and commonly have more than one nucleus. Frequently they contain fat droplets, pigment granules, and crystalline structures; the Leydig cells vary greatly in number and appearance among the various animal species. They are surrounded by numerous blood and lymphatic vessels, as well as by nerve fibres.

The embryonic differentiation of the primitive, indifferent gonad into either the testes or the ovaries is determined by the presence or absence of genes carried on the Y chromosome. Testosterone and its potent derivative, dihydrotestosterone, play key roles in the formation of male genitalia in the fetus during the first trimester of gestation but do not play a role in the actual formation of the testes. The testes are formed in the abdominal cavity and descend into the scrotum during the seventh month of gestation, when they are stimulated by androgens. About 2 percent of newborn boys have an undescended testis at birth, but this condition often corrects itself by the age of three months. The production of testosterone by the fetal testes is stimulated by human chorionic gonadotropin, a hormone secreted by the placenta. Within a few weeks following birth, testosterone secretion ceases, and the cells within the testes remain undeveloped during early childhood; during adolescence, gonadotropic hormones from the pituitary gland at the base of the brain stimulate the development of tissue, and the testes become capable of producing sperm and androgens.

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The seminiferous tubules, in which the sperm are produced, constitute about 90 percent of the testicular mass. In the young male the tubules are simple and composed of undeveloped sperm-producing cells (spermatogonia) and the Sertoli cells. In the older male the tubules become branched, and spermatogonia are changed into the fertile sperm cells after a series of transformations called spermatogenesis. The Sertoli cells found in both young and adult males mechanically support and protect the spermatogonia.

Each seminiferous tubule of the adult testis has a central lumen, or cavity, which is connected to the epididymis and spermatic duct (ductus deferens). Sperm cells originate as spermatogonia along the walls of the seminiferous tubules. The spermatogonia mature into spermatocytes, which mature into spermatids that mature into spermatozoa as they move into the central lumen of the seminiferous tubule. The spermatozoa migrate, by short contractions of the tubule, to the mediastinum testis; they are then transported through a complex network of canals (rete testis and efferent ductules) to the epididymis for temporary storage. The spermatozoa move through the epididymis and the spermatic duct to be stored in the seminal vesicles for eventual ejaculation with the seminal fluid. Normal men produce about one million spermatozoa daily.

In animals that breed seasonally, such as sheep and goats, the testes regress completely during the nonbreeding season and the spermatogonia return to the state found in the young, sexually immature males. Frequently in these animals the testes are drawn back into the body cavity except in the breeding season, when they again descend and mature; this process is known as recrudescence.

Regulation of testicular function

The principal androgen produced by the testes is testosterone. The production of testosterone by the testes is stimulated by luteinizing hormone (LH), which is produced by the anterior pituitary and acts via receptors on the surface of the Leydig cells. The secretion of LH is stimulated by gonadotropin-releasing hormone (GnRH), which is released from the hypothalamus, and is inhibited by testosterone, which also inhibits the secretion of GnRH. These hormones constitute the hypothalamic-pituitary-testes axis. When serum testosterone concentrations decrease, the secretion of GnRH and LH increase. In contrast, when serum testosterone concentrations increase, the secretion of GnRH and LH decrease. These mechanisms maintain serum testosterone concentrations within a narrow range. In addition, the secretion of GnRH and the secretion of LH must be pulsatile to maintain normal testosterone production. Continuous administration of GnRH results in a decrease in the secretion of LH and therefore a decrease in the secretion of testosterone.

In boys as in girls, puberty begins with the onset of nocturnal pulses of GnRH, which stimulate pulses of follicle-stimulating hormone (FSH) and LH. The testes enlarge and begin to secrete testosterone, which then stimulates the development of male secondary sex characteristics, including facial, axillary, pubic, and truncal hair growth; scrotal pigmentation; prostatic enlargement; increased muscle mass and strength; increased libido; and increased linear growth. Many boys also have transient breast enlargement (gynecomastia) during puberty. This process starts at age 10 or 11 and is complete between ages 16 and 18.

Testosterone produced locally in the testes and FSH produced distally in the pituitary gland stimulate the process of spermatogenesis. Testosterone inhibits the secretion of FSH, which is also inhibited by inhibin, a polypeptide hormone produced by the Sertoli cells. Testosterone production and spermatogenesis decrease very slowly in older men—in contrast to women, whose ovarian function ceases abruptly at the time of menopause.

Robert D. Utiger

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Testicular cancer: clinical presentation and stages of the disease.

William G. Jones
Leeds Teaching Hospital NHS Trust,
Cookridge Hospital, Leeds, UK

Clinical picture.

Testicular cancer is a relatively rare tumor and is not commonly seen by medical practitioners. As a rule, testicular cancer affects men of working age from 15 to 50 years [1]. The clinical picture of the disease consists of symptoms due to the presence of a primary testicular tumor and metastases, or a combination of both.The most common signs of primary testicular tumor are pain, enlargement or swelling of the organ with the appearance of a palpable tumor formation in it. These symptoms occur in 80-90% of patients [2]. Only 10% of patients complain of pain, often severe, indicating infringement of tumor masses, bleeding or infarction in the tumor tissue, or concomitant acute epididymitis. Patients often have a history of recent trauma to the scrotal region. Patients may also report that the affected testicle has recently changed in consistency and size, becoming denser, or, less commonly, becoming softer and smaller (due to atrophy).Often, patients notice a feeling of heaviness in the scrotum or dull pain in the lower abdomen or in the scrotum. Often, the patient’s sexual partner is the first to find a formation in the testicle and insists on consulting a doctor. In 5% of cases, the only symptom of the disease may be back pain. This is a very common and nonspecific symptom in this age group, but it can be a manifestation of testicular cancer metastases [3]. About 3% of patients have signs of gynecomastia, which occurs as a result of the secretion of tumor tissue of a significant amount of chorionic gonadotropin [4].

Symptoms associated with metastases often predominate over testicular symptoms. Severe back pain may indicate an increase in the retroperitoneal lymph nodes, which compress the nerve roots, or the involvement of the psoas muscle in the process. Gastrointestinal symptoms, weight loss are common, and sometimes a tumor is found in the abdominal cavity by palpation. The spread of the tumor above the diaphragm can lead to the detection of visible tumor masses in the left supraclavicular region and complaints of shortness of breath, chest pain [5].Very rarely, patients complain of bone pain resulting from metastatic lesions of the skeleton. When the central nervous system is involved in the process, symptoms of increased intracranial pressure, epileptiform seizures or other neurological symptoms appear. More than 50% of patients with nonseminoma and 25% with seminoma have metastases when they see a doctor, which are clinically manifested in only 10% of cases.

For the differential diagnosis of various pathological formations in the scrotum, ultrasound diagnostics can be used [1,6].Due to the fact that testicular cancer has a short cell doubling period (for non-seminoma, on average, 3 weeks), the tumor can grow in size very quickly. Therefore, it seems especially important to quickly refer such a patient to a specialist. This is especially true for patients in whom the hydrocele cannot resolve for a long time or patients with epididymo-orchitis who do not respond to antibiotic therapy for more than 2 weeks. Differential diagnosis of testicular cancer is carried out with epididymo-orchitis, testicular tuberculosis, granulomatous orchitis, hydrocele, hematocele, hematoma or hernia, as well as with gum and testicular torsion.Be that as it may, any mass in the testicle should be considered as possible testicular cancer and any patient with suspected malignant testicular tumor should be immediately examined by a urological surgeon or oncologist [1].

Late (late) diagnosis. A delay in diagnosis is rare and is usually the fault of a patient who has postponed a visit to a doctor for a long time [7-10]. It is quite obvious that late diagnosis leads to the need to treat a more common disease and, accordingly, to a worse prognosis.Patients postpone a visit to the doctor for various reasons: firstly, it is the fear of a sexually transmitted disease (especially in the case of adultery), and secondly, the fear that treatment may impair their sexual function. A small proportion of patients are embarrassed to discuss this issue or even allow the doctor to examine themselves, especially if the doctor is a woman.

In order to reduce the ignorance of the population in this matter and reduce the number of cases of late diagnosis, popular educational programs are needed [11].They should explain the severity and potential risk of this disease in men between the ages of 15 and 50, teach self-examination techniques and show the real possibility of cure with timely access to a doctor. On the other hand, doctors should always remember that any tumor formation in the testicle should be regarded as malignant until proven otherwise. An example is the reports of an athlete cyclist who won last year’s Tour de France after recovering from testicular cancer.Information about this case helped to reduce public ignorance and reduce social taboos on the discussion of this issue in the press.

Examination of the patient. Examination of the patient begins with careful palpation of the testicle. Normally, the testicles have a dense but homogeneous consistency and are quite mobile. The epididymis is usually palpable as a separate entity. Testicular tumor is usually suspected when the testicle becomes denser and larger. Less commonly, the testicle becomes atrophic and decreases in size.With the continuation of the examination, palpation of the groin areas, abdomen and supraclavicular areas is performed in order to exclude metastatic lesions of the lymph nodes in these areas. An examination would not be complete without a clinical examination of the chest and breast examination.

Ultrasound examination (US) of the scrotum should be included in the examination of a patient with suspected malignant testicular tumor and can be easily performed in any hospital. Ultrasound is a non-invasive, relatively inexpensive method that is able to distinguish normal testicular tissue from tumor formation in almost 100% of cases.Magnetic resonance imaging (MRI) is a more accurate method, but it cannot be used in routine practice due to the high cost of the method. However, in some cases, MRI can be used to resolve the emerging contradictions between the ultrasound and physical examination data. Orchofuniculectomy and histological examination of the obtained material clarify the diagnosis of testicular tumor. This procedure removes the testicle without damaging the tunica albuginea, thus avoiding local metastasis or local recurrence.

Staging of testicular cancer.

The stage of testicular cancer is established according to the extent of the spread of the process before removal of the primary tumor. As you know, the staging of various malignant tumors differs in different anatomical areas. Testicular cancer metastases by hematogenous and / or lymphogenous pathways. Through the lymphatic vessels, metastasis goes into the retroperitoneal space, mainly in the region of the kidneys. Right-sided tumors predominantly metastasize to the lymph nodes of the aorto-caval space, precaval and right para-aortic lymph nodes, while tumors of the left testicle tend to spread to the left para-aortic and pre-aortic lymph nodes.About 1/5 of tumors of the right testicle can also metastasize contralaterally to the retroperitoneal lymph nodes on the left, which is not typical for tumors of the left testicle. In the future, metastases spread to the lymph nodes of the hilum of the kidney and the legs of the diaphragm. Supraphrenic metastasis goes through the thoracic duct, reaching the upper mediastinal and supraclavicular lymph nodes. The penetration of cancer cells (emboli) through the supraclavicular vein into the pulmonary circulation leads to the appearance of pulmonary metastases. Direct lymphogenous spread through the diaphragm may lead to metastases in the posterior and lower mediastinum.Hematogenous testicular cancer metastases to the lungs, liver, bones, bone marrow, skin. This is more typical for non-seminom than for seminom.

The task of staging the process is to determine the prevalence and nature of metastases, which further determines the tactics of treating the patient. The level of serum markers of hCG (chorionic gonadotropin), AFP (alpha-fetoprotein) and LDH (lactate dehydrogenase) should be determined in the pre- and postoperative period, and further – at weekly intervals.The situation when after the operation the level of AFP and CG does not normalize indicates the prevalence of the disease, which makes it justified to perform these serological tests. In such a clinical situation, CT should be performed shortly after orchofuniculectomy (the benefits of MRI have not yet been proven) of the chest, abdomen and pelvis. CT or MRI of the brain is indicated for patients with multiple metastatic foci in the lungs or with a postoperative hCG level of more than 10,000 IU / ml, i.e.because they have a high risk of cerebral metastases.

Stages of testicular cancer before 1997 Bypassing the general agreement that stage I of the disease is a stage when only the testicle is affected, different classifications were used in the world before 1997. This inconsistency between individual centers made it impossible to analyze the results of various non-randomized trials. With the advent of effective chemotherapy regimens, it became clear that the success of treatment and, accordingly, the prognosis of the disease depends on the degree of prevalence of the disease.The mass of the metastatic tumor, the number of involved groups of lymph nodes and the localization of metastases are important for the prognosis. The increased level of expression of serum tumor markers AFP and hCG also began to be considered as an indicator of the biological aggressiveness of the tumor. There have been many attempts, in particular the EORTC and MRC [13,14], to determine the prognostic groups of patients. The main task was to develop a classification that would determine the patient’s prognosis and the corresponding therapeutic tactics.

Classification. Anatomical classification proposed by Royal Marsden Hospital (UK) has been used in the United Kingdom and Europe for over 20 years (Table 1) [15]. This system reflected the involvement of lymph nodes of various localizations in the pathological process, the size and number of pulmonary metastases. Extrapulmonary visceral metastases belonged to the IV stage of the disease. This classification continues to be used, although it has recently been slightly modified. It remains relevant for the management of seminomas and other, more rare types of tumors, such as a tumor from Leydig cells.Attempts to create a classification with predictive value led to the creation in 1997 of a new classification IGCCCG [16]. This classification was created thanks to the collaboration of clinicians from 10 countries, who summarized the experience of treating a large group of patients (5202 patients with non-seminoma testicular tumor and 660 patients with seminoma germ cell tumor) using combinations based on platinum derivatives. A multivariate analysis of the prognostic factors of survival and progression of these patients was performed.As can be seen from Table 2, 3 prognostic groups of patients were identified (good, intermediate and poor prognosis). The three most important prognostic factors were: serum markers (including LDH as a prognostic indicator, but not a specific marker), the presence or absence of pulmonary metastases, the presence or absence of extrapulmonary visceral metastases, and the presence of extragonadal mediastinal tumor. It is important to emphasize that the group of patients with testicular seminoma included patients in the majority (about 80%) who had stage I or II of the disease and received more radiation therapy than chemotherapy.The Union International Against Cancer (UICC) recognized the importance of this work and included this classification in the 5th edition of the international TNM classification in 1997 [17]. The summary of the classification is set out in Table 3. The stages of the disease are presented in Table 4. This new classification has proven to be of great help to clinicians in planning therapy for patients with germ cell tumors.

Symptoms of the disease not associated with the underlying testicular tumor.

Back pain.Tumor formation in the abdomen. Patients with retroperitoneal metastases of testicular cancer suffer from back pain, gastrointestinal disorders (constipation or other symptoms). The patient may not notice a tumor formation in one of the testicles, and if he does, then, as a rule, does not attach much importance to it. Such patients, as a rule, complain of weakness, rapid mental and physical fatigue. Upon further examination, it may turn out that there are tumor metastases in other organs.If the patient is in serious condition, the question of starting chemotherapy before removing the primary tumor becomes relevant. In such cases, the diagnosis of testicular germ cell tumor is based on elevated tumor markers.

Extragonadal retroperitoneal germ cell tumors. Primary extragonadal tumor with an undetectable tumor in the testicle in most cases is still secondary. On close examination, the history of such patients has indications of a slight increase in the testicle for several days or weeks in the past, often taking place many months or even years ago.The mechanism of development of extragonadal tumors in this situation is as follows: the growth of the testicular tumor was so rapid that it outpaced its own angiogenesis, and the tissue of the testicular tumor underwent necrosis, having had time, however, to give metastatic screenings to the retroperitoneal space or mediastinum. Often in such cases, a scar can be found in the testicle during histological examination after orchofuniculectomy. On examination, such a testicle is atrophic, and ultrasound may reveal pathology in the testicle [18].

Germ cell tumors of the mediastinum. About 5-7% of all germ cell tumors develop outside the gonads – in the mediastinum or retroperitoneal space. While most retroperitoneal extragonadal tumors are actually of gonadal origin, extragonadal tumors of the mediastinum are more often truly extragonadal and differ in nature and biological characteristics from true testicular tumors [19]. For extragonadal nonseminoma germ cell tumor of the mediastinum, the prognosis is completely different, and according to the latest IGCCCG classification, this group of tumors is classified as a poor prognosis.Primary seminomas, which account for approximately 30-40% of mediastinal malignancies, have a good prognosis and respond well to standard chemotherapy. A large volume of tumor in the mediastinum in such patients is usually discovered incidentally during examination for complaints of shortness of breath or discomfort (pain) in the region of the heart. Young patients with signs of gynecomastia should undergo pulmonary x-rays to exclude a tumor producing hCG.

Other metastatic manifestations. Patients with aggressive disseminated testicular cancer (usually nonseminoma with trophoblast elements) can have metastases of any localization: to the brain, liver, bones, bone marrow, skin, lymph nodes of the chest and abdominal cavity, head and neck. Sometimes the diagnosis is made on the basis of a biopsy of material from these foci. Very often, morphological interpretation is difficult, especially in the case of a tumor with a low degree of differentiation. Morphologists often give the answer “metastases of adenocarcinoma from an undetected primary focus.”Therefore, in any young patient with metastatic manifestations of the above localizations, a differential diagnosis with a germ cell tumor of the testicle should be carried out. AFP and hCG levels can provide useful information in this situation. When treating such a patient, even in the absence of clear evidence in favor of this diagnosis, it is necessary to consider the prospect of chemotherapy with the inclusion of platinum drugs.

Table 1.
Royal Marsden Hospital classification [15]

Stages
I
IM
No signs of disease outside the testicle
Boost markers only
II
IIA
IIB
IIC
IID *
Involvement of lymph nodes below the diaphragm
Maximum size
Maximum size 2-5 cm
Maximum size> 5
Maximum size> 10 cm
III Involvement of lymph nodes above and below the diaphragm
Retroperitoneal lymph nodes A, B, C, as above
Medistinal lymph nodes M +
Cervical lymph nodes N +
IV Visceral metastases
Retroperitoneal lymph nodes as in stage II
Medistinal or cervical lymph nodes as in stage III
Lung metastases:
– L1
– L2 multiple metastases with maximum size
– L3 multiple metastases with a maximum size> 2 cm
Liver metastases H +
Metastases to other organs and tissues please specify additionally

Table 2.
IGCCC classification. [16]

Non-seminoma tumors Seminoma
Good forecast with all signs:
Testicular tumor / extragonadal retroperitoneal
Metastases to lymph nodes and / or lungs
AFP
HG
LDH
56% of all patients with non-seminoma
5-year survival rate 92% 90,082

Any localization of the primary tumor
Metastases to lymph nodes and / or lungs
Normal AFP
Any HG
Any LDH
90% with metastatic seminoma
5-year survival rate 86% 90,082
Moderate forecast with all signs:
Testicular tumor / extragonadal retroperitoneal
Metastases to lymph nodes and / or lungs
AFP * 1000 and * 10000 ng / ml or
HG * 5000 units / l or * 50,000 units / l or
LDH * 1.5 norms * 10 norms
28% of all patients with non-seminoma
5-year survival rate 80%
Any localization of the primary tumor
Metastases to the liver, bones, brain
Normal AFP
Any HG
Any LDH LDH
10% seminom
5-year survival rate 73% 90,082
Poor prognosis with at least one feature:
Extragonadal mediastinal tumor
Metastases to the liver, bones, brain
AFP> 10000 ng / ml or
HG> 50,000 U / L or
LDH> 10 norms
16% of all patients with non-seminoma
5-year survival rate 48%
Sick seminomas do not qualify as a bad prognosis

Table 3.
1997 TNM classification [17]

Testicle
PTis
pT1
pT2
pT3
pT4
Intracubular tumor
Testicle and epididymis, no invasion of venous and lymphatic vessels
Testicle and epididymis, there is invasion of venous and lymphatic vessels
The tumor invades the cord
The tumor invades the tunica albuginea
Retroperitoneal lymph nodes
N1
N2
N3

> 2
> 5 cm

Distant metastases
M1a
M1b
Metastases to lymph nodes above the diaphragm and / or lungs
Metastases to the liver, bones, brain

Table 4.
Stage allocation according to TNM classification, 1997. [17]

Stages T N M Markers
Stage 0 pTis NO MO SO, SX
Stage I pT1-4 NO MO SX
IA Stage pT1 NO MO SO
Stage IB pT2 NO MO SO
pT3 NO MO SO
pT4 NO MO SO
IS Stage any pT / TX NO MO S1-3
Stage II any pT / TX N1-3 MO SX
Stage IIA any pT / TX N1 MO SO
any pT / TX N1 MO S1
Stage IIB any pT / TX N2 MO SO
any pT / TX N2 MO S1
Stage IIC any pT / TX N3 MO SO
any pT / TX N3 MO S1
Stage III any pT / TX any N M1, M1a SX
Stage IIIA any pT / TX any N M1, M1a SO
any pT / TX any N M1, M1a S1
Stage IIIB any pT / TX N1-3 MO S2
any pT / TX any N M1, M1a S2
Stage IIIC any pT / TX N1-3 MO S3
any pT / TX any N M1, M1a S3
any pT / TX any N M1b any S

Tumor markers – S

90 130 CG (mIU / ml)

LDH AFP (ng / ml)
SX tumor markers not detected or unknown
S0 tumor markers within normal limits
S1 S2 1.5 – 10 x VGN * 5000 – 50,000 1000 – 10000
S3 > 10 x VGN * > 50,000 > 10000

* VGN – upper limit of the norm

References.

1. Scottish Intercollegiate Guidelines Network (SIGN). Guidelines on the management of adult testicular germ cell tumors. Royal College of Physicians of Edinburgh. Edinburgh, 1998.

2. Cancer Research Campaign. Factsheet 16 1998: Testicular Cancer – UK. London, CRC, 1998.

3. Cantwell BMJ, Macdonald I, Campbell S, Millward MJ, Roberts JT. Back pain delaying diagnosis of metastatic testicular tumors. Lancet 1989, ii, 739-740.

4. Rustin GJ, Vogelzang NJ, Sleiffer DT, Nisselbaum JN. Consensus statement on circulating tumor markers and staging patients with germ cell tumours. In: Newling DWW, Jones WG (eds): EORTC Genitourinary Group Monograph 7: Prostate and Testicular Cancer.Wiley-Liss, New York. Prog Clin Biol Res 1989; 357: 277-284.

5. Kennedy BJ. Testis Cancer: Clinical signs and symptoms. In: Vogelzang NJ, Scardino PT, Shipley WU, Coffey DS. (eds). Comprehensive Textbook of Genitourinary Oncology. (2nd Edition). Lippincott Williams and Wilkins, Philadelphia, 2000. pp 877-879.

6. Thomas G, Jones W, van Oosterom A, Kawai T: Consensus statement on the investigation and management of testicular seminoma 1989. In: Newling DWW, Jones WG (eds): EORTC Genitourinary Group Monograph 7: Prostate and Testicular Cancer.Wiley-Liss, New York. Prog Clin Biol Res 1989; 357: 285 – 294.

7. Jones WG, Appleyard I. Delay in diagnosing of testicular tumors. Br Med J 1985, 290: 1550.

8. Thornhill JA, Fennelley JJ, Kelly DG, Walsh A, Fitzpatrick JM. Patients delay in the presentation of testis cancer in Ireland. Br J Urol 1987, 59: 447.

9. Medical Research Council Working Party on Testicular Tumors. Prognostic factors in advanced non-seminomatous germ-cell testicular tumors: results of a multicenter study.Lancet 1985, i: 8-12.

10. Chilvers C, Saunders M Bliss J, Nicholls J, Horwich A. Influence of delay on prognosis in testicular teratoma. Br J Cancer 1989,59: 126-128.

11. Jones WG. Testicular cancer. Br Med J 1987,295: 1488.

12. Stoter G, Sylvester R, Sleijfer DT, et al: Multivariate analysis of prognostic factors in patients with disseminated nonseminomatous testicular cancer: Results from an EORTC multiinstitutional phase III study. Cancer Res 1987; 47: 2714-2718.

13. Mead GM, Stenning SP: Prognostic factors in metastatic non-seminomatous germ cell tumours: the Medical Research Council studies. Eur Urol 1993; 23: 196-200.

14. Mead GM, Stenning SP, Parkinson MC et al: The Second Medical Research Council study of prognostic factors in nonseminomatous germ cell tumors. Medical Research Council Testicular Tumour Working Party. J Clin Oncol 1992; 10: 85-94.

15. Peckham MJ: Investigation and staging: general aspects and staging classification; in Peckham M (ed): The management of Testicular Tumors.Edward Arnold, London, 1971, pp 89 – 101.19.

16. The International Germ Cell Cancer Collaborative Group: International Germ Cell Consensus classification: A prognostic factor-based staging system for metastatic germ cell cancers. J Clin Oncol 1997; 15: 594 – 603.

17. Sobin LH, Wittekind Ch, (eds): TNM classification of Malignant Tumours (UICC – International Union Against Cancer). Wiley-Liss, New York, 1997, pp 174 – 179

18. Azzopardi JG, Mostofi FK, Theiss EA.Lesions of testes observed in certain patients with widespread choriocarcinoma and related tumors. Am J Pathol 1961, 38: 207-225.

19. Nichols CR. Mediastinal Germ Cell Tumors. In: Jones WG, Appleyard I, Harnden P, Joffe JK. (eds). Germ Cell Tumors IV. John Libbey, London, 1998. pp. 197-201

90,000 MRI and CT studies in the early diagnosis of testicular cancer in St. Petersburg Ramsey Diagnostics

As you know, MRI / CT studies are actively used in the diagnosis of oncological diseases.It is early diagnosis that helps to start the fight against the disease in time and usually leads to positive dynamics in the treatment of the disease.

To learn about the practice of using MRI and CT methods in the diagnosis of testicular cancer, as well as to clarify the main symptoms of testicular cancer, an article by Joseph Benigton-Castro and MD Sanjai Sinha will help.

Painless growths (lumps, bumps, tumors) in the testicles are one of the most common symptoms of testicular cancer.

Comparing testicular cancer with other types of cancer, it can be noted that testicular cancer most often affects men between the ages of 20 and 34.(according to the American Cancer Association).

Testicular cancer usually has a good prognosis and is treated successfully in most cases.

Knowing the main signs and symptoms of this condition will help you get an early diagnosis and treatment that will increase your chances of surviving the condition.

Signs and symptoms

Painless testicular growth is the most common symptom of testicular cancer according to the American Cancer Association.

Other possible symptoms of testicular cancer include:

  • Pain or discomfort in the testicles, often accompanied by a feeling of heaviness in the scrotum
  • Changes in testicular sensitivity
  • Bloated or swollen testicles (without a clear sensation of neoplasms)
  • Dull, prolonged pain in the groin or lower abdomen
  • Feeling of fluid in the scrotum

Early stage testicular cancer is also characterized by the following symptoms:

  • Enlargement of the mammary glands in men (gynecomastia), loss of sexual desire, manifestation of early signs of maturation in boys.

If the cancer has spread to other parts of the body, the following symptoms may be noted:

  • Low back pain
  • Abdominal pain
  • Headaches and mental confusion (e.g. confusion)
  • Chills, weight loss, severe weakness (associated with spinal cord injury)
  • Respiratory manifestations such as shortness of breath, chest pain, cough

Testicular self-examination

Regular self-examination of the testicles can help you catch the early physical signs of testicular cancer.

Some clinicians recommend self-examinations of the testicles at least once a month for all men of mature age, especially if you are at risk of testicular cancer.

Remember that the size of the testicles varies, the hanging testicles are different in length, and the small swellings (bumps) on the outside of the testicles are a manifestation of the structure of the testicles – the epidymidis – the epididymis.

While doing self-examination, gently roll the testicle between your thumb and the rest of the fingers of both hands to see and feel:

  • Solid neoplasms and bumps
  • Smooth smooth rounded neoplasms
  • Changes in the size, shape or structure of the testicles

Self-examination is best done when the scrotum is relaxed, such as after taking a hot bath or shower.

Diagnostics

If you feel something abnormal in your testicles, see your doctor immediately.

Testicular cancer diagnosis will begin with a conversation with your doctor. During the conversation, the doctor will ask the necessary questions about your previous medical conditions and the symptoms you are experiencing.

Your doctor will examine the size and location of any lesions you may have.

If the doctor finds solid growths, he can examine your scrotum with a special lamp.The doctor will also examine your groin, abdomen and other and body parts to see if the cancer has spread.

The doctor will prescribe you texts and diagnostic procedures, such as: ultrasound of the scrotum, blood tests for relevant tumor markers, such as alpha-fetoprotein, human chorionic gonadotropin (hCG), prolactin. In rare cases, doctors prescribe a biopsy – pinching and examining a small piece of testicular tissue – if ultrasound and blood tests do not give a complete picture of the disease.

The doctor will prescribe you a CT scan of the abdomen and kidneys, MRI studies of the small pelvis and genitourinary system in order to clarify the localization of the cancer process and be sure of the correct diagnosis.

Source http://www.everydayhealth.com

Cryptorchidism

You have a boy. This is a wonderful event.

And what is the first thing to pay attention to in the hospital? Of course, on how many fingers and toes, who the child looks like and whether there are testicles in the scrotum.

Should I immediately panic if the testicles in the scrotum are not palpable? Let’s try to figure it out.
We offer you a short, but very detailed overview of a disease such as cryptorchidism . It was prepared by the staff of the Pediatric Uroandrology Department of the N.A. Lopatkin – a branch of the Federal State Budgetary Institution “NMITs of Radiology” of the Ministry of Health of Russia

What is cryptorchidism?

Cryptorchidism is a condition in which the testicle is not defined in the scrotum, but stops at one of the levels of its path from the abdominal cavity to the scrotal cavity. According to statistics, the testicles do not descend into the scrotum at the time of birth, in 3% -4% of cases. In premature boys, this percentage can be as high as 30%.In about half of patients, spontaneous movement into the scrotum occurs during the first year of life. This usually happens with the so-called inguinal form of cryptorchidism. It occurs most frequently. In utero, the testicles are located in the region of the lower poles of the kidneys.

Etiology

The exact cause of cryptorchidism is not known, but several hypotheses have been put forward.
Malformations of the guiding ligament. It is believed that the reason for the violation of the lowering of the gonad from the lumbar region is associated with the advance of body growth compared to the growth of internal organs.Descent of the testicle is provided by the guiding ligament – the fibrous cord of the gubernaculum testit (testicular guide), located between the lower pole of the testicle and the scrotum. Possible causes of cryptorchidism are the absence of a guiding ligament or a defect in its development.
There are several theories of testicular prolapse in the norm . The normal descent of the testicle can undoubtedly be due to several factors, but the following five are most often suggested:
1. Traction downward due to the gubernaculum testit (testicular guide).
2. Differences in the growth rate of the body compared to the spermatic cord and gubernaculum testit.
3. Increased intra-abdominal pressure pushing the testicle through the inguinal ring.
4. Development and maturation of the epididymis.
5. Endocrine factors.

Pathogenesis and pathomorphology

The scrotum is a thermoregulator for the testicles, which maintains the temperature in them 1-1.5 degrees below body temperature. The cells of the spermatogenic epithelium are very sensitive to temperature rise.With a histological examination of the testicles with cryptorchidism, significant changes are found already in the 1st year of life, and by the 4th year, extensive collagen deposits are noted in the testes. In this regard, cryptorchidism should be eliminated during the first year of life. By the age of 6, the changes are even more noticeable. Many pediatric surgeons and pediatric urologists believe that such testicles should be removed after 10 years. The seminiferous tubules are narrowed, the number of spermatogonia is reduced, and there is pronounced fibrosis around the tubules.At the end of sexual development, the testes with cryptorchidism can maintain their normal size, but most of the spermatogenic epithelium is absent, so patients usually suffer from infertility.
We must not forget that in about 10% of cases, cryptorchidism is combined with primary or secondary hypogonadism. At the same time, spermatogenesis in the testes remains reduced, despite treatment.
Fortunately, Leydig cells are insensitive to temperature changes, so their number does not decrease with cryptorchidism.As a result, endocrine impotence is rare in this pathology.
In testicular biopsies from cryptorchidism, the most modern methods do not reveal any chromosomal abnormalities. Consequently, both cryptorchidism and malignant tumors are explained by other reasons.
Sometimes, for cryptorchidism, treatment is started with hormone therapy. Human chorionic gonadotropin is prescribed at 5000-10000 for two to three weeks. Success with this type of treatment can reach 15% -20%. The high success rate, we believe, may be due to the mistaken selection of a large number of patients with so-called pseudo-cryptorchidism.These are children with an increased cremaster reflex. In such children, there is a persistent and prolonged retraction of the testicle into the inguinal canal. In fact, most of the time the testicle is in the scrotum. But only a pediatric urologist-andrologist should and can make such a diagnosis.

Operational method for the treatment of cryptorchidism. Orchopexy

After the diagnosis of inguinal cryptorchidism is made, the child undergoes “open” surgery.
The skin, the anterior wall of the inguinal canal is dissected.
The testicle is visualized.
Carefully and carefully separate the neurovascular bundle together with the vas deferens from the vaginal process of the peritoneum.
After the formation of the tunnel, the testicle descends and is fixed in the scrotum.
If the testicle is not found before the operation, then it is preferable to start the operation from the laparoscopic stage. On which it is possible not only to see the testicle in the abdominal cavity, but also to assess its condition.
If the testicle is absent or is sharply underdeveloped, then in such cases, the testicle is removed.
In all others – the obligatory relegation of the organ.

Complications if the operation is not performed.

Approximately 10 times more often in such patients, testicular cancer occurs at an older age. Moreover, most often it happens with the abdominal form of cryptorchidism.
Sometimes children have an infringement of intestinal loops in the open process of the vaginal peritoneum.
Testicular torsion occurs 3-4 times more often with a non-descended testicle.

Conclusion

Treatment of a non-descended testicle should be started after 1 year of age.
Differentiate with false cryptorchidism.
As a rule, open surgery is necessary for the inguinal form.
If the testicle cannot be found, laparoscopic surgery is necessary.
With proper and timely treatment, it is possible to preserve the organ and its function.

Pediatric Uroandrology Department of N.A. Lopatkina, a branch of the National Medical Research Center of Radiology of the Ministry of Health of the Russian Federation, has all the necessary methods for treating cryptorchidism, including surgical operations.
This allows young patients to preserve the organ and its functions, and therefore health, even in infancy.
Call us today so we can help you!

Tel .: 8 (499) 110 40 67

Download brochure PDF

Clinical guidelines for the provision of emergency medical care for trauma of the male genitourinary organs, foreign body of the urethra and bladder, phimosis and paraphimosis

S.H. Al-Shukri, S. Yu. Borovets, E. T. Goloshchapov, A. G. Gorbachev, V. Ya. Belousov, A. G. Boriskin, M. A. Rybalov

Department of Urology of the First St. acad. I.P. Pavlova

F Clinical recommendations for the provision of emergency medical care at the prehospital stage and in the conditions of the emergency department, developed by the staff of the Department of Urology, are presented. The protocols are drawn up taking into account the modern views of clinicians and the recommendations of the European Association of Urology.The strength of the recommendation is indicated based on the level of evidence.

Key words: trauma to the scrotum, testicles, penis; foreign body of the urethra and bladder; phimosis; paraphimosis; emergency.

Contusion of the external genital organs

Definition

Contusion of the external genital organs – a closed trauma of the external genital organs with possible damage to the organs of the scrotum, intrascrotal hemorrhage and the formation of a hematoma.

ICD-10 code Nosological form
S30.2

Contusion of the external genital organs

Closed injuries of the external genital organs, penile fracture

The mechanism of injury – damage to the pubic articulation and scrotum during sports, hostilities, falling on a hard object and deliberate harm to health (domestic fight).

Description – cyanotic skin of the scrotum and penis, diffuse hematoma, the boundaries of which extend to the suprapubic region and perineum, enlargement of the scrotum and penis. resulting from hemorrhages, especially pronounced with a ruptured testicle.

Penile fracture

Penile fracture occurs as a result of rupture of the tunica albuginea of ​​the corpora cavernosa and in 10-22% of cases may be accompanied by the development of subcutaneous hematoma, damage to the urethra or corpus spongiosum.The fracture is possible in a state of erection. In the absence of an erection, blunt trauma to the penis usually does not rupture the tunica albuginea. In such cases, only a subcutaneous hematoma occurs.

Degree of damage to the scrotum (European Urological Association protocol)

Group Description
I Concussion
II Rupture <25% of the scrotum diameter
III Rupture> 25% of the scrotum diameter
IV Avulsion (detachment) of the skin of the scrotum <50%
V

Avulsion (detachment) of the skin of the scrotum> 50%

Severity of testicular injury (European Urological Association protocol)

Group Description
I Concussion or hematoma
II Subclinical rupture of the protein coat
III Rupture of the tunica albuginea with loss of parenchyma <50%
IV Rupture of the parenchyma with loss of parenchyma> 50%
V Complete destruction of the testicle or avulsion (avulsion)

Provision of emergency medical care at the prehospital stage in case of contusion of the external genital organs

Clinical picture

Acute pain in the scrotum after a stroke, sometimes accompanied by loss of consciousness and painful shock.

Fracture of the penis is accompanied by a sudden sound (crunch), pain and immediate cessation of erection. In connection with the growth of hematoma, local edema develops rapidly.

Diagnostics

Examination, palpation in order to determine fluctuations in the scrotum, which is a sign of testicular rupture.

If the hematoma is not very pronounced, the rupture of the tunica albuginea can be palpated.

Treatment (D, 4)

Painkillers (ketorolac – 0.45 mg, metamizole sodium – 0.45 mg), it is possible to prescribe narcotic analgesics (once), hemostatic therapy (dicinone – 2.0 ml.), a pressure bandage (in some cases – a suspensory), in the presence of only subcutaneous hematoma – ice locally. Transportation to the hospital (to the urological or surgical department).

Further patient management (indications for hospitalization)

Delivery of the patient to the hospital is indicated in all cases.

Provision of emergency medical care at the hospital stage in the inpatient emergency department (STOSMP) in case of contusion of the external genital organs

Diagnostics (D, 4)

Examination, palpation in order to determine fluctuations in the scrotum, which is a sign of testicular rupture, ultrasound of the scrotal organs.In case of inconclusive ultrasound data, CT or MRI should be performed. Cavernosography or MRI can detect damage to the tunica albuginea in unclear situations.

Treatment (D, 4)

Painkillers (ketorolac – 0.45 mg, metamizole sodium – 0.45 mg), in case of non-refractory pain syndrome – the appointment of narcotic analgesics, hemostatic therapy (dicinone – 2.0 ml.). Calling a urologist for a consultation.

Further patient management is determined by the urologist.

In the presence of a small subcutaneous hematoma – referral for treatment on an outpatient basis.

Forecast 90,719

Depends on the extent of the injury. With crushing and removal of the testicle – organ-carrying operation, with bilateral injuries and extirpation of crushed testicles – infertility and an unfavorable prognosis.
open wound of the penis

Definition

Open wound of the penis – damage to the penis, accompanied by a violation of the integrity of the skin.

ICD-10 code Nosological form
S31.2 Open wound of the penis

Open lesions of the penis are the result of mechanical damage and are manifested by the presence of a skin wound, bleeding and pain, especially pronounced with amputation of the penis.

Mechanism of trauma

Depending on the mechanism of injury, the following are distinguished: Torn-bruised, stab-cut, gunshot (bullet, fragmentation, mine-explosive), bitten.

Classification of penile injury by severity of the European Urological Association

Severity Characteristic of damage
I Tear / Concussion
II Rupture of Buk’s fascia (corpus cavernosum) without tissue loss
III Tissue rupture (avulsion) (rupture of the glans penis involving the external opening of the urethra), defect less than 2 cm of the cavernous body or urethra
IV Defect of more than 2 cm of the cavernous body or urethra, partial penectomy
V Complete penectomy

Provision of emergency medical care at the pre-hospital stage with an open wound of the penis

Clinical picture

Bleeding, pain.Pain and bleeding are especially intense after amputation of the penis. Painful and hemorrhagic shock is possible. Bleeding from the frenum of the penis is less intense, but prolonged. Bleeding caused by damage to small vessels in a scalped wound is usually not intense and of short duration.

Diagnostics

Based on anamnestic data (collecting anamnesis, you should collect complete information about the mechanism of injury and the circumstances of its receipt) and examination data.

Treatment (D, 4)

Imposition of a protective aseptic, and, if necessary, pressure, bandage on the penis with hydrogen peroxide and, if possible, a tourniquet on the area of ​​the root of the penis. In case of traumatic amputation of the proximal section, it is necessary to apply a bandage with a roller to the root of the penis, tightly bring the hips and even tie them and transport the victim on a stretcher. Anesthetics are administered (ketorolac – 0.45 mg, metamizole sodium – 0.45 mg).Delivery of the patient to the hospital (to the urological or surgical department).

In case of complete traumatic amputation of the penis, the cut off organ must be preserved, since during the first 18-24 hours after the injury it can be sewn into the stump. To preserve the viability of an amputated organ, it is washed with a povidone-iodine solution, packed in a sterile bag filled with a complex sodium lactate solution (Ringer Lactate Viaflo solution), and stored on ice until the operation.

Further patient management (indications for hospital admission)

Delivery of the patient to the hospital is indicated in all cases.

Provision of emergency medical care at the hospital stage in the inpatient emergency department (STOSMP) with an open wound of the penis

Diagnostics (D, 4)

Diagnosis of open lesions of the penis is based on data from anamnesis, examination (localization, nature of the wound, direction of the wound channel, presence of an exit hole), palpation (defects in the cavernous body, foreign body), ultrasound and plain radiography (to determine the presence and localization of foreign bodies ).Recognizing an open wound to the penis is usually straightforward. The nature of the damage is established after stopping bleeding, primary surgical treatment and revision of the wound.

Treatment (D, 4)

Carrying out measures aimed at stopping bleeding and removing the patient from a state of shock, it is necessary to perform the most sparing surgical treatment of the wound of the penis with excision of necrotic tissues in order to prevent cicatricial deformity of the organ in the future.

Tetanus toxoid is administered. In the treatment of infected wounds of the penis, administration of broad-spectrum antibiotics (cephalosporins and macrolides) is indicated. For animal bites – administration of rabies vaccine. Calling a urologist for a consultation.
Further patient management is determined by the urologist

The prognosis depends on the nature of the wound.

OPEN WOUND OF SCREW AND CELLS

Definition

Open wound of the scrotum and testicles – violation of the integrity of the tissue of the scrotum and testicles.

ICD-10 code Nosological form
S31.3 Open wound of the scrotum and testicles

The mechanism of injury – gunshot, cut, stab injuries, with polytrauma, intentional, industrial, animal bites, falling on a solid object.

Description – lacerated, shapeless, possibly with a hematoma, the boundaries of which are difficult to determine, in some cases – scalping the scrotum with damage (testicular rupture) and without damage to the testicle.

Classification of damage to the scrotum and its organs

I. Open lesions by etiology:

1) cut;

2) chipped;

3) firearms (bullet and fragmentation, through and blind, with the presence of a foreign body in the scrotum).

II. Open damage by nature:

1) without damage to the organs of the scrotum;

2) with prolapse of the testicle;

3) with damage to the testicle;

4) with injury to the spermatic cord;

5) traumatic scrotal amputation.

III. Closed or subcutaneous injuries:

1) without damage to the organs of the scrotum;

2) with dislocation of the testicle;

3) with testicular rupture;

4) with damage to the spermatic cord.

IV. In combination with damage to other organs:

1) isolated;

2) combined (with damage to the urethra, pelvic bones, bladder, rectum, thighs, etc.).

V. Other damage:

1) bruised-cut wounds;

2) bitten wounds.

Provision of emergency medical care at the prehospital stage with an open wound of the scrotum and testicles

Clinical picture

Acute pain in the scrotum, bleeding from the scrotum, vomiting, shock.

Diagnostics

Interviewing the patient, examination, in some cases palpation.

Treatment (D, 4)

Painkillers (ketorolac – 0.45 mg, metamizole sodium – 0.45 mg), cold, pressure bandage (in some cases, a support), rest, transportation to the hospital (to the urological or surgical department).

Further patient management (indications for hospital admission)

Delivery of the patient to the hospital is indicated in all cases.

Provision of emergency medical care at the hospital stage in the inpatient emergency department (STOSMP) with an open wound of the scrotum and testicles

Diagnostics

Examination of the wound (localization, nature of the wound, direction of the wound channel, the presence of an exit hole).Ultrasound of the scrotum organs. Plain X-ray of the scrotum allows you to identify a foreign body with gunshot blind wounds.

Treatment (D, 4)

Carrying out measures aimed at stopping bleeding and removing the wounded from shock, primary surgical treatment of the edges of the wound. Calling a urologist for a consultation.

Further patient management is determined by the urologist.

Forecast 90,719

Depends on the extent of the injury.In severe injuries, the prognosis may be poor.

Foreign body in the urethra, bladder

Definition

Foreign body – an object foreign to the body that has invaded its tissues, organs or cavities through damaged integuments or natural openings.

ICD-10 code Nosological form
T19.0 Foreign body in the urethra
T19.1 Foreign body in the bladder

Foreign bodies in the urethra are found mainly in males (children and adults) due to the longer and curved shape of the urethra. Through the external opening, foreign bodies are introduced into the urethra for children left unattended, mentally ill for the purpose of masturbation or in a state of alcoholic intoxication by sexual partners.Sometimes the foreign body of the urethra is parts of endoscopic instruments or cotton balls used in urethroscopy. The localization of a foreign body in the urethra can be different, but more often it lingers in its front part, and if it enters the back, then it usually moves from it to the bladder.

Foreign bodies of the bladder are more often found in women, since their urethra is short and wide.

Provision of emergency medical care at the prehospital stage with a foreign body in the urethra, bladder

Clinical picture

With a foreign body of the urethra: complaints of patients – difficulty urinating, mucopurulent discharge from the urethra, pain, aggravated by urination and erection.When an infection joins, purulent and bloody discharge, increased frequency and difficulty of urination appear, in some cases – its acute retention. Large objects with sharp edges injure the wall of the urethra and cause urethrorrhagia. Small, smooth objects are of little concern to patients.

In case of a foreign body of the bladder: Typical symptoms are: dysuria, hematuria (usually terminal), urinary incontinence, in cases where the foreign body is partially entrapped in the neck of the bladder.If a foreign body enters the urethra from the bladder, an acute urinary retention develops.

Diagnostics

The diagnosis is made on the basis of anamnesis and palpation of the urethra – a foreign body is palpated when localized in the hanging or perineal parts of the urethra. Digital rectal examination allows palpation of a foreign body in the membranous part of the urethra.

Diagnosis of foreign bodies of the bladder is mainly based on anamnestic data and requires additional research methods in a hospital setting.

Treatment (D, 4)

If the size and shape of a foreign body allows hoping for its independent discharge, patients are advised to accumulate urine and, at the beginning of urination, for a short time squeeze the external opening of the urethra. It is sometimes possible to get rid of a foreign body with a strong stream of urine. Anesthetic drugs are prescribed (1 ml of a 2% solution of pro-medol or 1 ml of a 1% solution of pantopon subcutaneously). If it is impossible to independently depart – transportation to the hospital (to the urological department).

What not to do

It is inappropriate to try to remove a foreign body from the urethra, which can cause urethrorrhagia and painful shock.

Further patient management (indications for hospital admission)

Transportation of the patient to the hospital is indicated in all cases, except for the independent discharge of a foreign body from the urethra.

Provision of emergency medical care at the hospital stage in the inpatient emergency department (STOSMP) with a foreign body in the urethra, bladder

Diagnostics (D, 4)

For a foreign body of the urethra: The lumen of the urethra is examined with an elastic or metal bougie, as well as with the help of urethroscopy and urethrography.During the examination, caution is necessary, since it is possible to push the foreign body even deeper into the urethra. Plain radiography of the urethra is advisable, allowing in most cases to identify foreign bodies.

For a foreign body of the bladder: ultrasound of the bladder or plain radiography, cystoscopy.

Treatment (D, 4)

For a foreign body of the urethra: A smooth foreign body should be displaced towards the distal urethra, for which it is fixed with the thumb and forefinger, having previously introduced liquid petroleum jelly into the lumen of the urethra, and gradually shifting to the external opening.If these techniques are not successful, instrumental removal is required – a call to a urologist.

In case of a foreign body in the bladder: surgical removal of the foreign body is required – call a urologist. Prescribe anti-infectious treatment (furadonin 0.1 g 3-4 times a day by mouth, benzylpenicillin 300,000 IU 4 times a day intramuscularly, streptomycin 0.25 g 2 times a day intramuscularly.

What not to do

Any manipulation of the urethra should be performed using local anesthesia.It should be especially careful to perform bougienage of the urethra, so as not to cause perforation of its wall and urethrorrhagia. In this case, the execution of this manipulation should be stopped.

Further patient management is determined by the urologist.

In case of spontaneous discharge of a foreign body from the urethra and the absence of urethrorrhagia, the patient is released for follow-up follow-up by the urologist of the polyclinic for the prevention and timely treatment of urethral strictures that arise in some cases.

In some cases, the consultation of a psychiatrist is indicated.

Forecast 90,719

With a foreign body of the urethra, bladder: The prognosis is favorable.

In case of a foreign body of the bladder: The prognosis with timely treatment is favorable, but prolonged mechanical irritation of the transitional epithelium of the bladder can in some cases cause its metaplasia and malignant degeneration.

Phimosis and paraphimosis

Definition

Phimosis – narrowing of the outer opening of the foreskin, making it difficult to expose the head.

Paraphimosis – infringement of the glans penis by a ring of narrowed foreskin.

ICD-10 code Nosological form
N47 Excessive foreskin, phimosis and paraphimosis

Classification

Phimosis

1.Hypertrophic phimosis.

2. Atrophic phimosis.

Provision of emergency medical care at the prehospital stage for phimosis and paraphimosis Clinical picture

With a pronounced narrowing of the outer opening of the foreskin, urination becomes difficult, possibly delayed.

Diagnostics

Physical examination (examination, palpation of the external genitalia).

Treatment (D, 4)

Ice Gloves Method.Apply anesthetic gel to the glans penis and foreskin for 5 minutes. Pour ice water into a rubber glove, tie it in a knot to prevent the contents from spilling out. Invaginate the penis with a glove. This can relieve swelling and allow the foreskin to be pulled back into place.

Granular sugar is placed in a condom or in a glove that is put on the glans of the penis to relieve swelling by osmosis.

Dundee Technique.Anesthetize the penis at its base using a 26 G needle and inject 10-20 ml of 0.5% bupivacaine through it. Wash the glans penis and foreskin with an antiseptic. Using a needle, make about 20 injections into the swollen foreskin. Squeeze out the swollen fluid and return the foreskin to its normal position. Delivery to the hospital (to the urology department).

Further patient management (indications for hospital admission)

Delivery of the patient to the hospital is indicated in all cases.

Provision of emergency medical care at the hospital stage in the inpatient emergency department (STOSMP) with phimosis and paraphimosis

Diagnostics (D, 4)

Physical examination (examination, palpation of the external genitalia).

Treatment (D, 4)

Approximately one third of patients require circumcision. With paraphimosis, it is necessary to perform under local anesthesia – a 0.5% solution of novocaine 5-10 ml – dissection of the narrow foreskin ring that restrains the head of the penis.Calling a urologist for a consultation. Broad-spectrum antibiotics such as ciprofloxacin 500 mg orally should be prescribed.

Further patient management is determined by the urologist.

The forecast is favorable.

Appendix

Strength of recommendations (A-D), levels of evidence (1 ++, 1+, 1-, 2 ++, 2+, 2-, 3, 4) according to tables 1 and 2 are given in the text of clinical guidelines (protocols) …

Table 1 Rating scheme for assessing the strength of recommendations

Levels of Evidence Description
1 ++ High quality meta-analyzes, systematic reviews of randomized controlled trials (RCTs), or RCTs with very low risk of bias
1+ Well-conducted meta-analyzes, systematic, or RCTs with low risk of bias
1- Meta-analyzes, systematic, or RCTs with high risk of bias
2 ++ High-quality systematic reviews of case-control studies or cohort studies.High-quality reviews of case-control studies or cohort studies with very low risk of confounding effects or bias and an average likelihood of a causal relationship
2+ Well-conducted case-control or cohort studies with an average risk of confounding or bias effects and an average likelihood of a causal relationship
2- Case-control or cohort studies with a high risk of confounding effects or bias and an average likelihood of a causal relationship
3 Non-analytical studies (e.g. case reports, case series)
4 Expert Opinions

Table 2.Rating scheme for assessing the strength of recommendations

Force Description
A At least one meta-analysis, systematic review, or RCT rated 1 ++ that is directly applicable to the target population and demonstrates robustness of the results, or a pool of evidence including research results rated 1+ that is directly applicable to the target population and showing overall sustainability of results 90,082
V A pool of evidence comprising research results rated 2 ++ that are directly applicable to the target population and demonstrating overall robustness of the results or extrapolated evidence from studies rated 1 ++ or 1+
C A pool of evidence comprising research results rated 2+ that are directly applicable to the target population and demonstrating overall robustness of the results or extrapolated evidence from studies rated 2 ++
D Level 3 or 4 evidence or extrapolated evidence from studies graded 2+

References

1.Urology. National leadership. Ed. N. A. Lopatki-na. M .: GEOTAR-Media, 2009.1024 p.

2. Urology. Ed. S. Kh. Al-Shukri and V. N. Tkachuk (textbook). M .: GEOTAR-Media, 2012.480 p.

3. Summerton D. J., Djakovic N., Kitrey N. D. et al., Eds. Guidelines of Urological Trauma. Eur. Ass. of Urology, 2014.76 p.

4. Tiktinsky OL, Mikhailichenko VV Andrology. SPb .: Media Press, 1999.464 p.

5.Eliseev OM Reference book on the provision of ambulance and emergency care. Saint Petersburg: Leila, 1996.672 p.

6. Haas C. A., Brown S. L., Spirnak J. P. Penile fracture and testicular rupture // World Journal Urol. 1999. Vol. 17, No. 2.P. 101-106.

7. Tsang T., DembyA. M. Penile fracture with urethral injury // J. Urol. 1992. Vol. 147, No. 2.P.466-468.

8. Nicolaisen G. S., Melamud A., Williams R. D., McAninch J. W. Rupture of the corpus cavernosum: surgical management // J.Urol. 1983. Vol. 130, No. 5. P.917-919.

9. Phonsombat S., Master V. A., McAninch J. W. Penetrating external genital trauma: a 30-year single institution experience // J. Urol.

2008. Vol. 180, No. 1. P.192-195.

10. Monga M., Hellstrom W. J. Testicular Trauma // Adolesc Med. 1996. Vol. 7, No. 1. P.141-148.

Clinical recommendation for first medical emergency treatment in case of male urogenital organs trauma, foreign body in urethra and bladder, phimosis and paraphimosis

Al-Shukri S.Kh., Borovets S. Yu., Goloshchapov Ye. T., Gorbachev A. G., Belousov V Ya., Boriskin A. G., Rybalov M. A.

90,000 Minimally invasive treatment of hydrocele in Yekaterinburg. In “URO-PRO”

Clinical picture

As a rule, dropsy develops slowly, so symptoms may not appear for a very long time.Usually the patient is concerned only with the enlargement of the scrotum on one or both sides. Pain is extremely rare, and most often it is associated with the appearance of complications. With a combination of several causal factors at once (for example, the early postoperative period after removal of an inguinal hernia with the addition of inflammatory diseases or genital infections), a hydrocele can develop very quickly with an increase in the scrotum by more than 10 cm in diameter. In this case, the following symptoms occur:

  • Change in density, volume, shape of the testicles.
  • Discomfort while walking.
  • Feeling of heaviness in the scrotum.
  • Discomfort during intercourse.

Without timely treatment, hydrocele can lead to serious complications, for example, rupture of the membranes of the testicles, inguinal-scrotal hernia, impaired reproductive function.

Diagnostics

Determining the presence of a hydrocele is not particularly difficult, since during the examination, the asymmetry of the scrotum or its general increase is immediately visible.During palpation (finger examination), the location and density of the testicles are determined. The following methods are used to diagnose dropsy:

  • Diaphanoscopy – scanning the scrotum with a narrow beam of light in a dark room.
  • Ultrasound allows you to determine the approximate amount of fluid, detect tumors, cysts of the spermatic cord, which can be the cause of a hydrocele. If ultrasound is combined with Doppler ultrasound, then additionally, blood flow in the testicles can be assessed.
  • MRI is rarely used.The study allows you to get a layer-by-layer image of the testicles and its membranes. If there is fluid, cysts, hernias, etc., they will all be reflected in the images.
  • To determine the general condition of the patient and in order to identify complications, the doctor may prescribe a general and biochemical blood test, urinalysis, an STI test, etc.

Treatment of hydrocele

The main method of treatment is surgery. Drug therapy can help if the hydrocele is caused by an inflammatory condition or infection.However, the likelihood that the fluid will disappear after such treatment is low.
There are several author’s methods of surgical intervention (Ross, Lord, Bergman, Winckelmann), but their common goal is the same – to remove excess fluid. An alternative to surgical treatment is hardening. During this procedure, excess fluid is also removed, and then a sclerosing drug is injected, which “glues” the testicular membranes and prevents the disease from developing again.This method of treatment is painless, safe and effective.
If we compare sclerotherapy with classical operations, then many advantages can be noted:

  • No need for general anesthesia, only local anesthesia.
  • Sclerotherapy is performed on an outpatient basis, that is, a person can go home in a few hours.
  • No incisions and, consequently, no scars after the procedure.
  • Minimal tissue trauma.

The rehabilitation period after sclerosis lasts about 7 days, while after surgery, recovery takes much longer – about a month. At the same time, painful sensations are also less pronounced, which affects the general condition of the patient.

Medical Corp Moscow | Epididymitis orchitis

Epididymitis orchitis

A special place among diseases
the male genital organs are occupied by inflammation of the epididymis – epididymitis, and
also testicular inflammation – orchitis .

The most common cause of epididymitis is infection,
penetrating from the urethra or from the prostate with inflammation.
Inflammation of the epididymis can be caused by both commonplace bacteria
(staphylococcus, streptococcus, proteus, Escherichia coli), and specific
Trichomonas). In young men, most cases of epididymitis are associated with
the presence of urethritis, the characteristic causative agents of which are gonococci and
chlamydia – sexually transmitted infections.In older men
epididymitis is more commonly caused by E. coli.

A special group is made up of non-infectious
epididymitis – stagnant, resulting from irregular sexual activity,
sexual excesses, constipation and epididymitis resulting from traumatic
damage. The combination of traumatic and infectious factors is the most
indicative of epididymitis associated with instrumental examination
patients (holding various instruments through the urethra), and
also during operations on the genitourinary organs (for example, removal of an adenoma
prostate).

In most cases, epididymitis
is one-sided. Infection in the epididymis most often comes from the urethra,
prostate, seminal vesicles by reverse flow along the vas deferens.

Orchitis can develop as a complication
mumps (mumps), influenza, scarlet fever, chickenpox, pneumonia,
brucellosis, typhoid fever, syphilis, or trauma to the testicle.

Microorganisms can enter
the testicle through the vas deferens, and can be brought from purulent foci into
body with blood flow.

Clinical picture

Acute epididymitis is characterized by
a rapid increase in the corresponding half of the scrotum, sharp soreness,
an increase in body temperature to 38-39 0 C, chills. Slightest
touching the scrotum, including when walking, causes severe pain,
extending to the thigh, groin area. Scrotal skin over the affected
the epididymis can be purple-red, edematous. More often inflammatory
the process is limited to the epididymis without affecting the testicle.However, in the absence
treating inflammation leads to the formation of reactive dropsy of the testicular membranes
(accumulation of fluid in the scrotum) and therefore, after a while, compacted and
an enlarged epididymis cannot be distinguished from a testicle. The acute process lasts 5-7 days,
and, if untreated, may be complicated by involvement in testicular inflammation.

In some cases, epididymitis can
start sluggishly, slowly. The appendage gradually increases, soreness
moderate, body temperature not higher than 37.5 0 C.This is how inflammation can proceed.
an appendage caused by tuberculosis. At the same time, patients hesitate to
a visit to the urologist and the process progresses and can go to the appendage
the opposite ovary, which complicates treatment and worsens its results.

Symptoms of orchitis practically
are similar to symptoms of epididymitis, but mumps orchitis occupies a special place
(arising against the background of developed mumps, orchitis develops on
3-12 days from the onset of the disease or in the first week after recovery.Often such orchitis causes testicular atrophy, and in 30% of patients,
a two-way process, which is often the cause of infertility.

Prevention

Reduced
to the treatment of chronic inflammatory
diseases of the genitourinary organs, careful observation of your
condition during general infectious diseases (mumps,
flu, scarlet fever, pneumonia and others), with trauma to the scrotum, perineum and area
pelvis.

Treatment

Long-term and labor-intensive treatment necessarily includes
in itself the treatment of the underlying disease.A course of taking antibacterial drugs is also carried out,
local thermal and physiotherapeutic procedures are actively used.

Bilateral testicular volvulus in a newborn

Testicular volvulus remains relevant in emergency pediatric urology due to its high prevalence, the risk of ischemic complications of the gonad, leading to its atrophy and impairing the patient’s fertility in the future, ambiguity of surgical tactics [1,2].In addition, the frequency of gonad loss due to necrosis varies in this condition from 14.3% to 94.4% in various studies, averaging about 45-50% [3-5]. Meanwhile, despite the incidence of the disease, bilateral testicular volvulus is casuistic and much less common. Publications on this issue are isolated, and the material presented in them is limited to the description of individual cases [6]. Cases of bilateral volvulus in newborns are extremely rare.Thus, the presentation of such a case, in our opinion, is of certain interest.

Clinical case. Out of 226 patients with testicular volvulus, bilateral volvulus during the neonatal period was observed in one patient (0.44%). The age of the child with synchronous volvulus is 7 days.

Boy N., 7 days old, brought from home by the ambulance team with edema and hyperemia of the scrotum. Directive diagnosis: inflamed hydrocele?

From the anamnesis: a child from the first birth in a cephalic presentation weighing 3425 grams.and a height of 52 cm. Childbirth is physiological, without obstetric benefits. No trauma during childbirth was noted. Discharged from the maternity hospital on the 4th day in satisfactory condition.

According to the mother, reddening of the scrotum was noted for two days, at the same time the child was periodically restless. On admission, the patient was in a state of moderate severity. In organs – no peculiarities. The scrotum is edematous, hyperemic, the testicles are dense on both sides, enlarged, painful. The inguinal canals are intact. Internal organs were normal.

Ultrasound of the scrotum and groin area:

D: testicle 14x9x11 mm, typical location, contours are even, clear. Echogenicity: alternation of areas of pronounced hypo- and hyperechogenicity, the structure is sharply heterogeneous. The head of the epididymis is 6×8 mm. The contours are smooth and clear. Echogenicity: alternation of areas of hypo- and hyperechoicity, the structure is heterogeneous. The veins of the groin plexus are not dilated. In the serous cavity there is an interlayer of heterogeneous effusion with a dispersed suspension of 4 mm. The blood flow in the spermatic cord is not visible, the cord is twisted, 3 mm in diameter.The blood flow in the testicular parenchyma is not fixed (Fig. 1).

Fig 1. Ultrasound picture of the testicle on the right. Sharply inhomogeneous structure with foci of vacuum, alternating zones of hypo- and hyperechoicity

S: testicle 14x10x11 mm, typical location, contours are even, clear. Echogenicity: alternation of areas of hypo- and hyperechoicity, the structure is heterogeneous. The head of the epididymis is 6×8 mm. The contours are smooth and clear. Echogenicity: alternating areas of hypo- and hyperechogenicity, heterogeneous structure.In the serous cavity there is an interlayer of heterogeneous effusion with a dispersed suspension of 4 mm. The veins of the groin plexus are not dilated. The blood flow in the spermatic cord is not visible, the cord is twisted, 3 mm in diameter. The blood flow in the testicular parenchyma is not fixed (Fig. 2).

Fig 2. Ultrasound picture of the testicle on the left. Alternating areas of hypo- and hyperechogenicity, heterogeneous structure

Conclusion: bilateral testicular necrosis. Testicular volvulus? Vascular thrombosis of the spermatic cord?

Based on the results of clinical and ultrasound data, bilateral testicular necrosis was established.Differential diagnosis between volvulus and spermatic cord thrombosis.

The child was operated on urgently after 2 days from the onset of the disease and 4 hours from admission to the clinic. Longitudinal bilateral scrototomy. The membranes are thickened, after opening their hemorrhagic effusion. The testicles are brought out into the wound. An intravaginal curvature of their medially by 720 ° was revealed. Their location in the scrotal cavity is completely intravaginal, the ligamentous apparatus is absent. Detorsion was carried out. Assessment of the viability of the gonads after 15 minutes (Fig.3) – testicles of black color without dynamics during observation, there is no pulsation of the vessels of the spermatic cord. Bilateral testicular necrosis was noted. Orchiectomy was performed with suturing of the spermatic cords in the scrotal part. Suturing scrotomy wounds to graduation. Primary wound healing. Discharged home on the 7th day after surgery.

Fig 3. Detorsion of volvulus is performed. When assessing the viability of the gonads after 10 minutes, their bilateral necrosis was stated

Thus, this observation confirms the position that testicular volvulus in a newborn is almost always fatal from the point of view of preserving the gonad.And bilateral volvulus leads to inevitable reproductive dysfunctions.

REFERENCES

1. Shimizu F, Tsounapi P, Dimitriadis F, Higashi Y, Shimizu T, Saito M Testicular torsion-detorsion and potential therapeutic treatments: A possible role for ischemic postconditioning. Int J Urol 2016; 23 (6): 454-463 doi: 10.1111 / iju.13110.

2. D’Andrea A., Coppolino F., Cesarano E., Russoli A., Cappabianca S.

Genovese E. A. et al. US in the assessment of acute scrotum.Crit Ultra sound J. 2013; 5 Suppl 1: S8. doi: 10.1186 / 2036-7902-5-S1-S8.

3. Ervinovich A.A. Optimization of the treatment and diagnostic program for the management of acute testicular diseases in childhood: av.