3-80
is quite curable in its early stages. However, the cancer can grow rapidly so early detection and referral is
necessary to avoid treatment delays.
Subjective: Symptoms
Testicular pain, enlarged scrotum or testis. Increased risk of benign tumors with history of trauma and
vasectomy.
Objective: Signs
Using Basic Tools: Tender testis; palpable mass in testis, spermatic cord or epididymis; mass may appear
smooth and spherical, be located on the surface or deep in the testis, enlarge with standing, transilluminate
with a bright flashlight.
Using Advanced Tools: Lab: Urinalysis: Nitrite and leukoesterase positive urine suggest infection.
Assessment:
Differential Diagnosis
Solid, non-transilluminating mass that is >4 millimeter size, located below the testicular surface and
inseparable from the testis must be considered to be cancer until proven otherwise.
Transilluminating smooth spherical masses are benign and are hydrocele (around the testis), spermatocele or
loculated hydrocele (above the testis). Rarely it can be a cyst adenoma.
Small 1-4 mm size nodules on the surface of the testis are benign.
“Wormy” mass above the left testis that gets smaller when patient shifts from the standing to the supine
position are varicoceles. Right-sided varicoceles need elective referrals.
Other masses in the scrotum, either on the cord, in the scrotal skin or in the midline area near the penis
are almost always benign.
Painful area behind the testis is usually an indication of epididymitis (see Epididymitis section).
If the urinalysis shows leukoesterase or heme positivity, assume that there may be an infection (see UTI
section).
If the pain in the scrotum is severe, refer to sections on epididymitis and torsion.
Plan:
Treatment
Primary: Give 2-week course of NSAIDs (e.g., Naprosyn 375 mg po bid or ibuprofen 800 mg po tid with
food). If epididymitis is suspected or cannot be eliminated, add doxycycline 100 mg po bid x 14 days.
Elevate scrotum with comfortable athletic supporter and decrease activity.
Patient Education
General: Watch benign masses, such as a hydrocele. Perform monthly testicular self-exams.
Activity: Avoid activities that increase testicular pain until the pain is gone. Avoid lifting more than 10-15 lbs.,
prolonged standing (greater than 30 min.) or walking greater than 1⁄4 mile. Use an athletic supporter.
Medications: Avoid sun exposure if on doxycycline.
Follow-up Actions
Return evaluation: Check patient in 2-4 weeks for change in mass.
Evacuation/Consultation Criteria: Urgently evacuate patients with suspected cancer. Any mass that
prevents examination of the entire testis, that is increasing in size, or appears to be inseparable from the testis
should be referred for further evaluation.
Symptom: Male Genital Problems: Prostatitis
CAPT Leo Kusuda, MC, USNIntroduction: Prostatitis is used liberally to describe voiding problems and pain associated with the prostate.