The Testes

The scrotal pouch is covered with a thin skin. Immediately beneath is a muscular layer which contracts or expands with the surrounding temperature to keep the testes at a constant temperature slightly lower than the body temperature which is necessary for the production of sperm. As a fetus develops, the testes move from the abdomen down the inguinal canals to the scrotum. If the decent is not complete, one or both of the testes may be arrested in the abdomen or along the inguinal canal. This is called crybroblisiam. If the testis remains above the scrotum it will not develop properly. This may require hormonal or surgical treatment and should be considered before the age of 1. The scrotum is divided into two pouches each one containing a testis and epididymis. The average testis is 1 1/2 to 2 inches in length and 1 inch in width. The left testicle typically hangs a little lower than the right. The epididymis connects the tiny tubules in the testis and serves as a transportation system for the sperm. It sits on top and along the side of the testis and joins the vas deferens which runs up the scrotum and into the inguinal canal and enters the seminal vesicle on each posterio-laterial side of the prostate. The sperm are stored here until ejaculation. The testes are egg shaped structures and have two functions:

• Production of testosterone, the male hormone
• Production of sperm

The testes are also considered part of the urogenital tract in males because of their physical connection to the prostate through the vas deferens.

Disorders of the testes include congenital abnormalities, infection, cancer, and infertility. Initial evaluations of the testes can include blood tests, urine tests, examination of the seminal fluid, and ultrasound imaging. Occasionally, x-ray examinations are employed.

Obviously, the most serious disease of the testes is cancer. Testicular cancer is one of the most common cancers in young men. It affects about 5000 males in the United States each year. This occurs primarily in younger men with a peak age being around 15-35. It is sometime seen in elderly men. A tumor (cancer) of the testicle often shows itself by a fast enlargement of the testicle. It is an aggressive cancer which grows quickly and spreads early and easy. Many young men have a sense of shame about problems in this area and fail to go to the doctor quickly. The tumor is usually painless and this also delays their willingness to seek help.

Several high profile individuals have helped to make the public aware of this disease and the importance of testicular self-exams. Just as women should do monthly brest self-exams, men should routinely exam their testicles to screen for cancer. The age to start monthly checking of the testicle for masses is at puberty or about age 15. The scrotum is looser and the testicle easier to feel in a warm environment such as the shower, and the shower is a convenient and private place to perform self-exams. Fortunately, this is one of the most treatable forms of cancer.

One of the more common masses felt in the scrotum is a varicocele. Varicoceles are enlarged veins in the scrotum, much like varicose veins in the legs. They often feel like a bag of worms or a squishy tube. A varicocele is most common on the left side. Varicoceles occur in about 15 percent of all men. The majority of men have no problems with a varicocele, but about one in six men that have a varicocele have problems with fertility and testicular growth.
Varicocles are easily treated surgically if infertility or poor testicular growth is evident.

Hydrocele is a collections of fluid around the testis. It is often painless, but may grow to a large size and cause discomfort. It may occur in male infants but most of these will subside without treatment. Needle drainage can be done in an office setting or surgical drainage can be done as an outpatient.

Spermatocele may resemble a hydrocele but is a cyst that develops in the epididymis and not around the testis. It requires surgical treatment when size or discomfort becomes a factor. These lumps are freely mobile from the testicle itself.

Infections of the testis and its neighboring structure, the epididymis, are common and are relatively easily treated with scrotal support, limited activity, and antibiotics.

Investigations into abnormalities of sperm production is an area of active research. Men who are having trouble with fertility are often seen by urologists at the same time their wives are being evaluated by obstetricians.