Testicular cancer

Testicular tumours are cancers arising from the testicular tissue.   They are usually detected when the patient notices a lump or swelling on the testicle. Testicular tumours are relatively rare, affecting 6.5 per 100, 000 men in Australia. They most commonly affect young men, with the two most common tumour types affecting men between 15-39 years and 25-49 years respectively. Risk factors for testicular cancer are a family history of the disease, history of undescended testicle and previous testicular cancer.

Diagnosis:

When a lump is felt in the testicle your doctor will usually arrange an ultrasound scan of the testicles. If this suggests there may be a tumour present, the next step is for blood tests (to check for tumour markers) and a referral to a Urologist. Your Urologist can then arrange further scans (usually a CT scan), as appropriate.

Treatment:

Cure rates for all types of testicular cancer are excellent, with a 5 year survival rate of more than 98%.

Radical Orchidectomy:

All patients diagnosed with testicular cancer will require the surgical removal of the testicle via an incision in the groin. This operation usually requires an overnight admission to hospital.

Post- Surgical Treatment:

Additional treatment after the surgical removal of the testicle depends on the type of tumour identified and whether there is spread beyond the testicle. This may in involve close monitoring, a short course of chemotherapy or, rarely, radiation treatment or further surgery.

Impact on Sexual Function and Fertility:

As testicular tumours commonly affect young men who haven’t started or completed their family, fertility is often a concern. Removing one testicle does not affect sexual function or fertility. Additional treatments, such as chemotherapy, may affect fertility and if this is required your Urologist can arrange sperm banking prior to starting treatment.

Testicular Prosthesis Insertion:

Some men are concerned about their appearance after one testicle has been removed. It is possible to insert an artificial testicle (prosthesis) either at the time of the orchidectomy surgery or at a later date.

Hydrocele

A hydrocele is a collection of watery fluid in a sac around the testicle. Patients with a hydrocele will usually notice swelling of one of both sides of the scrotum. Hydroceles occur when there is an imbalance between production and reabsorption of the normal lubricating fluid that sits around the testicle.

Diagnosis:

Hydroceles are usually diagnosed by examining the scrotum. An ultrasound is then performed to confirm the diagnosis and exclude any underlying testicular problems.

Treatment:

Most hydroceles do not require treatment, but if they are very large or painful they may require surgery.

Surgical Repair of Hydrocele:

A small incision is made on the front of the scrotum and the hydrocele sac is dissected out and drained. The sac is then oversewn to minimize the risk of fluid reaccumulating. This can usually be done as a day case, but if the hydrocele is very large it may be necessary to stay in hospital overnight.

Varicocele

A varicocele is an enlargement of veins in the scrotum, similar to a varicose vein in the legs. Small varicoceles do not usually cause symptoms and do not require treatment. When they become larger they can cause pain (usually a heavy or dragging sensation at the end of a day) or cause swelling in the scrotum.

Varicoceles and Fertility:

Because the varicocele stores blood next to the testicle it can increase the temperature within the testicle, which can impair sperm production and lead to a shrinking in testicular size. This can lead to reduced fertility in some men.

Diagnosis:

Your GP will often have already organized an ultrasound of the scrotum. You will also need an ultrasound or CT scan of the abdomen to exclude any other problems.

Treatment:

Varicoceles that cause pain, testicular shrinkage or reduced sperm counts require treatment.

Embolisation:

It is often possible for the radiology doctors to occlude the enlarged veins under XRay guidance through a tube inserted into the groin. This can be done under local anaesthetic as a day case. There is a small risk of recurrence of the varicocele with this approach.

Laparoscopic (or Open) Varicocelectomy:

An alternative to embolization is an operation to tie off the distended veins. This can be done either with laparoscopic (key-hole) surgery through ports inserted into the abdomen or open surgery through an incision in the groin. There are small risks associated with an operation, including developing a hydrocele, recurrence of the varicocele and damage to the testicular artery.

Epididymal cysts

Epididymal cysts are benign, fluid-filled cysts arising from the epididymis (separate to the testicle). Diagnosis is confirmed with examination and a scrotal ultrasound. Epididymal cysts are very common and rarely require treatment.

Excision of epididymal cyst:

If an epididymal cyst causes pain or discomfort due to its large size it is possible to remove the cyst via an incision in the scrotum. This procedure is avoided, where possible, in young men due to the risk of damage or scarring to the ducts transporting sperm.

Vasectomy

Vasectomy is a form of permanent contraception (male sterilization). The vas deferens (tubes that transport sperm from the testicles to the penis) are divided and tied off, through two tiny incisions in the scrotum. A general anaesthetic is used.

Micro-surgical Vasectomy Reversal

Whilst vasectomy is considered a permanent procedure, it is possible to restore fertility by re-joining the divided vas deferens tubes. This procedure has higher success rates when a microscope and microscopic instruments are used to assist the Urologist to re-align the tubes. There are many factors that affect the success rates following vasectomy reversal including the time since vasectomy, complications at the time of vasectomy, partner’s age and fertility status.