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Testicular examination

Introduction

  • Wash hands
  • Introduce self
  • Ask Patient’s name, DOB and what they like to be called
  • Explain examination and obtain consent
  • Get a chaperone
  • Patient should stand up and be exposed from waist down
  • Put on gloves

General inspection

  • Patient: well/unwell, pain/discomfort, cachexia, gynaecomastia

Inspection

Inspect from the front but also ensure you lift the scrotum to inspect posteriorly:

  • Skin: erythema, rashes, excoriations, scars, ulcers
  • Testes: level (left usually lower), swelling, oedema, obvious masses
  • Inspect penis and retract foreskin: check for phimosis, adhesions and glans abnormalities. (Make sure you replace the foreskin.)

Palpation

Support the testes with your non-dominant hand and palpate with the index finger and thumb of your dominant hand:

  • Testes: feel inferior, middle and superior parts of testes. Note size, consistency, and any lumps or masses.
  • Epididymis: feel around the posterior aspect of each testis for the epididymis (tenderness/swelling = epididymitis
  • Spermatic cord: with thumb anteriorly and index finger posteriorly, feel neck of scrotum for spermatic cord (superior to testes, feels like string)
  • Palpate for inguinal lymphadenopathy (infection/inflammation)
  • Reflexes
    • Prehn’s test: if testicular pain is relieved by elevating the testes, suspect epididymitis; if not, suspect testicular torsion
    • Cremasteric reflex: stroke inside of leg and watch scrotal skin tighten (usually absent in torsion)
Testicular pathology

Finally

  • Palpate for supraclavicular lymphadenopathy: testicular cancer commonly metastasises here (rather than superficial inguinal nodes)

To complete

  • Thank patient and allow them to get dressed in privacy
  • β€˜To complete my examination, I would perform a full abdominal examination and examine herneal orifices.’ 
  • Summarise and suggest further investigations you would consider after a full history (e.g. urinalysis, testicular ultrasound)

Types of testicular pathology

Hydrocele

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Varicocele

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Epididymal cyst

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Testicular tumour

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Inguinal-scrotal hernia

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Epididymitis

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Testicular torsion

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Orchitis

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Here’s some viva questions

When may you use Prehn’s test and what do the results indicate?

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What is the difference between phimosis and paraphimosis?

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List some risk factors for testicular torsion

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What are the main types of testicular tumour and which biomarkers may they secrete?

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2 Comments

  1. Todd Curtis says:

    May I use the image of testicular pathologies for a textbook that I’m writing.

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