Testicular problems

Having three balls would be a very worrying testicular problem.

Definition

Problems with the testicles (referred to as "balls" herein).

Epidemiology

Generally quite common, but rather rare in women.

Pathophysiology

Two main types of problem:

• Pain - hurting balls.
• Swelling - massive balls.

Clinical and Associated Features

Medical Emergency - Testicular torsion is a surgical emergency! It needs prompt treatment, and usually the ball in question can be saved.

Testicular torsion usually presents with sudden, severe one sided testicular pain, with sudden testicular swelling. Sometimes the testicular pain can present as generalised abdominal pain, or even just as indigestion.

A doppler ultrasound will show if the blood supply has arrested.

Other causes

There are a variety of other causes. The commonest problems are scrotal or testicular swelling, or pain. You can also get reddening.

Differential Diagnosis

• Torsion of the testis
• Incompletely descended testis - can cause a swelling in the affected ball. Predisposes you to...
• Testicular tumours - two main types - Teratoma, fast, aggressive, responds well to treatment. Seminoma, slow, less aggressive, responds less well to treatment.
• Hydrocoele - congenital, infective or caused by cancer.
• Varicoele - commoner on left side, due to vein draining to higher pressure renal vein (see picture on testis page.
• Hernias - especially inguinal can cause scrotal swelling.
• Epididymal cyst - common in cystic fibrosis (where congenital absence of the vas deferens occurs in 99%).
• Epididymo-orchitis - inflammation of the epididymis or the ball, with bacterial or viral infection.
• Referred pain - for example from renal colic.

Investigations

In any acute swelling/pain situation, you need to do a doppler ultrasound, to check there's blood supply going there and to exclude a torsion.

After that, the next most concerning thing is weird lumps and bumps for cancer.