MEN'S HEALTH THE TESTICLES

MEN'S HEALTH THE TESTICLES Information Leaflet Your Health. Our Priority.

of 6 The Anatomy of the testicles Men have two testicles which descend from the abdomen into the scrotum before birth. They hang in a bag (scrotum) outside the body just behind the penis. They are outside the body because sperm needs to be kept cooler than the rest of the body. Sperm may be damaged or killed if overheated. The testicles themselves are egg-shaped organs with a smooth covering. They are responsible for making sperm and for producing the male hormone called testosterone. It is normal for one testis to be slightly bigger than the other and to hang slightly lower than the other ( usually the left). At the top and to the back of each testis is the epididymis, ( this stores the sperm). The epididymis feels like a hard sausage shaped ridge on the top of the testes, it can be quite tender if pressed firmly. Leading from the epididymis is the vas deferens, this feels like a soft narrow tube. (The vas deferens carries the sperm to the penis). Normal testes The best time to check your testicles is after a bath or shower when you are relaxed and warm. How to examine yourself You need to feel each testicle in turn. Using both your hands with your thumbs on top and index fingers below, gently roll the testicle. You will feel the hard sausage shaped ridge ( the epididymis) on the top of the testicle this is absolutely normal. The testes themselves feel like smooth soft balls surrounded by a baggy scrotum. It is important to be aware of the size of your testicles; this can be done by looking at them in a mirror and to weigh them in a cupped hand. They should each weigh about the same and look approximately the same; however it is normal for one to be slightly bigger than the other. To check for any bumps or lumps again look at them in a mirror this is best done when standing, as the testicles hang down with gravity. Look for any swelling or lumps and gently feel the testicles between your finger and thumb paying particular attention to the smooth surfaces of the testicle, and the head (top) and tail (bottom) of the epididymis. You should check your testicles regularly so that you know what feels normal for you. What changes should I look for? If you notice that there is any change in size or weight of the testes, or when checking the testes you feel any swelling or lumps or tender areas then it is advised to see your GP. Doctors are used to performing this type of examination, so please do not feel embarrassed by this. Your doctor will be able to advise you if there is anything abnormal that may require further investigation. Most lumps and bumps are not cancer, but harmless conditions such as:

of 6 Epididymal Cyst Most lumps which occur in the epididymis are non-cancerous. When self examining, if the testicle can be easily felt and a lump is detected separate from the testicle itself, it will almost certainly be a cyst of the epididymis. Other similar lumps can be caused by enlarged sperm channels (spermatocele). Such lumps only require surgery if they become large or cause persistent discomfort. Hydrocele This is the fluid inside the scrotum around the testicle causing an enlargement of the scrotum rather than the testicle. The testicle usually cannot be felt within the swelling. These can become quite large. The treatment is to remove the fluid with a syringe and needle or insert a special drain to allow the fluid to drain away. Your surgeon can stitch the layers around the testicle in a special way to prevent this happening again. Varicocele This condition produces varicose veins around the cord which suspends the testicle. The veins produce several small soft swellings, described as feeling like a bag of worms". This condition can cause some aching in the testicle. It can be associated with infertility, but in most cases although unpleasant it rarely requires treatment. Pain Acute Torsion of the testicle The testicle can occasionally rotate suddenly. This causes a twisting of the cord upon which the testicle hangs and which carries its blood vessels. This twisting will cut off the blood supply to the testicle which can become gangrenous within 4-6 hours. The condition is more common in children but can occur in young adults. It is an emergency requiring immediate admission to hospital and an operation. Infection Orchitis (infection of the testicle) and epididymitis (infection of the epididymis) can both produce a sudden painful swelling of the hemiscrotum with fever and generalised illness. It often requires admission to hospital for antibiotic treatment. The condition comes on suddenly and goes down slowly. The testis/epididymis takes up to 6 weeks to return to normal size. Pain chronic Any of the above lumps in the scrotum can cause pain in the testicle, the groin and occasionally the inner surface of the upper thigh. This can also occur after vasectomy. Sometimes patients complain of chronic pain in the scrotum lasting for several weeks or months. Examination by a doctor may reveal some mild thickening of the epididymis. Or in some instances the doctor will find no abnormality. This condition is extremely difficult to cure, and very frustrating for the patient. The position of the testicles makes them very susceptible to repetitive minor trauma (e.g. driving, sitting for long periods, posture changes, sport, sex) so that any minor injury prevents the condition from settling down naturally, prolonging the discomfort. Other conditions such as chronic prostatitis ( infection of the prostate) may need to be excluded. Antibiotics, anti-inflammatory drugs, pain-killers or a change of underwear type (e.g. y-front to boxer shorts) can all be tried in an attempt to help with this condition.if you play contact sports it is advisable to wear a box.

of 6 Surgery to remove the epididymis is almost always unsuccessful, disappointing and can cause more prolonged post-surgical discomfort. A more extensive operation to denervate ( removal of the nerve) from the spermatic cord or referral to a pain clinic may be required. Cancer of the testicle Around half of all cases occur in men under 35. It is the most common cancer in men aged 15 to 44 years of age. It is important to let your doctor know if you are worried as more than a third of men with this cancer consult their doctor once the cancer has spread making it more difficult to treat. It is really important to contact your GP if you are worried. What causes testicular cancer? The exact reason why a cell becomes cancerous is unclear. It is thought that a cancerous tumour starts from genes in the cell that may have been damaged or altered in some way. This makes the cell abnormal and multiply out of control. There are certain risk factors thought to increase the development of testicular cancer, they are: Geographical white northern European men experience the highest rate of testicular cancer. ( genetic or environmental factors may be involved) Family history ( brothers and sons of affected men are at increased risk) Infertility- men with an abnormal sperm count have a slightly increased risk Klinefelter s Syndrome ( a chromosomal condition) Other medical conditions such as hypospadias, inguinal hernia, HIV/AIDS How is testicular cancer diagnosed and assessed? If your GP suspects that a lump is a cancer you will be referred to a Consultant Urologist You will be examined again and may be advised to undergo some tests; Ultrasound scan. This is a painless test which can detect whether the lump is a solid mass (this can indicate that there is a cancer present) if the lump is fluid filled it is most likely a harmless cyst. Blood tests. These can tell us if there are chemicals in the blood which can help confirm that there is a testicular cancer. They are a marker of testicular cancer. However care must be taken as you can have a testicular cancer without being able to detect the marker chemical. Therefore a negative blood test does not mean that a cancer is not present. What will happen if cancer is diagnosed? Your urologist will perform an operation to remove the affected testicle and it will be sent to the laboratory to confirm the type of cancer. Removing the testicle is often enough to cure the cancer if it is in an early stage and has not spread. If the cancer has spread then further surgery

of 6 may be required, this is to remove lymph nodes from the abdomen and the chest, this would be done after chemotherapy and radiotherapy treatment. Chemotherapy Chemotherapy is a treatment using anti cancer drugs, which kill the cancer cells, or stop them from multiplying.not all patients will need to have chemotherapy this will be discussed with you by your doctor. Radiotherapy This is a treatment for cancer using high focused energy beams of radiation which target the cancerous tissue.radiotherapy kills the cancer cells or stops them from multiplying. Your doctor will advise you if you require this as well as removing the affected testicle. If chemotherapy and radiotherapy are require after surgery this is known as adjuvant therapy. Will this affect my fertility? If you have one testicle removed this should not affect your sex life. You can still father children as your remaining testicle will still produce sufficient sperm and hormones and you will be able to have normal erections. If you have Chemotherapy and radiotherapy this may affect your fertility. Many men report that their fertility returns a year after treatment.all of this will be discussed with you before you have any treatment. What follow up will I need? After successful surgery and treatment you can expect to be followed up for several years to check that the cancer has not returned. This will mean you will need regular blood tests, x-ray and scans, as-well as being examined by a doctor. Useful Telephone Numbers Stepping Hill Urology Department 0161 419 5698 Tameside Urology Department 0161 331 6714 Macclesfield Urology Department 01625 661 517

of 6 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678 Information Leaflet. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number URO49 Publication date January 2015 Review date January 2017 Department Urology Location Stepping Hill Hospital