Testicular disorders are significant causes of acute scrotal pain, infertility, and malignancy in males. The three major conditions—testicular torsion, orchitis, and tumors—affect testicular structure and function in distinct ways, but often present with overlapping clinical features such as swelling and tenderness.
⚙️ Anatomy Overview
The testes are paired organs suspended within the scrotum, producing sperm and testosterone. They receive blood supply from the testicular artery and are drained by the pampiniform plexus. The spermatic cord contains vessels and the vas deferens, which is important in torsion pathophysiology.
🔄 Testicular Torsion
Definition: Twisting of the spermatic cord leading to obstruction of venous drainage, followed by arterial compromise and ischemic necrosis of the testis.
- Predisposing factors: Bell-clapper deformity, trauma, or sudden movement
- Pathophysiology: Venous obstruction → congestion → hemorrhagic infarction
Clinical Features
- Sudden, severe unilateral scrotal pain
- Swelling and erythema
- Absent cremasteric reflex on affected side
- Nausea and vomiting (in adolescents)
Treatment
- Immediate surgical detorsion (orchiopexy)
- Contralateral testis should also be fixed to prevent recurrence
- Non-viable testis requires orchiectomy
🦠 Orchitis
Definition: Inflammation of the testis, usually secondary to infection or trauma. It may be viral, bacterial, or autoimmune.
Causes
- Mumps virus – most common viral cause (postpubertal males)
- Gonorrhea or Chlamydia – in sexually active men
- Mycobacterium tuberculosis – may extend from epididymis
Pathology
- Edema and neutrophilic infiltration
- Microabscess formation
- Fibrosis → infertility (chronic cases)
Clinical Features
- Painful, enlarged testis
- Fever and tenderness
- Possible hydrocele
🧬 Testicular Tumors
Testicular tumors are divided into germ cell tumors (≈95%) and non-germ cell tumors. Germ cell tumors are malignant in most adults, while non-germ cell tumors are often benign.
Germ Cell Tumors
- Seminoma: Most common; radiosensitive; presents as painless enlargement
- Embryonal carcinoma: Aggressive; hemorrhagic and necrotic
- Yolk sac tumor: Common in children; ↑AFP levels
- Choriocarcinoma: Highly malignant; ↑hCG; hematogenous spread
- Teratoma: Composed of multiple tissue types
Non-Germ Cell Tumors
- Leydig cell tumor: Produces androgens → precocious puberty or gynecomastia
- Sertoli cell tumor: Rare, may be hormonally inactive
🧠 Key Takeaways
- Testicular torsion is a surgical emergency requiring prompt detorsion.
- Orchitis is commonly infectious, especially from mumps or sexually transmitted pathogens.
- Testicular tumors are mainly germ cell in origin; painless swelling is the hallmark.
- Serum tumor markers (AFP, hCG) are vital for diagnosis and follow-up.