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Urology (Expert Forum)
Concern about testicular anatomy/malignancy
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D.
Boston - MA
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
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Concern about testicular anatomy/malignancy
by bmw1, Jan 14, 2005 12:00AM
I am a 43 (nearly 44) year old male. I have never performed any testicular self-exams. My left scrotal sac and testicle are larger than my right, and hang lower, but I believe they have always been that way. I have no historical risk factors, such as undesended testicles. The only cancer in my family was with my father, who died of colorectal cancer when he was 66. (I started colonoscopy screenings at 40, which was clean).
About two months ago, while showering, I detected a small bump or ridge on the underside of my left testicle which I don't recall having felt before. I noticed it, but did not take any action about it. I did not feel it during subsequent showerings. A month ago, I did feel it again, and last week, yet again. It seems transient, and is not enlarging. I then read how to do a proper TSE, which out of worry I seem to be doing in the shower daily now! I do realize that the risk of testicular malignancy decreases significantly after 40, but it is still possible.
What I am feeling can best be described as something like a disconnected ridge or vein - perhaps like several grains of cooked rice. There are also adjacent ridges or veins. One seems more prominent than the others, and they are on the bottom of my left testicle -- one large vein-like structure seems to extend to the right of the main one that I feel. They do not seem hard, they feel somewhat tender, and they seem to be extratesticular, but attached to the testicle, as they move with it. I cannot detect such a prominent structure under my right testicle.
I have occassional very recent diffuse aching in the groin region, which may be psychological, or caused by the constant examination of my testicle. I don't have any back, abdominal or other pain or symptoms.
My questions are as follows:
1) in testicular anatomy diagrams I have seem the epididymis appears to cover the back of the testicle, but does not wrap around the bottom. Is it possible that what I am feeling is the lower edge of the epididymis? Does it wrap around the bottom of the testicle?
2) Are there veins on the underside of the testicle?
3) In order of likelihood, what might be causing the previously described findings? Things such as cysts, prominent veins, etc. (technical names please!)
4) I have my annual physical next week (with a nurse practitioner, so I am not sure how experienced she will be at testicular exams). I will bring this to her attention for discussion, but due to its seemingly transient nature, she might not be able to detect it.
5) Would a 'wait and see' attitude be appropriate, or do you think I should push for a uroligical referral for examination and ultrasound?
Thank you in advance for your opinion.
About two months ago, while showering, I detected a small bump or ridge on the underside of my left testicle which I don't recall having felt before. I noticed it, but did not take any action about it. I did not feel it during subsequent showerings. A month ago, I did feel it again, and last week, yet again. It seems transient, and is not enlarging. I then read how to do a proper TSE, which out of worry I seem to be doing in the shower daily now! I do realize that the risk of testicular malignancy decreases significantly after 40, but it is still possible.
What I am feeling can best be described as something like a disconnected ridge or vein - perhaps like several grains of cooked rice. There are also adjacent ridges or veins. One seems more prominent than the others, and they are on the bottom of my left testicle -- one large vein-like structure seems to extend to the right of the main one that I feel. They do not seem hard, they feel somewhat tender, and they seem to be extratesticular, but attached to the testicle, as they move with it. I cannot detect such a prominent structure under my right testicle.
I have occassional very recent diffuse aching in the groin region, which may be psychological, or caused by the constant examination of my testicle. I don't have any back, abdominal or other pain or symptoms.
My questions are as follows:
1) in testicular anatomy diagrams I have seem the epididymis appears to cover the back of the testicle, but does not wrap around the bottom. Is it possible that what I am feeling is the lower edge of the epididymis? Does it wrap around the bottom of the testicle?
2) Are there veins on the underside of the testicle?
3) In order of likelihood, what might be causing the previously described findings? Things such as cysts, prominent veins, etc. (technical names please!)
4) I have my annual physical next week (with a nurse practitioner, so I am not sure how experienced she will be at testicular exams). I will bring this to her attention for discussion, but due to its seemingly transient nature, she might not be able to detect it.
5) Would a 'wait and see' attitude be appropriate, or do you think I should push for a uroligical referral for examination and ultrasound?
Thank you in advance for your opinion.
Doctor's Answer
by Kevin Pho, MD, Jan 15, 2005 12:00AM
, Jan 15, 2005 12:00AM
To answer your questions:
1) Tough to say without examining you myself, but it may be possible that it is the epididymis that you are feeling. Again, I can't be sure without examinination.
2) Again, there will be variation between patients as to where the testicular veins lie.
3) Other than cancer, other things that can cause testicular masses are hydroceles, epididymal cysts or varicoceles - all of which are non cancerous.
4) I would consider a testicular ultrasound - and have this followed up with a urology referral depending on what the ultrasound shows.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
1) Tough to say without examining you myself, but it may be possible that it is the epididymis that you are feeling. Again, I can't be sure without examinination.
2) Again, there will be variation between patients as to where the testicular veins lie.
3) Other than cancer, other things that can cause testicular masses are hydroceles, epididymal cysts or varicoceles - all of which are non cancerous.
4) I would consider a testicular ultrasound - and have this followed up with a urology referral depending on what the ultrasound shows.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Member Comments (2)
by bmw1, Jan 14, 2005 12:00AM
To: Testicular Cancer
0
by bmw1, Jan 19, 2005 12:00AM
To: Testicular Cancer
0
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