All Men are created. (more or less) Rod Moser, PA, PhD Sutter Roseville Pediatrics Founding President, CAPA

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1 Rod Moser, PA, PhD Sutter Roseville Pediatrics Founding President, CAPA Balls Stones Family Jewels Meatballs Reece's Pieces Nuts Coconuts Weights Walnuts Gonads / Nads Dumbbells Truffles The sperm factory Peanuts Chestnuts Package Grenades Huevos Water Balloons Wheels Itchy and scratchy Beavis and butthead Tweedledee and Tweedledum Easter eggs Fiery Coals Jellybeans Sack The two amigos Maracas All Men are created Equal (more or less) 1

2 HhyHypospadias The scrotum should appear symmetrical Testes are often easily visible, but you still need to carefully palpate Have them sit cross-legged to relax their cremasteric reflex Sitting in a warm bathtub may bring down a shy, retractile testicle Imaging studies 2

3 Some are quite obvious some are not Some are migratory or retractile May occur with an inguinal hernia Also called cryptorchidism Poop Role of hormonal therapy Monorchidism (1:5000) and anorchidism (1:20,000) Polyorchidism is the rarest of all. Testes not in scrotum, but can be easily palpated and coerced back in the sack and will not automatically retract again After puberty, the increased size of the testicle prevents retraction Usually bilateral and most common in boys age 5-6 Infants under 3 months do not have adequate cremasteric responses. Intermittent groin swelling Incarceration or strangulation requires urgent surgery A reducible hernia can be electively repaired 3

4 The Acute Scrotum (Testicular Torsion) Epididymitis /Orchitis Testicular Cancer Varicocele Spermatocele Testicular Trauma Most common in neonates and postpubertal boys 1:4000 males under age 25 A true, surgical emergency Abrupt onset, severe pain Only 16-42% of boys with acute scrotum have torsion color Doppler US confirms On exam, a highriding testicle on one side suggests torsion Tender and swollen as compared to the other side Cremasteric reflex is rarely present in torsion Can have a history of intermittent, selfresolving torsion 4

5 Dramatic pain relief can be achieved with manual detorsion Sedate / Demerol first Rotate testes away from the midline, like opening a book Confirms diagnosis; no longer a surgical emergency Early diagnosis and treatment will prevent the loss of a testicle Will also prevent the loss of a license and a large malpractice judgment. Often related to sexual activity in teens and young males (or older guys) Does not present as a classic UTI (which is rare) In pre-pubertal boys, epididymitis is usually associated with a urinary track anomaly Occurs in 10-25% of males Dilated and tortuous veins in the pampiniform plexus surrounding the spermatic cord Feels like bag of worms 85-95% occurs on the left A right varicocele could be trouble 5

6 Grade I: Only palpable Grade II: Visible distention Grade III: Very large and heavy. Painless, fluid-filled cyst of the head of the epididymis Filled with non-viable sperm May transilluminate Ultrasound can confirm diagnosis Spermatoceles do not affect fertility Treatment is only symptomatic More stories. This is Philadelphia s first-baseman, John Kruk. More stories. This is the infamous, Lance Armstrong and his Indianapolis oncologist, Lawrence Einhorn. 6

7 20% of all cancers diagnosed in males age / Most common solid tumor in this age group Risk factors include: cryptorchism, family hx of testicular cancer, HIV, and race Presents as painless mass discovered by patient. May be dull, aching mass. Scrotal US first. MRI can differentiate hematoma and infarcts from a tumor Treated by a radical, inguinal orchiectomy Teaching testicular self-exam important in adolescent and well adult exams. Rare: 0.4% chance, but 8,000 cases in US per year More common in white male; rare in Asian or African origin Cryptorchidism is the most common risk factor: times Pain free mass; enlarged testicle Missed on 25% of exams It was a brutal rugby match 7

8 Virgil Adrian Beltre of the Seattle Mariners 8