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A testicle or testis is the male gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testicles are to produce both sperm and androgens, primarily testosterone. Testosterone release is controlled by the anterior pituitary luteinizing hormone, whereas sperm production is controlled both by the anterior pituitary follicle-stimulating hormone and gonadal testosterone.
Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply to the testicle. The most common symptom in children is sudden, severe testicular pain. The testicle may be higher than usual in the scrotum and vomiting may occur. In newborns, pain is often absent and instead the scrotum may become discolored or the testicle may disappear from its usual place.
Cryptorchidism, also known as undescended testis, is the failure of one or both testes to descend into the scrotum. The word is from Greek κρυπτός 'hidden' and ὄρχις 'testicle'. It is the most common birth defect of the male genital tract. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis. However, about 80% of cryptorchid testes descend by the first year of life, making the true incidence of cryptorchidism around 1% overall. Cryptorchidism may develop after infancy, sometimes as late as young adulthood, but that is exceptional.
The cremaster muscle is a paired structure made of thin layers of striated and smooth muscle that covers the testicles and the spermatic cords in human males. It consists of the lateral and medial parts. Cremaster is an involuntary muscle, responsible for the cremasteric reflex; a protective and physiologic superficial reflex of the testicles. The reflex raises and lowers the testicles in order to keep them protected. Along with the dartos muscle of the scrotum, it regulates testicular temperature, thus aiding the process of spermatogenesis.
A hydrocele testis is an accumulation of clear fluid within the cavum vaginale, the potential space between the layers of the tunica vaginalis of the testicle. It is the most common form of hydrocele and is often referred to simply as a "hydrocele". A primary hydrocele testis causes a painless enlargement in the scrotum on the affected side and is thought to be due to the defective absorption of fluid secreted between the two layers of the tunica vaginalis. A secondary hydrocele is secondary to either inflammation or a neoplasm in the testis.
Orchitis is inflammation of the testicles. It can also involve swelling, pains and frequent infection, particularly of the epididymis, as in epididymitis. The term is from the Ancient Greek ὄρχις meaning "testicle"; same root as orchid.
Orchiopexy is a surgery to move and/or permanently fix a testicle into the scrotum. While orchiopexy typically describes the operation to surgically correct an undescended testicle, it is also used to resolve testicular torsion.
A hematocele is a collections of blood in a body cavity or potential space. The term most commonly refers to the collection of blood in the tunica vaginalis around the testes, known as a scrotal hematocele. Hematoceles can also occur in the abdominal cavity and other body cavities. Hematoceles are rare, making them harder to diagnose and treat. They are very common especially as slowly growing masses in the scrotum usually in men older than 50 years.
The testicular vein, the male gonadal vein, carries deoxygenated blood from its corresponding testis to the inferior vena cava or one of its tributaries. It is the male equivalent of the ovarian vein, and is the venous counterpart of the testicular artery.
A testicular nubbin is the residual tissue of the human testis after a supposed perinatal vascular accident involving the testicular blood supply. The blood supply of the testis twists thereby cutting off the blood supply to the testis and results in testicular atrophy (shrinking). The nubbin is usually identified in childhood by the absence of a palpable testis in the scrotal sac. The tissue remnant usually includes fibrous tissue and signs of old infarction with hemosiderin deposition identified histologically. There is some disagreement as to whether these should be removed and whether there is a risk of future malignancy. They are typically removed surgically by pediatric urologists or pediatric general surgeons through either a scrotal or inguinal incision.
Epididymal cyst is a harmless sac in the testicles filled with fluid. The most frequent clinical presentation occurs when a routine physical examination yields an unexpected finding, which is then confirmed by scrotal ultrasonography. Although the exact cause of epididymal cysts is unknown, it is likely a congenital anomaly associated with hormonal imbalances during the embryonic stage of development.
Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient's specific pain. When pain in the epididymides is the primary symptom, post-vasectomy pain syndrome is often described as congestive epididymitis.
Odynorgasmia, or painful ejaculation, also referred to as dysejaculation, dysorgasmia, and orgasmalgia, is a physical syndrome described by pain or burning sensation of the urethra or perineum during or following ejaculation. Causes include: infections associated with urethritis, prostatitis, epididymitis; use of anti-depressants; cancer of the prostate or of other related structures; calculi or cysts obstructing related structures; trauma to the region.
Splenogonadal fusion is a rare congenital malformation that results from an abnormal connection between the primitive spleen and gonad during gestation. A portion of the splenic tissue then descends with the gonad. Splenogonadal fusion has been classified into two types: continuous, where there remains a connection between the main spleen and gonad; and discontinuous, where ectopic splenic tissue is attached to the gonad, but there is no connection to the orthotopic spleen. Patients can also have an accessory spleen. Patients with continuous splenogonadal fusion frequently have additional congenital abnormalities including limb defects, micrognathia, skull anomalies, Spina bifida, cardiac defects, anorectal abnormalities, and most commonly cryptorchidism. Terminal limb defects have been documented in at least 25 cases which makes up a separate diagnosis of splenogonadal fusion limb defect (SGFLD) syndrome.
Sarcoidosis is a systemic disease of unknown cause that results in the formation of non-caseating granulomas in multiple organs. The prevalence is higher among black males than white males by a ratio of 20:1. Usually the disease is localized to the chest, but urogenital involvement is found in 0.2% of clinically diagnosed cases and 5% of those diagnosed at necropsy. The kidney is the most frequently affected urogenital organ, followed in men by the epididymis. Testicular sarcoidosis can present as a diffuse painless scrotal mass or can mimic acute epididymo-orchitis. Usually it appears with systemic manifestations of the disease. Since it causes occlusion and fibrosis of the ductus epididymis, fertility may be affected. On ultrasound, the hypoechogenicity and ‘infiltrative’ pattern seen in the present case are recognized features. Opinions differ on the need for histological proof, with reports of limited biopsy and frozen section, radical orchiectomy in unilateral disease and unilateral orchiectomy in bilateral disease. The peak incidence of sarcoidosis and testicular neoplasia coincide at 20–40 years and this is why most patients end up having an orchiectomy. However, testicular tumours are much more common in white men, less than 3.5% of all testicular tumours being found in black men. These racial variations justify a more conservative approach in patients of Afro-Caribbean descent with proven sarcoidosis elsewhere. Careful follow-up and ultrasonic surveillance may be preferable in certain clinical settings to biopsy and surgery, especially in patients with bilateral testicular disease.
Orchiectomy is a surgical procedure in which one or both testicles are removed. The surgery can be performed for various reasons:
Scrotalultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.
Eosinophilic cystitis is a rare type of interstitial cystitis first reported in 1960 by Edwin Brown. Eosinophilic cystitis has been linked to a number of etiological factors, including allergies, bladder tumors, trauma to the bladder, parasitic infections, and chemotherapy drugs, though the exact cause of the condition is still unknown. The antigen-antibody response is most likely the cause of eosinophilic cystitis. This results in the generation of different immunoglobulins, which activate eosinophils and start the inflammatory process.
Male genital examination is a physical examination of the genital in males to detect ailments and to assess sexual development, and is normally a component of an annual physical examination. The examination includes checking the penis, scrotum, and urethral meatus. A comprehensive assessment of the male genitals assesses the pubic hair based on Sexual Maturity Rating and the size of the testicles and penis. The exam can also be conducted to verify a person's age and biological sex. The genitourinary system can also be assessed as part of the male genital examination. During a genital examination, the doctor can detect any of the following: structural abnormalities, urethral opening abnormalities, problems related to not being circumcised, lumps, tumors, redness, excoriation, edema, lesions, swelling, cancer, hair-related issues, and many others. In some instances where a physical examination of the male genitals is not sufficient to diagnose an individual, then an internal genital examination using imaging or ultrasounds will be needed for further evaluation.
Marc Goldstein, MD, DSc (hon), FACS is an American urologist and the Matthew P. Hardy Distinguished Professor of Reproductive Medicine, and Urology at Weill Cornell Medical College; Surgeon-in-Chief, Male Reproductive Medicine and Surgery; and Director of the Center of Male Reproductive Medicine and Microsurgery at New York Presbyterian Hospital. He is Adjunct Senior Scientist with the Population Council's Center for Biomedical Research, located on the campus of Rockefeller University.
References
- 1 2 Soomro, Sirajuddin; Mughal, Sikandar Ali (June 2008). "Perineal ectopic testis — a rare encounter in paediatric surgical practice" (PDF). Journal of the College of Physicians and Surgeons--Pakistan. 18 (6): 386–387. PMID 18760056 . Retrieved 5 January 2024.
- ↑ Stevenson, Roger; Hall, Judith (2006). Human malformations and related anomalies. Oxford New York: Oxford University Press. p. 1272. ISBN 0-19-516568-3.
- ↑ "Ectopic testis". GP Notebook. Retrieved 2011-12-15.
- ↑ Middleton, George W.; Beamon, Charles R.; Gillenwater, Jay Y. (1976). "Two Rare Cases of Ectopic Testis". Journal of Urology. 115 (4). Ovid Technologies (Wolters Kluwer Health): 455–458. doi:10.1016/s0022-5347(17)59241-1. ISSN 0022-5347. PMID 4633.
- ↑ Ramareddy, Raghu S.; Alladi, Anand; Siddappa, O.S. (2013). "Ectopic testis in children: Experience with seven cases". Journal of Pediatric Surgery. 48 (3). Elsevier BV: 538–541. doi:10.1016/j.jpedsurg.2012.10.005. ISSN 0022-3468. PMID 23480908.
- ↑ Nounla, J.; Tröbs, R.B.; Rolle, U. (2001). "Perineal Ectopic Testis: A Rare Cause of Empty Scrotum". Urologia Internationalis. 67 (3). S. Karger AG: 246–248. doi:10.1159/000050997. ISSN 0042-1138. PMID 11598455. S2CID 23498735.
- ↑ HUTCHESON, JOEL C.; SNYDER, HOWARD M.; ZUÑIGA, ZACHARY V.; ZDERIC, STEPHEN A.; SCHULTZ, DELRAY J.; CANNING, DOUGLAS A.; HUFF, DALE S. (2000). "Ectopic and Undescended Testes: 2 Variants of a Single Congenital Anomaly?". Journal of Urology. 163 (3). Ovid Technologies (Wolters Kluwer Health): 961–963. doi:10.1016/s0022-5347(05)67864-0. ISSN 0022-5347. PMID 10688032.
- ↑ Ku, Ja-Hyeon; Jeon, Youn-Soo; Lee, Nam-Kyu; Kim, Min-Eui; Park, Young-Ho (2000). "Two cases of perineal ectopic testis". International Journal of Urology. 7 (8). Wiley: 307–309. doi: 10.1046/j.1442-2042.2000.00194.x . ISSN 0919-8172. PMID 10976819.
- 1 2 Ulubay, Mahmut (2019). "Perineal ectopic testis: A rare congenital anomaly". Urology Case Reports. 24. Elsevier BV: 100853. doi: 10.1016/j.eucr.2019.100853 . ISSN 2214-4420. PMC 6562294 . PMID 31211064.