Examination of Testes & Scrotum

Transcription

1 Examination of Testes & Scrotum

2 Goal To perform a thorough breast examination of the male genitalia whilst preserving patients modesty and identifying abnormal findings Objectives; ; SSBAT Describe indications, contraindications & rationale for performing an examination of the testes & scrotum Acquire the necessary skills for performing the examination of the testes & scrotum Describe normal & abnormal findings associated with the examination of the testes & scrotum

3 Examination Indications For routine preventative screening for testicular cancer For diagnostic purposes Contraindications There is no medical contraindications Complications Temporary discomfort from palpation of the scrotum (Dehn & Asprey,, 2007)

4 Statistics Annual incidence 4 per 100,000 men Accounts for 1-2% 1 of all neoplasms in men Most common in males between yrs Incidence is greater in white men ( Irish Cancer Society, 2006, p9) Early detection yield better outcomes 5 yr survival rate of 92% (97% stage1) Cure rates greater than 80% (all stages)

5 Risk Factors Age: highest group Cryptorchidism Previous cancer in the other testicle History of mumps orchitis, hydrocele or inguinal hernia as a child Smoking Family history Infertility (Irish Cancer Society 2006, p9) Maternal hormone ingestion during pregnancy (e.g. diethylstilbestrol)

6 Clinical Presentation Acute pain in the testicle, scrotum or abdomen Patients often present with a painless testicular mass Pain, swelling or hardness in scrotum 10% report recent testicular trauma (no link between injury & trauma found, but injury may cause tumor to become more obvious Irish Cancer Society, 2006) Swelling in lower extremities, back pain, cough may indicate advanced disease

7 Patient Preparation Ensure privacy as the examination can be embarrassing Ensure examination is no rushes, plan enough time Take time to explain the procedure and obtain consent prior to commencement of the examination Ask patient of remove all clothing from the waist down, cover to ensure privacy. (Dehn & Osprey, 2007)

8 Examination Check for any swelling Place the index and middle fingers of both hands under the testicles with the thumbs placed on top Check one testicle at the time with the unused hand placed on the septum Roll the testicle gently between the thumb and fingers- no pain should be felt Find the epididymis, the soft tube-like structure behind the testicle Clearly document the performance of the examination was performed Ensure further diagnostic or screening studies are carried out if warranted

9 Normal findings- no lumps or bumps Abnormal Findings Lumps or swelling on testes Change in size or weight Bulge or swelling in the scrotum Other signs Dull abdominal or back pain

10 Diagnosis by History Physical exam Diagnostic tests Diagnosis & Staging CT scan, ultrasound, serum tumor markers (Irish cancer Society, 2006) surgical biopsy Three stages of disease ( I, II, III) Treatment Surgery Radiation +/- chemotherapy ( depending on histology and stage of disease Can be used alone or all together ( Irish Cancer Society)

11 Follow-Up Inform patient before & during the examination that self-examination examination of the scrotal sac is useful for early detection of testicular cancer. Instruct the patient in the technique for self- examination and encourage to perform on a monthly basis (after warm bath or shower-heat heat help relax the scrotum making it easier to detect abnormalities) Patients who do not keep appointments should be followed up

12 References American cancer society Irish Cancer Society (2006), Understanding Testicular Cancer Supplement, Dublin

13 Recommended Reading Dehn,, R.W. and Asprey,, D.P (2007) Essential Clinical Procedures.. 2nd ed. Saunders Elsevier, Philadelphia. Junnila,, J. & Lassen,, P. (1998) Testicular Masses. American Family Physician 57(4): Taylor, S. et al (2004) Teaching the Testicular Exam: A Model Curriculum From A A to Zack Medical Student Education 36 (3):209 Seidel, H.M., Ball, B.W., Dains,, J.E. & Benedict, (2003) Male genitalia: Anus, Rectum, and Prostate. In Mosby s Guide to Physical Examination 5 th ed. St Louis, Mosby. Swartz M.S. Male Genitalia and Hernias (2006) In Swartz MS: textbook of Physical diagnoses: History and Examination, 5 th ed. Philadelphia, WB Saunders,