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Department of Urology SLK Kliniken Heilbronn - Testicular disorders

Best chances of recovery with early recognition

Diseases of the testes vary greatly in their severity. The spectrum of disorders includes inflammation, testicular torsion (twisting) and malignant tumours. The majority of testicular diseases are benign.

The easiest diseases to treat include hydrocele and varicocele. If the disease progresses unfavourably a testicular inflammation or epididymitis can result in surgical removal of the inflamed testicles. Testicular inflammation or epididymitis are amongst the most frequent causes of infertility in men.

A testicular torsion, however, requires an immediate surgical treatment. Testicular tumor is one of the most frequent cancers in men aged 18-40 years. With early treatment, the prospects for healing over one’s entire lifetime are good.

Hydrocele

Hydrocele is a plump and painless accumulation of fluid in the tissue that covers the scrotum. It can be caused by a general displacement, an injury to the testes or epididymis, or a testicular inflammation. Hydrocele can be diagnosed by ultrasound examination. In the Urology Clinic at Heilbronn, hydroceles are surgically corrected using a minimally traumatic technique (Lord-procedure).


Varicose veins (varicoceles)

Varicoceles are benign enlargements of the vessels in the venous plexus surrounding the testicle, caused by a hindered drainage of blood from the testicles. The majority of patients suffer from a left-sided varicocele.

The causes underlying the obstruction of blood outflow are a reduced or lacking function of the valves in the abdomen (kidney and retroperitoneum) or a congenital weakness of the blood vessel walls. Only rarely does a varicocele represent a sign for a tumor (Wilms' tumor in children or renal cell cancer in older men,particularly on the right side). In 15% of all men, however, this disease can lead to infertility.

The Urology Clinic at Heilbronn offers minimally invasive laparoscopic vein resections as treatment for varicose veins.


Testicular inflammation (Orchitis)

Orchitis is either the result of an infectious disease, is very painful, or is a sign of an epididymitis crossing over into the testes.


Inflammation of the epididymis
(Epididymitis)

Epididymitis usually occurs as a result of inflammation of the prostate or urinary tract, whereby it can occur either as an acute or chronic form.

Acute epididymitis is associated with severe pain that may radiate to the groin and lower abdomen. Urine tests can be used to detect pathogens, while ultrasound examinations can be used to discount other testicular disorders.

Besides pain relieving and anti-inflammatory drugs in combination with a test-appropriate antibiotic therapy, physical bedrest is also an important therapeutic measure. Later, after the symptoms have receded, the causes of the outflow obstruction in the area of the urethra (benign prostatic hyperplasia, urethral stenosis) should be sought and if necessary excluded. If a chronic epididymitis should be diagnosed a surgical removal of the affected testicle may be required.


Testicular torsion
(acute emergency!)

Testicular torsion always represents an acute emergency, since blood perfusion is interrupted due to the longitudinal rotation of the testes and the spermatic cord. Such a condition arises particularly in children or young people as a result of sporting activities.

Testicular torsion is associated with sudden severe pain that extends to the groin. A testicular swelling can also sometimes be seen. In the early stages of testicular torsion, diagnostic options can be restricted by using Doppler / Colour Duplex sonography.

A timely operation is important so that the testicle can be brought back into position. A countertwisting is induced by applying sutures (orchidopexy). If perfusion is interrupted for longer than 6 hours, the testicular tissue begins to die so that the testicle may be lost.


Testicular tumor

Testicular tumors are the most common malignant tumours in young men. If the tumour is detected early, a cure is almost always possible. Regular self-examination of the testicle is the best way to detect a tumour in time. Amongst the risk factors predisposing the development of a testicular tumour include cryptorchidism (undescended testicles) in childhood or a familial predisposition (testicular tumours in male relatives).

After the initial testicular removal and the required diagnostics for determining whether metastasization has occurred, treatment at the Urology Clinic in Heilbronn is carried out a according to the guidelines of national and international Urological Societies (EAU, DGU), with chemotherapy (carboplatin, PEB or PEI) or removal of potentially affected lymph nodes depending on the exact findings. Our own laparoscopic specialists then carry out a modified retroperitoneal lymph node resection either for diagnostic purposes or for the removal of residual tumour after chemotherapy using a keyhole surgical method.