Testicular Disorders

The testicles are located in the scrotal sac. Their primary function is to produce sperm and hormones. Testicular disorders can occur at any age, but they are fortunately uncommon and rarely serious. 

The most common testicular problems seen in children include undescended testicles and hernias. The testicles are formed behind the abdomen and descend into the scrotum. Sometimes this descent is delayed in one or both testicles. If the testicle does not descend spontaneously by 6 months of age then surgery may be required to correct this issue.

As the testicle descends into the scrotum, a small connection to the abdominal cavity is formed. If this abdominal connection does not spontaneously close, a small hernia may form which can allow fluid or bowel into the scrotum. This may also require surgical correction if it does not spontaneously resolve by 2 years of age.

Testicular torsion may occur in teenagers and young men. Testicular torsion is a twisting of the testicle which can restrict blood flow to the testicle. Any acute onset of pain and swelling of the testicle should be evaluated in the emergency room where a scrotal ultrasound can be readily performed. The testicle needs to be untwisted surgically within 4 hours to prevent permanent damage.

Testicular cancer is rare but most commonly occurs in teenagers and young men. Any painless lump found in the testicle should be evaluated by a urologist. If there is a high suspicion for cancer the testicle may be surgically removed. The patient may also require radiation or chemotherapy. Close follow up is required after confirming the diagnosis to monitor for any recurrence or metastasis.

Painful and swollen testicles can occur at any age. There is usually a history of straining prior to the start of symptoms. This can be a sign of infection in the testicle called orchitis. There can also be infection in the epididymis which is a structure located just above the testicle called epididymitis. This can be associated with fever and other urinary complaints. This usually requires urgent evaluation for treatment with antibiotics and scrotal support. More serious infections may require hospitalization and IV antibiotics.

Some men may have other benign testicular disorders which are typically found on physical exam or scrotal ultrasound. These include hydroceles which are fluid collections around the testicle, spermatoceles which are cyst-like masses that form in the epididymis, and varicoceles which are an enlargement of the veins within the scrotum. These are typically asymptomatic. Surgical intervention is only required if they become painful or cosmetically unappealing. 

Any male having trouble conceiving after 1 year should have a testicular exam and semen analysis performed. Some men have low sperm production due to certain testicular disorders or congenital disorders.

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