Urology – Scrotal Masses: By Nicholas Power M.D.
Scrotal masses occur in approximately 15% of the male population. These can be categorized into benign and malignant conditions. Because these conditions may occur extensively in the population, it is important to be able to determine the conditions that may be life threatening. Here are two conditions you cannot afford to miss: The first is testicular cancer. Testicular cancer is the most common solid organ malignancy in males between the ages of 15 and 35 years. All intra-testicular masses must be considered malignant until proven otherwise. Patients generally present with a painless mass, however pain has been known to occur. Initial assessment starts with a physical examination to palpate for any obvious gross abnormalities.
Imaging with ultrasound is then used to determine any suspicious areas within the scrotum and testicles. Suspicious areas should then be followed up with blood tests to identify the presence of any tumour markers (bHCG, AFP, and LDH). Treatment is stage dependent; therefore it is important to first stage the cancer to determine the appropriate treatment plan. This is primarily done using radiographic tests, preferably pelvic, abdominal, and chest CTs. Treatment includes radical orchiectomy, plus or minus chemotherapy, radiotherapy, and/or additional surgery.
Pathological testing will confirm the diagnosis and determine the type of cancer. Sperm cryopreservation should be offered to patients who are concerned about future fertility; this is generally done prior to any radiological tests or further treatment. The second condition is testicular torsion. Although, not life-threatening, it is a surgical emergency. Think about a young male patient with acute scrotal pain, asymmetrical high-riding testis, and absent cremasteric reflex.
Confirmation by way of an urgent ultrasound is warranted. Treatment includes prompt surgical exploration with intraoperative detorsion and fixation within the scrotum. The longer you wait, the less likely the testicle can be salvaged.
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