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Testicular Mass Removal

TESTICULAR BIOPSY AND
TESTICULAR MASS REMOVAL

Most testicular masses (those needed to be removed by testicular mass removal surgery) are benign and the majority of them prove to be a hydrocele, a spermatocele, a varicocele, an inguinal hernia, or epididymitis. However, testicular cancer is another possibility. When a mass is detected, physical examination, imaging studies, and biopsy or testicle removal can provide diagnosis and treatment.

HYDROCELES:

Accumulation of fluid inside the scrotum and around the testicle(s)

Most common form of scrotal masses

Generally soft and painless

Causes: none, inflammation, infection, trauma, tumor

Diagnosis: physical examination, light test, ultrasound

Treatment: usually not necessary if small and painless. Surgical testicle removal of large or painful

HYDROCELES:

Dr. Elist treats a hydrocele by removing the abnormal fluid filled sac in the scrotum or in the inguinal canal. After injecting an area with local anesthetic and using aseptic techniques, Dr. Elist makes an incision in the scrotum or in the inguinal area. Care is taken to keep the hydrocele intact while it is dissected free of its attachments to the testis and other structures. The sac is opened high along its front surface and the testis is pushed up through the sac and out through the incision. This inverts the hydrocele sac which is tacked by suturing to the spermatic cord structures behind the testis. The testis is returned to the scrotum and is anchored to the inside of the scrotum with three sutures to prevent later torsion or twisting of the testis. A rubber drain may be left in the scrotum and the incision closed in layers by suturing.

Dr. Elist treats a hydrocele of the spermatic cord by removing from the spermatic cord above the testis in the scrotum or in the inguinal canal. After injecting the area with local anesthetic, Dr. Elist makes an incision in the scrotum or in the inguinal area. The hydrocele is kept intact while it is freed of its attachments to the spermatic cord. The sac is opened, drained, and excised all the way to the internal inguinal ring in the upper groin area. The remaining tissues are repaired and closed by suturing. The testis is anchored to the inside of the scrotum with three sutures to prevent later torsion or twisting of the testis. A drain may be placed in the scrotum and the incision closed in layers by suturing.

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SPERMATOCELE:

Most common retention cysts in the scrotum

Cysts of the spermatic cord filled with fluid and sperm

Size varies from some millimeters to centimeters

Can be soft or hard, painless or associated with discomfort

Harmless

Treatment: None, if small and painless. Surgery may be required, if large and painful.

PROCEDURE:

Dr. Elist removes a lesion of the spermatic cord by dissection and excision. After injecting the area with local anesthetic, Dr. Elist makes an incision in the scrotum or in the inguinal area and dissects the tissues to expose the lesion. Care is taken to keep the lesion intact while it is dissected free of its attachments to the spermatic cord. This may involve mobilization of the testis.

The lesion is removed by cutting all of its attachments. The tissues damaged during the dissection are repaired and closed by suturing. If the testis has been mobilized, it is anchored to the inside of the scrotum with three sutures to prevent later torsion or twisting. A drain may be placed in the scrotum and the incision is closed in layers by suturing.

VARICOCELE:

Enlargement of the veins draining the testicles

Uni- or bilateral; more common on the left side

Symptoms can vary from none, to feeling of “sack of worms” in the scrotum, dragging and pulling pain, feeling of heaviness, testicular atrophy (shrinkage of the testicle), low testosterone, or infertility

Usually not dangerous, but can result in infertility

Diagnosis: physical examination, ultrasound

Treatment: none, if no complaints or infertility, surgical removal, if large, painful, unsuccessful conception, and future plans for pregnancy

PROCEDURE:

Dr. Elist ligates the spermatic veins and/or excises a varicocele. An abdominal approach is performed by an incision made in the pubic area just medial to the bony prominence of the pelvic bone on the affected side and carried down through the abdominal musculature to the spermatic vein and artery. The cord is brought up into the incision and the structures of the cord are dissected, the veins identified, and ligated with suture material. Alternately, an incision is made in the scrotum and the dilated veins ligated separately may be removed. The operative incision is closed in layers by suturing. If an inguinal hernia is present at the same time, Dr. Elist repairs it by folding and suturing of tissues to strengthen the abdominal wall and correct the weakness responsible for to hernia. In very rare cases testicular mass removal may be necessary.

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EPIDIDYMITIS:

An infection, acute or chronic, of the epididymis may warrant a surgical intervention if conservative drug therapy is of no help.

Acute: usually accompanied by inflammation, infection, swelling and warmth of the scrotum

Chronic: usually pain is the only symptom

Pain can range from mild to severe, and may or not be associated with swelling and hardening of one or both epididymis

Causes: none, urinary reflux, bacterial infection (most common: Chlamydia Gonococcus, E. Coli), and surgical interventions in the genital area

Diagnosis: history and physical, doppler ultrasound, bacterial testing if infection is suspected

Important: your doctor needs to distinguish between acute epididymitis and testicular torsion in order to provide the right treatment

Treatment: antibiotics, cold compresses, anti-inflammatory medication, surgical testicular mass removal (rarely necessary).

INGUINAL HERNIAS:

Inguinal hernias are caused by a weakness in the abdominal wall allowing its contents to protrude between the muscle (direct hernia) or through the inguinal canal (indirect hernia). An indirect inguinal hernia can descent into the scrotum causing a swelling, especially prominent when coughing or pressing.

Very common: lifetime risk for men is 27%, for women is 3%

Hernia repair surgery is the most commonly performed surgical procedure

Signs and symptoms: none to bulging in the groin area, rarely painful (pain indicates bowel strangulation and needs immediate surgical attention), the bulging disappears when lying down.

Diagnosis: History and physical, ultrasound, further imaging studies is required

Treatment: Asymptomatic small hernias do not need a repair. Bigger hernias should be evaluated on individual basis and surgically repaired if warranted, testicular mass removal may be needed.

TESTICULAR CANCER:

Testicular cancer is the most common cancer in men aged 20-39 years. It can present with or without pain. The mass usually feels firm and arises from the testicle. Testicular cancer has one of the highest rates of cure, over 90%, and even 100% if it has not spread. Occasionally, testicular cancer may appear with symptoms of metastasis, which could include cough, shortness of breath, or weight loss. Even in case of metastasis, modern chemotherapy can achieve a cure rate of over 80%. Monthly testicular self-exams are recommended for every man between the ages of 18-40 years old.

Signs and symptoms:

a lump in one testis which may or may not be painful

sharp pain or a dull ache in the lower abdomen or scrotum

a feeling often described as “heaviness” in the scrotum

breast enlargement (gynecomastia) from hormonal effects of β-hCG

low back pain (lumbago) tumor spread to the lymph nodes along the back

If testicular cancer spreads, the following symptoms may be present:

shortness of breath (dyspnea), cough or coughing up blood (hemoptysis) from metastatic spread to the lungs

a lump in the neck due to metastases to the lymph nodes

Diagnosis: Self-examination, physical and history, imaging studies, biopsy, or a removal of affected testicle (orchiectomy) for diagnosis and treatment purposes.

Treatment: Treatment of testicular cancer is depending on the pathology and may include surgery, radiation therapy, and chemotherapy, testicular mass removal may be necessary.