Varicocele is a dilated pampiniform venous plexus and internal spermatic vein, usu-ally on the left side. It may cause infertility. Clinically, it resembles a “bag of worms” superior to the testicle.
Hydrocele refers to fluid within the tunica vaginalis.
Spermatocele is an epididymal cyst containing sperm. On physical examination it transilluminates.
Epididymitis presents with fever and gradual onset of scrotal pain.
• Acute epididymitis that affects men age <35 is often caused by N. gonorrhoeae or C. trachomatis.
• Acute epididymitis that affects men age >35 is often caused by E. coli or Pseu-domonas.
• Chronic epididymitis can be caused by TB.
Orchitis presents with sudden onset of testicular pain and fever. It is frequently viral, particularly due to the mumps virus.
Testicular torsion is twisting of the spermatic cord; may be associated with physical activity or trauma; and is a clinical emergency that can cause painful hemorrhagic infarction leading to gangrene.
Cryptorchidism is a failure of one or both testes to descend; the undescended testes are most commonly found in the inguinal canal. The undescended testes have an increased risk for developing seminoma.
• Decreased sperm count due to primary testicular dysfunction can be caused by Leydig cell dysfunction or seminiferous tubule dysfunction.
• Decreased sperm count due to secondary hypogonadism can be caused by pituitary and hypothalamic dysfunction.
• Inability of sperm to exit the body in sufficient numbers may be caused by obstruction of the vas deferens or disordered ejaculation.
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