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.)

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

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)

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

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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Try an OSCE station

1. Testicular exam
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