A testicular ultrasound (sonogram) is a test that uses reflected sound waves to produce a picture of the testicles and scrotum. An ultrasound can show the long, tightly coiled tube that lies behind each testicle and collects sperm (epididymis) and the tube (vas deferens) that connects the testicles to the prostate gland. The ultrasound does not use X-rays or other types of radiation. See an illustration of the male reproductive system.

A small handheld instrument called a transducer is passed back and forth over the scrotum. The transducer sends the sound waves to the computer which converts them into a picture that is displayed on a video monitor. The picture produced by ultrasound is called a sonogram, echogram, or scan. Pictures or videos of the ultrasound images may be saved as a permanent record.

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.

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.

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.

Testicular cancer occurs when cells that are not normal grow out of control in the testicles (testes). It is highly curable, especially when it is found early.

The testes are the two male sex organs that make and store sperm. They are located in a pouch below the penis called the scrotum. The testes also make the hormone testosterone.

Testicular cancer is most common among white males. It is not common in men of African or Asian background.¹ Although rare, testicular cancer is the most common form of cancer in men between the ages of 20 and 34.

What causes testicular cancer?

Experts don’t know what causes testicular cancer. But some problems may increase your chances of getting it. These include:

• Having a testicle that has not dropped down into the scrotum from the belly. This is called an undescended testicle. Normally, a baby’s testicles drop down into his scrotum before he is born or by the time he is 3 months old.
• Klinefelter syndrome. This is a genetic problem that affects males. Normally, males have one X and one Y chromosome. Males with Klinefelter syndrome have at least two X chromosomes and, in rare cases, as many as three or four.
• A family history of testicular cancer.

Most men who get testicular cancer don’t have any risk factors.

What are the symptoms?

The most common symptoms of testicular cancer include:

• A change in the size or shape of one or both testes. You may or may not have pain.
• A heavy feeling in the scrotum.
• A dull pressure or pain in the lower back, belly, or groin, or in all three places.

How is testicular cancer diagnosed?

Most men find testicular cancer themselves during a self-exam. Or your doctor may find it during a routine physical exam.

Because other problems can cause symptoms like those of testicular cancer, your doctor may order tests to find out if you have another problem. These tests may include blood tests and imaging tests of the testicles such as an ultrasound or a CT or CAT scan. These tests can also help find out if cancer has spread to other parts of your body.

How is it treated?

Nearly all men with testicular cancer begin treatment with surgery to remove the testicle that has cancer. This surgery is called radical inguinal orchiectomy. Removing the testicle allows your doctor to find out the type of cancer cells you have. It also helps him or her plan any other treatment you may need.

Treatment after surgery may include:

• Watchful waiting. You may be able to wait and watch to see what happens. During watchful waiting, you will have regular checkups with your doctor to make sure that the cancer is gone.
• Chemotherapy. This is powerful medicine that destroys any cancer cells that remain after surgery.
• Radiation therapy. This is a high dose of X-rays used to destroy cancer cells. It is mostly used to treat a kind of cancer called seminoma, but it is sometimes used after surgery to kill leftover cancer cells. Radiation therapy can also be used to treat cancer that has spread beyond the testes.

Chemotherapy is often used for cancer that has spread to other parts of the body. In some cases surgery is used to remove that kind of cancer.

Testicular cancer is highly curable when it is found early. Even when it is found at an advanced stage, it is considered very curable.

How will having testicular cancer affect you?

In most cases, removing a testicle does not cause long-term sexual problems or make you unable to father children. But if you had these problems before treatment, surgery may make them worse. Talk to your doctor if you have any questions or concerns about sexual problems or whether you can father children.

Some men choose to get an artificial, or prosthetic, testicle. A surgeon places the artificial testicle in the scrotum to keep the natural look of the genitals.

Unlike many other kinds of cancer, most testicular cancers grow slowly and respond well to treatments such as chemotherapy and radiation therapy. But these treatments can cause side effects. Most of the time, the side effects last only a little while and then go away. Long-term side effects from treatment are rare.

An orchiectomy is a common treatment for testicular cancer. It may also be done to treat other conditions such as prostate cancer or in the event of severe trauma to one or both testes.

During the procedure, a small incision is made in the lower abdomen just below the belt line. The testicle is then pushed up from the scrotum through the incision and removed. The procedure is usually finished in less than an hour.

What To Expect After Surgery

Orchiectomy can be done as an outpatient procedure or with a short hospital stay. Regular activities are usually resumed within 1 to 2 weeks, and a full recovery can be expected within 2 to 4 weeks.

Why It Is Done

Orchiectomy is always performed when testicular cancer is suspected. This is because testicular lumps are often cancerous and must be removed as part of treatment. Also, performing a biopsy on a testicle before it is surgically removed can cause cancer cells to spread, making successful treatment more difficult.

Sometimes bilateral orchiectomy (removal of both testes) is necessary, though this is rare.

How Well It Works

Orchiectomy is the most effective way to remove cancerous tumors of the testicles. In some cases, orchiectomy is followed by additional surgery to remove cancer that has spread or by adjuvant therapies such as chemotherapy or radiation therapy.

In some cases of early-stage testicular cancer, orchiectomy is the only treatment necessary and is followed only with a watchful waiting program. Watchful waiting, or surveillance, is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment.

Testicular cancer is a very curable form of cancer, especially if it is diagnosed and treated at an early stage. Orchiectomy is important to the successful treatment of this disease and offers the best chance for cure.

Risks

Orchiectomy surgery is relatively low-risk, and complications are uncommon. However, orchiectomy carries all the risks of any major surgery, including:

• Reactions to anesthesia or medications.
• Infection.
• Bleeding.

Bilateral orchiectomy (removal of both testes) is rarely done and carries the possibility of side effects. They are related to the loss of testosterone following the removal of both testes. These include:

• Infertility.
• Loss of sexual interest.
• Erection problems.
• Hot flashes.
• Breast enlargement (gynecomastia).
• Weight gain.
• Loss of muscle mass.
• Osteoporosis.

What To Think About

In the majority of cases, orchiectomy does not result in long-term sexual side effects or infertility, though it may increase these problems if they were present before the surgery. If a man has one healthy testicle, he should not notice any negative change in his quality of life. Men who do not have one normally functioning testicle after orchiectomy will need to take hormone therapy to fulfill the body’s need for testosterone.

Some men choose to have a prosthetic testicle(s). After an orchiectomy, the surgeon places the artificial testicle(s) in the scrotum to maintain the natural appearance of the genitals.

If you have any questions or concerns about this surgery, talk to your doctor.

The causes of testicular cancer are not completely understood. However, the following conditions increase the risk of development:

• Undescended testicle. Men with undescended testicles have the highest risk for developing testicular cancer. This is true even if surgery has been done to secure the testicle in the scrotum.
• Abnormal testicular development.
• Klinefelter syndrome.
• Previous diagnosis of testicular cancer.

The main symptom of testicular cancer is swelling or a painless lump in the scrotum (in or on a testicle). Other symptoms include a dull ache in the abdomen or pelvis, pain or a feeling of heaviness in the testicles, and fluid collection (edema) in the scrotum.

Testicular cancer is treated with a combination of surgery, chemotherapy, and radiation therapy. The exact treatment depends on the type and extent of the testicular cancer. Most forms of testicular cancer are curable when detected early.