General Surgery
Penis, Testis and Scrotum
MBBS surgery notes on the penis, testis and scrotum: testicular torsion, scrotal swellings and testicular cancer, mapped to NMC codes SU30.1 to SU30.6.
MedNext Academy | 3 min read
Penis, Testis and Scrotum
MBBS surgery notes on the penis, testis and scrotum: testicular torsion, scrotal swellings and testicular cancer, mapped to NMC codes SU30.1 to SU30.6.
This chapter covers surgical disease of the penis, testis and scrotum. It emphasises the emergency of testicular torsion, the differential diagnosis of a scrotal swelling and testicular cancer in young men.
High-yield: Penis, Testis and Scrotum
- Testicular torsion is a surgical emergency of sudden severe testicular pain, most common in adolescents, needing exploration within about six hours.
- In torsion the testis is high-riding with a horizontal lie, and the cremasteric reflex is usually absent.
- Torsion is a clinical diagnosis and surgery should not be delayed for imaging when suspicion is high.
- At exploration for torsion, both testes are fixed because the underlying anatomical predisposition is bilateral.
- Epididymo-orchitis gives gradual onset scrotal pain and swelling with fever, and pain is relieved by lifting the testis, the Prehn sign.
- A hydrocele is a fluid collection around the testis that transilluminates and you cannot get above it if it extends into the groin.
- A varicocele feels like a bag of worms, is commoner on the left and may be associated with subfertility.
- An epididymal cyst is a cystic swelling separate from and above the testis that transilluminates.
- An undescended testis increases the risk of testicular cancer and infertility, so orchidopexy is done in early childhood.
- Testicular cancer is the commonest solid malignancy in young men and presents as a painless firm testicular lump.
- Seminoma and non-seminomatous germ cell tumours are the two main types of testicular cancer.
- The tumour markers alpha fetoprotein, beta human chorionic gonadotropin and lactate dehydrogenase help diagnose and monitor testicular cancer.
- A suspected testicular tumour is removed by inguinal orchidectomy, not through a scrotal incision.
- Phimosis is a non-retractile foreskin and paraphimosis is a retracted foreskin trapped behind the glans, which is an emergency.
- Carcinoma of the penis is a squamous cell carcinoma linked to poor hygiene and human papillomavirus and is rare in the circumcised.
The acute and chronic scrotal swelling
- **Testicular torsion:** Sudden severe pain, high-riding testis, absent cremasteric reflex; explore within about 6 hours.
- **Epididymo-orchitis:** Gradual pain and swelling with fever; positive Prehn sign; treated medically.
- **Hydrocele:** Transilluminates; you can get above it if confined to the scrotum.
- **Testicular tumour:** Painless firm lump in a young man; inguinal orchidectomy, never a scrotal approach.
NMC competencies in this chapter
- **SU30.1:** Assessment of scrotal and penile conditions
- **SU30.2:** Testicular torsion and the acute scrotum
- **SU30.3:** Scrotal swellings: hydrocele, varicocele and cysts
- **SU30.4:** Undescended testis and its management
- **SU30.5:** Testicular tumours
- **SU30.6:** Penile conditions including phimosis and carcinoma
- **SU29.2:** Related lower urinary tract obstruction
- **SU29.4:** Haematuria and urological assessment
Frequently Asked Questions
Why is testicular torsion an emergency?
The twist cuts off the testicular blood supply, and the testis can be lost after about six hours, so torsion needs urgent surgical exploration on clinical suspicion without waiting for imaging.
How is a hydrocele distinguished from other scrotal swellings?
A hydrocele transilluminates and you can usually get above it when it is confined to the scrotum, unlike an inguinoscrotal hernia which you cannot get above.
How does testicular cancer present?
As a painless, firm lump within the testis in a young man. It is worked up with tumour markers and removed by inguinal orchidectomy, never through a scrotal incision.
What is the difference between phimosis and paraphimosis?
Phimosis is a foreskin that cannot be retracted, while paraphimosis is a retracted foreskin trapped behind the glans causing swelling, which is a urological emergency.
Continue reading
MBBSAll General Surgery chapters
Continue through the General Surgery chapter map.
Continue studying General Surgery
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans