Testicular Swellings

TESTICULAR SWELLINGS

DEVELOPMENT OF THE TESTIS • • • •

• •

Development There are two phases in which the testes grow substantially, namely in embryonic and pubertal age. [edit] Embryonic During mammalian development, the gonads are at first capable of becoming either ovaries or testes.[6] In humans, starting at about week 4 the gonadal rudiments are present within the intermediate mesoderm adjacent to the developing kidneys. At about week 6, sex cords develop within the forming testes. These are comprised of early Sertoli cells that surround and nurture the germ cells that migrate into the gonads shortly before sex determination begins. In males, the sex-specific gene SRY that is found on the Y-chromosome initiates sex determination by downstream regulation of sex-determining factors, (such as GATA4, SOX9 and AMH), which leads to development of the male phenotype, including directing development of the early bipotential gonad down the male path of development. [edit] Pubertal The testes grow in response to the start of spermatogenesis. Size depends on lytic function, sperm production (amount of spermatogenisis present in testis), interstitial fluid, and Sertoli cell fluid production. After puberty, the volume of the testes can be increased by over 500% as compared to the pre-pubertal size.[citation needed] In humans the average testicle size after puberty measures up to around 2 inches long, 0.8 inch in breadth, and 1.2 inches in height (5 x 2 x 3 cm). Testicles are fully descended before one reaches puberty.

ANATOMY Anatomy and physiology • [Male mammals have two testes covered in pubic hair most of the time, which are often contained within an extension of the abdomen called the scrotum. Internal structure Duct system • Under a tough membraneous shell, the tunica albuginea, the testis contains very fine coiled tubes called the seminiferous tubules. The tubes are lined with a layer of cells that, from puberty into old-age, produce sperm cells • The sperm travel from the seminiferous tubules to the rete testis located in the mediastinum testis, to the efferent ducts, and then to the epididymis where newlycreated sperm cells mature (see spermatogenesis). The sperm move into the vas deferens, and are eventually expelled through the urethra and out of the urethral orifice through muscular contractions.

SYMPTOMS

KEY POINTS IN EXAMINATION: I) Can you get above the swelling? II) Can you identify the testis and epididymis? III) Is the swelling translucent? IV) Is the swelling tender?

SWELLINGS CONFINED TO THE SCROTUM NOT DEFINABLE

OPAQUE

DEFINABLE

TRANSLUCENT

TENDER TORSION EPIDIDYMO-ORCHITIS NONTENDER TUMOUR GUMMA

VAGINAL HYDROCELE

OPAQUE

TRANSLUCENT

NON TENDER

CYST OF EPIDIDYMI

TUMOUR TUBERCULOUS EPIDIDYMIS

TENDER

ACUTE EPIDIDYMO-ORCHITIS

HYDROCELE A) Definition : Collection of excessive fluid in tunica vaginalis B) Aetiology : -excessive production of fluid in the sac -defective absorbtion of fluid -interference with lymphatic drainage of scrotal structures -connection with a hernia of the peritoneal cavity in the congenital variety C) Classification: -Congenital -Acqiured

CONGENITAL HYDROCELE : i ) Vaginal hydrocele – sac patent only in the scrotum ii) Infantile hydrocele – sac is patent up to the deep inguinal ring iii)True congenital hydrocele- sac connects to the peritoneal cavity iv)Encysted hydrocele of the cord- traction test v)Hydrocele of canal of nuck-swelling in the inguinal region in female

ACQUIRED HYROCELE PRIMARY

SECONDARY

AETIOLOGY

Defective absorption of fluid

Excessive production of Fluid

EXAMPLES

Vaginal hydrocele Infantile hydrocele

Filirial hydrocele Secondary to testicular malignancy Tuberculous epididymoorchitis Pyocele,haematocele

SIZE

Moderate , big

Small

Palpation

difficult

easy

Transillumination

positive

negative

consistency

Tensely cystic

Lax, cystic

Treatment

Partial excision and eversion

Treatment of the primary

TREATMWNT OF HYDROCELE: 1)Lord’s plication – sac is opened and plicated to the tunica albuginea 2)Partial excision and eversion of the sac-Joboulay’s operation 3)Aspiration COMPLICATIONS: 1)Haematocele 2)Pyocele 3)Calcification 4)Rupture 5)Hernia of the hydrocele sac

TESTICULAR TUMOURS