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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.
  • If you feel a mass/swelling, note its characteristics (SSSCCCTTT)
    • Size, Shape, Surface, Consistency, Contours, Colour, Temperature, Tenderness, Transillumination
  • 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)
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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
  • ‘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

Here’s some viva questions

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  1. Testicular exam
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