Bilateral varicocele with oligospermia

ABC OF : TESTICULAR CANCER. (Part II ). MAY BE USEFUL. *** TESTICULAR CANCER TYPES :- More than 90% testicular tumors originate from the testicular cells (also known as GERM CELL TUMORS). There are TWO PRIMARY HISTOLOGICAL VARIETIES : SEMINOMA and NONSEMINOMA. *** IT'S VERY RARE....... Fewer than 100 thousand cases per year in India....... Treatable by a medical professionals....... Requires a medical diagnosis....... Lab tests or imaging always required....... Consult a doctor for medical advice....... *** RISK FACTORS :- Scientists have found few risk factors that make someone more likely to develop testicular cancer. Also, most boys and men with testicular cancer do not have any of the known risk factors....... Risk factors for testicular cancer include : * AN UNDESCENDED TESTICLE * FAMILY HISTORY OF TESTICULAR CANCER * CARCINOMA IN SITU OF THE TESTICLE * HIV INFECTION * HAVING HAD TESTICULAR CANCER BEFORE * Being of a CERTAIN RACE/ETHNICITY....... * BODY SIZE....... Several studies have found that tall men have a somewhat higher risk of testicular cancer, but some other studies have not. Most studies have not found a link between testicular cancer and body weight. * AGE....... ABOUT HALF of TESTICULAR CANCERS OCCUR in men BETWEEN the ages of 20 AND 34. But this cancer can affect males of any age, including infants and elderly men....... *** CAN TESTICULAR CANCER BE FOUND EARLY ? Most testicular cancers can be found at an early stage. In some men, early testicular cancers cause symptoms that lead them to seek medical attention. Most of the time a LUMP ON THE TESTICLE IS THE FIRST SYMPTOM, or the testicle might be swollen or larger than normal. BUT SOME testicular cancers MAY NOT CAUSE SYMPTOMS until after they have REACHED an ADVANCED STAGE....... ***** TESTICULAR SELF-EXAM :- The best time for you to examine your testicles is during or after a bath or shower, when the skin of the scrotum is relaxed. ● Hold your penis out of the way and examine each testicle separately. Hold your testicle between your thumbs and fingers with both hands and roll it gently between your fingers. ● Look and feel for any hard lumps or nodules (smooth rounded masses) or any change in the size, shape, or consistency of your testicles. ● It’s normal for one testicle to be slightly larger than the other, and for one to hang lower than the other. Normal testicles also contain blood vessels, supporting tissues, and tubes that carry sperm. Some men may confuse these with abnormal lumps at first. If you have any concerns, ask your doctor......who will rule out hydrocele or varicocele....... *** SIGNS AND SYMPTOMS :- * LUMP or SWELLING IN THE TESTICLE * feeling of HEAVINESS or ACHING IN the LOWER ABDOMEN OR SCROTUM. * Some testicular tumors might cause PAIN, but most of the time they do not. * BREAST GROWTH or SORENESS.......certain types of germ cell tumors secrete high levels of HCG, which stimulates breast development....... Some Leydig cell tumors can make estrogens, which can cause breast growth or LOSS OF SEXUAL DESIRE....... * EARLY PUBERTY IN BOYS : Some Leydig cell tumors can make androgens (male sex hormones)...... Androgen-producing tumors may not cause any specific symptoms in men, but in boys they can cause signs of PUBERTY AT AN ABNORMALLY EARLY AGE, such as a deepening voice and the growth of facial and body hair. *** SYMPTOMS OF ADVANCED TESTICULAR CANCERS :- Even if testicular cancer has SPREAD to other parts of the body, many men might not have symptoms right away. But some men might have some of the FOLLOWING SYMPTOMS: LOW BACK PAIN, from cancer spread to the lymph nodes (bean-sized collections of immune cells) in back of the belly ● SHORTNESS OF BREATH, chest pain, or a cough (even coughing up blood) may develop from cancer spread in the lungs. ● BELLY PAIN, either from enlarged lymph nodes or because the cancer has spread to the liver. ● HEADACHES or CONFUSION, from cancer spread in the brain. ** A number of NON-CANCEROUS CONDITIONS, such as testicle injury or inflammation, CAN CAUSE SYMPTOMS SIMILAR TO those of testicular CANCER. Inflammation of the testicle (known as ORCHITIS) and inflammation of the epididymis (EPIDIDYMITIS) can cause swelling and pain of the testicle. Both of these also can be caused BY VIRAL OR BACTERIAL infections. SIGNS OF TESTICULAR CANCER : Some men with testicular cancer have no symptoms at all, and their cancer is found during medical testing for other conditions. Sometimes IMAGING TESTS done to find the cause of infertility can UNCOVER a small testicular cancer. *** HOW IS TESTICULAR CANCER DIAGNOSED ? Testicular cancer is usually found as a result of symptoms that a person is having. It can also be found as a result of tests for another condition. Often the next step is an exam by a doctor. * ULTRASOUND OF THE TESTICLES * Blood tests for tumor markers like alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG). *** NON-SEMINOMAS often raise AFP and/or HCG levels. PURE SEMINOMAS occasionally raise HCG levels but NEVER AFP LEVELS, so any increase in AFP means that the tumor has a non-seminoma component....... * lactate dehydrogenase (LDH). LDH levels can also be increased in conditions other than cancer. A high LDH level often (but not always) indicates widespread disease. * SURGERY TO DIAGNOSE TESTICULAR CANCER : Most types of cancer are diagnosed by removing a small piece of the tumor and looking at it under a microscope for cancer cells....... *** IMAGING TESTS :- * Computed tomography (CT) SCAN and CT GUIDED NEEDLE BIOPSY....... * Magnetic resonance imaging (MRI) SCAN....... * Positron emission tomography (PET) SCAN....... can help spot small collections of cancer cells in the body....... * Bone scan....... *** SURVIVAL RATES, BY STAGE :- ** Stage 5-Year Relative Survival Rate Localized 99% Regional 96% Distant 73% *** OTHER PROGNOSTIC FACTORS :- As can be seen in the table above, how far the cancer has spread at the time it’s diagnosed can affect chances of long-term survival. But IN GENERAL, the outlook for testicular cancers is VERY GOOD, and most of these cancers can be cured, even if they have spread. Some other factors can also affect outlook, such as: ● The type of testicular cancer ● Levels of tumor markers after the testicular tumor has been removed....... Patient should ASK his DOCTOR how these or other prognostic factors might affect his outlook.......

A 28 yr female comes with her husband for infertility. She has regular menstruations. Her physical exam is normal. They are married for 2 years and have not used any contraception. Next step? A) LH levels mid-cycle and Progesterone levels at 21st day of menstruation B) LH and FSH levels. C) Hysterosalpingography D) Ovarian ultrasound E) None of the above. Correct answer is None of the above. (Evaluate the husband first and do Sperm analysis!) -Infertility: Inability to conceive after 1 yr of intercourse without contraception. -First step in diagnosing infertility: Do Semen analysis.

Which of the following is the most likely diagnosis? A) Varicocele B) Indirect hiatal hernia C) Testicular torsion D) Hydrocele E) Epididymitis

which is the most likely diagnosis? Varicocele Indirect hiatal hernia Testicular torsion Hydrocele Epididymitis

27 yrs Male Patient Dx of Infertility 1 degree x5yrs He was taking Allopathic medicine No Hx of DM HTN Thyroid Dysfunction Varicocele Hydrocele Scrotal injury o/E male external Genitalia Good kindly give valuable opinion and Treatment for Severe Oligospermia