Archive for January 2009

Testicular Scan

22nd January 2009, 10:50 am

A testicular scan uses a camera to take pictures of the testicles after a radioactive tracer accumulates in testicular tissues (nuclear medicine test).

During a testicular scan, the tracer substance is injected into a vein in the arm. It travels through the bloodstream to the testicles. Areas of the testicles where the tracer accumulates in abnormal amounts may indicate some types of tumors. The tracer may also indicate a pocket of fluid (cyst) or infection (abscess).

A testicular scan may be done in an emergency to evaluate the cause of sudden, painful swelling of a testicle, which can be caused by a twisted spermatic cord inside the testicle. This condition is called testicular torsion and needs immediate medical evaluation and treatment.

Testicular ultrasound has largely replaced testicular scans to investigate possible testicular tumors and testicular torsion.

Why It Is Done

A testicular scan is done to:

  • Determine the cause of a painful, swollen testicle.
  • Assess the damage to the testicles caused by an injury.
  • Assess the flow of blood within the testicles.

How To Prepare

No special preparation is needed for a testicular scan.

You may be asked to sign a consent form before the test. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will indicate.

How It Is Done

A testicular scan is usually done by a nuclear medicine technologist. The scan pictures are usually interpreted by a radiologist or nuclear medicine specialist.

You will need to remove any jewelry that might interfere with the scan. You may need to take off all or most of your clothes, but you will be given a cloth or paper covering to use during the test.

The technologist cleans the site on your arm where the radioactive tracer will be injected. A small amount of the radioactive tracer is then injected.

You will lie on your back on a table and your penis will be taped to your abdomen to prevent it from interfering with the scan. A sling or towel may be used to support the testicles under the scanner. After the radioactive tracer is injected, the camera will scan for radiation released by the tracer and produce pictures of the tracer in your testicles. Two scans are done about 15 minutes apart. You need to lie very still during each scan to avoid blurring the pictures. The camera does not produce any radiation, so you are not exposed to any additional radiation while the scan is being done.

A testicular scan takes about 45 minutes.

How It Feels

You may feel nothing at all from the needle puncture when the tracer is injected, or you may feel a brief sting or pinch as the needle goes through the skin. Otherwise, a testicular scan is usually painless. You may find it uncomfortable to remain still during the scan, especially if your testicles are sore. Ask for a pillow or blanket to make yourself as comfortable as possible before the scan begins.

Risks

Allergic reactions to the radioactive tracer are rare. Most of the tracer will be eliminated from your body (through your urine or stool) within a day, so be sure to promptly flush the toilet and thoroughly wash your hands with soap and water. The amount of radiation is so small that it is not a risk for people to come in contact with you following the test.

Occasionally, some soreness or swelling may develop at the injection site. These symptoms can usually be relieved by applying moist, warm compresses to your arm.

There is always a very slight risk of damage to cells or tissue from being exposed to any radiation, including the low level of radiation released by the radioactive tracer used for this test.

Results

A testicular scan uses a camera to take pictures of the testicles after a radioactive tracer accumulates in testicular tissues (nuclear medicine test). The results of a testicular scan are usually available within 2 days. In an emergency, results can be available within an hour.

Testicular scan
Normal: The radioactive tracer flows evenly through the testicles. No accumulations of the tracer are found in any area of the testicles.
Abnormal: The tracer does not flow evenly through the testicles, indicating narrowing of, blockage of, or damage to the blood vessels in the testicles. This could indicate that blood flow has been reduced by a twisted spermatic cord inside the testicle. This is called testicular torsion.
Areas where the tracer accumulates in an abnormal amount could indicate a condition such as a cyst, tumor, pocket of infection (abscess), a blood clot, or inflammation of the tubes (ducts) that carry sperm (epididymis). This is called epididymitis.

What Affects the Test

The results of a testicular scan may not be accurate if you cannot remain still during the test.

What To Think About

  • Testicular ultrasound has largely replaced testicular scans to investigate possible testicular torsion or tumors in the testicles.
  • Abnormal results from a testicular scan may be further investigated by other tests, such as a testicular biopsy, an ultrasound test, or X-ray tests.
  • If a testicular scan is done for a young boy, a parent can accompany him while the test is being done.
  • Share/Save/Bookmark
Category: Testicular cancer  |  Comment

Testicular Examination and Testicular Self-Examination (TSE)

14th January 2009, 03:23 pm

Testicular examination and testicular self-examination (TSE) are two different methods to detect lumps or abnormalities of the testicles.

The two testicles, or testes, are inside the scrotum. The testicles are the male reproductive organs that produce sperm and the male hormone testosterone. Each testicle is approximately the size and shape of a small egg. At the back of each testicle is the epididymis, a coiled tube that collects and stores sperm.

The testicles develop within the abdomen of a male baby (fetus) and normally descend into the scrotum before or shortly after birth. A testicle that has not descended can increase the risk for testicular cancer.

Testicular examination

A testicular examination includes a complete physical examination of the groin and genital organs (penis, scrotum, and testicles) by your health professional. Your health professional will feel (palpate) the organs and examine them for the presence of lumps, swelling, shrinking (testicular atrophy), or other visual signs of an abnormality. A testicular examination can detect the causes of pain, inflammation, swelling, congenital abnormalities (such as an absent or undescended testicle), and lumps or masses that may indicate testicular cancer.

An examination of the genitals is an important part of a routine physical examination for every boy and man, regardless of age. Male babies should also have their genitals examined for congenital abnormalities or an undescended testicle. An undescended testicle is more common in premature male babies than in full-term male babies.

Regular testicular examination is recommended for men between the ages of 15 and 40 to detect testicular cancer in its early stages. Testicular cancer is one of the most common cancers in men younger than age 35. Many testicular cancers are first discovered by men themselves, or by their sex partners, as a lump or enlarged swollen testicle. In the early stages of testicular cancer, the lump, which may be about the size of a pea, usually is not painful. Testicular cancer found early and treated promptly has a very high cure rate.

Testicular self-examination (TSE)

Testicular self-examination (TSE) may detect testicular cancer at an early stage. Many testicular cancers are first discovered by self-examination as a painless lump or an enlarged testicle.

Some health professionals recommend that men between the ages of 15 and 40 perform monthly testicular self-examination. However, this is controversial. Many health professionals do not believe monthly TSE is necessary for men at average risk of developing testicular cancer. Monthly TSE may be recommended for men at high risk of developing testicular cancer. This includes men with a history of an undescended testicle or a family or personal history of testicular cancer.

Many testicular lumps are cancerous and require immediate treatment. Usually, the affected testicle is removed by surgery. In some cases, the lymph nodes may also be removed, and chemotherapy or radiation therapy may be given. An artificial testicle may be inserted into the scrotum to provide a normal appearance. Since one normal testicle remains, a man’s sexual and reproductive functions usually are not affected.

Why It Is Done

Testicular examination

A testicular examination may detect the causes of pain, inflammation, swelling, congenital abnormalities (such as an absent or undescended testicle), and lumps or masses in the testicles.

Testicular self-examination (TSE)

Testicular self-examination (TSE) is done to familiarize a man with the normal size, shape, and weight of his testicles and the area around the scrotum. This allows him to detect any changes from normal.

How To Prepare

No special preparation is needed before a testicular examination by your health professional. However, for comfort, you should empty your bladder ahead of time. You will be asked to undress and put on a hospital gown.

Testicular self-examination (TSE) is painless and takes only a minute. It is best performed after a bath or shower, when the scrotal muscles are warm and relaxed.

How It Is Done

Testicular examination

The examination may be done initially while you are lying down, then repeated while standing. Your health professional will inspect your abdomen, groin, and genital area (penis, scrotum, testicles). The scrotum and both testicles will be felt (palpated) for their size, weight, texture, and consistency and for physical signs of swelling, lumps, or masses. The absence of one testicle usually indicates an undescended testicle. Shrinking (atrophy) of one or both testicles will also be noted.

If a mass is found in a testicle, your health professional will place a strong light behind the testicle to determine whether light can pass through it (called transillumination). A testicular tumor is too solid for light to pass through it. Also, a testicle with a tumor generally appears heavier than a normal testicle. A palpable mass or swelling caused by a hydrocele will allow light to pass through it. A hydrocele feels like water in a thin plastic bag. The other testicle also will be felt and examined to make sure it does not contain any lumps, masses, or other abnormalities.

Your health professional will also feel the lymph nodes in your groin and along your inner thigh for signs of enlargement.

Testicular self-examination (TSE)

TSE is best performed after a bath or shower, when the scrotal muscles are warm and relaxed. If you do the exam at another time, remove your underwear so that your genitals are exposed. See a picture of testicular self-examination.

Stand and place your right leg on an elevated surface about chair height. Then gently feel your scrotal sac until you locate the right testicle. Roll the testicle gently but firmly between your thumb and fingers of both hands, carefully exploring the surface for lumps. The skin over the testicle moves freely, making it easy to feel the entire surface of the testicle. Repeat the procedure for the other side, lifting your left leg and examining your left testicle. Feel the entire surface of both testicles.

How It Feels

A testicular examination by your health professional may cause mild discomfort if your testicles are painful, swollen, or inflamed. Whenever the genital area is touched, there is a possibility your body will react, and you may have an erection. This is a normal response that your health professional is aware of and you do not need to feel embarrassed.

Generally, there is no pain or discomfort associated with a testicular self-examination (TSE) unless a testicle is swollen or tender. A cancerous lump usually is firm to the touch and usually is not tender or painful when pressed.

Risks

There are no risks associated with a testicular examination or testicular self-examination (TSE).

Results

Testicular examination and testicular self-examination (TSE) are two different methods to detect lumps or abnormalities of the testicles.

Testicular examination and testicular self-examination (TSE)
Normal: Each testicle should feel firm but not hard, and the surface should be very smooth, without any lumps or bumps. The spongy, tubelike structure (epididymis) may be felt on the top and down the back side of each testicle. One testicle (usually the left) may hang slightly lower than the other, and one testicle may be slightly larger than the other. This difference is usually normal.
No pain or discomfort is experienced during testicular examination or TSE.
Abnormal: A small, hard lump (often about the size of a pea) is felt on the surface of the testicle, or the testicle is swollen or enlarged. If you notice a lump or swelling during TSE, contact your health professional immediately. Do not delay or wait for the lump to go away because it may be an early sign of testicular cancer. Immediate treatment provides the best chance for a cure.
One or both testicles are not felt. If you cannot feel one or both testicles while performing TSE, contact your health professional. This may indicate an undescended testicle.
A soft collection of thin tubes (often referred to as a “bag of worms” or “spaghetti”) is felt above or behind the testicle. This may indicate a varicocele.
Sudden (acute) pain or swelling in the scrotum that is noticed during the testicular examination or TSE may indicate an infection (epididymitis) or blockage of blood flow to the testicle (testicular torsion), either of which require immediate medical evaluation.
A free-floating lump in the scrotum that is not attached to a testicle may be present but is not a cause for concern.

If you cannot feel both testicles in your baby’s scrotum (descended), talk to his doctor.

What Affects the Test

There are no factors that interfere with a testicular examination or testicular self-examination (TSE).

What To Think About

  • Undescended testicles may be a risk factor for testicular cancer. Parents should check their children or have them checked by a health professional to be sure that both testicles have descended properly before puberty.
  • Expert recommendations on testicular examinations:
    • The American Cancer Society recommends that all men between the ages of 15 and 40 have a testicular examination as part of a regular physical examination by their health professional. However, ACS does not recommend regular self-examinations for men who do not have risk factors for testicular cancer.
    • The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for testicular cancer in teen and adult men who have no symptoms of cancer. The USPSTF recommends that men who have an increased risk of developing testicular cancer talk to their health professional about regular screening.
  • Share/Save/Bookmark
Category: Testicular cancer  |  Comment

Testicular Biopsy

3rd January 2009, 05:30 pm

A testicular biopsy is a test to remove a small sample of tissue from one or both testicles and examined under a microscope to evaluate a man’s ability to father a child.

The testicles (testes) are oval-shaped glands that hang in the scrotum beneath the base of the penis. The testicles produce sperm (necessary for reproduction) and male hormones, such as testosterone.

Why It Is Done

A testicular biopsy may, on rare occasions, be done to help determine the cause of male infertility. Testicular biopsy may be done if both of the following are present:

  • The man’s semen has an abnormal sperm count.
  • Hormone test results are within the normal range.

Testicular biopsy is not usually used to detect testicular cancer. When cancer is suspected, an open surgical procedure (orchiectomy) is done to confirm the diagnosis.

How To Prepare

Before having a testicular biopsy, be sure to tell your doctor if you:

  • Have had any bleeding problems.
  • Are allergic to any medications, including anesthetics.
  • Take any medications regularly. Be sure your doctor knows the names and doses of all your medications.
  • Are taking any blood-thinning medications, such as warfarin (Coumadin), heparin, enoxaparin (Lovenox), aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).

You will need to sign a consent form that says you understand the risks of a testicular biopsy and agree to have the biopsy. Talk to your health professional about any concerns you have regarding the need for the biopsy, any alternative methods for the biopsy, its risks, how it will be done, or what the results will indicate.

If a testicular biopsy is done under local anesthesia, no other special preparation is needed.

If the biopsy is done under general anesthesia, do not eat or drink anything for 8 to 12 hours before the biopsy. During preparation for the biopsy, an intravenous line (IV) is inserted in your arm, and a sedative medication is given about an hour before the biopsy.

How It Is Done

This biopsy is done by a surgeon or a doctor who specializes in men’s sexual problems (urologist) in the doctor’s office, a day surgery clinic, or a hospital operating room.

You will lie on your back on an examining table. The skin over your testicle is cleaned with an antiseptic solution, and the area around it is covered with sterile cloth. Your doctor will wear sterile gloves. It is very important that you do not touch this sterile area.

A local anesthetic will be injected into the skin of the scrotum to numb (anesthetize) the area. Then a small incision is made through the skin, and a tiny piece of testicular tissue is removed with small scissors. A single stitch is used to close the incision in the testicle, and another stitch is used to close the incision in the skin. (Absorbable sutures are used so the stitches do not need to be removed.) The procedure is usually repeated on the other testicle. The scrotal area is then bandaged. You will be asked to wear an athletic supporter for several days after the procedure to help support the testicles while the incisions heal.

If a general anesthetic is used, you will be asleep during the procedure but the same method will be used.

The biopsy usually takes 15 to 20 minutes. You will probably be advised to refrain from sexual activity for 1 to 2 weeks after the biopsy. You should avoid washing the area for several days.

How It Feels

You will feel a brief sting when the IV line is inserted or when the local anesthetic is injected. Other than that, the procedure should be painless.

Your scrotum and testicles may be somewhat sore for 3 to 4 days after the biopsy and some bruising may be present. You may also notice a small amount of bleeding through the bandage, which is normal. Talk to your doctor about how much bleeding to expect.

Risks

There is a slight risk of prolonged bleeding or infection from this procedure. There is no risk of erection problems or infertility as a result of this biopsy. If general anesthesia is used, there is a small risk of complications from anesthesia.

After the biopsy

Call your doctor immediately if you have:

  • Severe pain in your scrotum. Some mild discomfort is normal.
  • Severe swelling of your scrotum. Some mild swelling is normal.
  • A fever higher than 100° (38°).
  • Excessive bleeding through the bandage.

Results

A testicular biopsy is a test in which a small sample of tissue is taken from one or both testicles and examined under a microscope to evaluate a man’s ability to father a child. Results are usually available in 2 to 4 days.

A pathologist examines the biopsy sample through a microscope for any abnormalities in sperm production or maturation. If sperm development appears normal yet a semen analysis test shows reduced or absent sperm, a blockage of the tube (vas deferens) from the testes to the urethra is suspected. A blocked vas deferens can sometimes be repaired by surgery.

What Affects the Test

It is important to remain completely still while a biopsy is done under local anesthesia. If this is not possible, general anesthesia may be needed.

What To Think About

Testicular cancer is more likely to spread when a testicular biopsy is done. For this reason, a biopsy usually is not done if testicular cancer is suspected. A testicular ultrasound is generally done to help diagnose suspected testicular cancer. For more information, see the medical test Testicular Ultrasound. When cancer is suspected, an open surgical procedure (orchiectomy) is done to confirm the diagnosis.

  • Share/Save/Bookmark
Category: Testicular cancer  |  Comment