SU30.1-6 | Penis, Testis and Scrotum — Glossary

A tumour marker produced by yolk-sac and embryonal elements; raised in NSGCT and never raised by a pure seminoma.

The genital form of lichen sclerosus, producing a white, atrophic, scarred preputial ring and a common cause of pathological adult phimosis.

Platinum-based combination chemotherapy (bleomycin, etoposide, cisplatin) that makes germ-cell tumours, even when metastatic, among the most curable solid cancers.

Beta-human chorionic gonadotrophin, a tumour marker from trophoblastic tissue; modestly raised in some seminomas and markedly raised in choriocarcinoma.

The deep fascia enveloping the erectile bodies of the penis; an anatomical barrier that initially limits the deep spread of penile carcinoma.

Malignant tumour of the penis, squamous cell carcinoma in over 95% of cases, arising on the glans or prepuce and spreading first to the inguinal lymph nodes.

Surgical removal of the prepuce; definitive treatment for pathological phimosis and, when performed neonatally, strongly protective against carcinoma penis.

Elevation of the testis when the inner thigh is stroked (genitofemoral nerve); preserved in epididymo-orchitis and characteristically absent in testicular torsion.

An emergency incision of the constricting preputial band used to relieve paraphimosis when manual reduction fails.

A testis that has completed descent but come to lie in an abnormal site, most often the superficial inguinal pouch.

Inflammation/infection of the epididymis (and often the testis), usually from ascending infection — STI organisms in young men, urinary coliforms in older men.

A (usually staged) procedure for a high intra-abdominal testis in which the testicular vessels are divided so the testis survives on collateral deferential blood supply and is brought to the scrotum.

The dominant category of testicular tumour (~95%), arising from germ cells and divided into seminoma and non-seminomatous germ-cell tumours.

A bedside test: if the examining fingers meet above a scrotal swelling it is confined to the scrotum (e.g. hydrocele); if not, an inguinoscrotal hernia is likely.

The expanded distal end of the corpus spongiosum, normally covered by the prepuce; a common site of penile inflammation and carcinoma.

The fibromuscular cord that guides the testis during its descent from the posterior abdominal wall to the scrotum.

An abnormal collection of serous fluid within the tunica vaginalis, presenting as a painless, transilluminant scrotal swelling above which the examiner can get.

An undescended testis that cannot be felt — either truly intra-abdominal or absent/atrophic — for which diagnostic laparoscopy is the gold-standard investigation.

The first-echelon lymphatic drainage of the penile skin and glans; their status is the key prognostic factor in penile carcinoma, so both groins must be examined.

Surgical treatment of a hydrocele by eversion of the tunica vaginalis sac.

A non-specific tumour marker reflecting tumour bulk, used in staging and prognosis of germ-cell tumours.

Surgical treatment of a hydrocele by plicating (bunching) the tunica vaginalis sac with sutures rather than excising it.

Germ-cell tumours other than pure seminoma — embryonal carcinoma, yolk-sac tumour, choriocarcinoma, teratoma and mixed forms — typically treated with chemotherapy ± RPLND.

Removal of the testis, used for an atrophic or post-pubertal intra-abdominal testis that contributes little to fertility and is hard to monitor for malignancy.

The operation that mobilises an undescended testis and fixes it in a subdartos scrotal pouch, ideally performed at about 6–18 months of age.

Penis-preserving treatment (wide local excision, glansectomy, laser or topical therapy) used for small, superficial, low-grade penile tumours and premalignant lesions.

An undescended testis that can be felt, usually in the inguinal canal or at the superficial ring, and is treated by inguinal orchidopexy.

The network of testicular veins in the spermatic cord that condenses into the testicular vein; its dilatation forms a varicocele.

The first-echelon lymphatic drainage of the testis (at the level of the renal vessels), the reason nodal disease presents as a retroperitoneal mass and a scrotal approach is forbidden.

A urological emergency in which a retracted foreskin is trapped behind the glans, forming a constricting ring that causes progressive oedema and can lead to glans ischaemia.

Partial or total surgical removal of the penis for invasive carcinoma when organ-sparing surgery is not adequate.

Inability to retract the prepuce (foreskin) over the glans; physiological in young boys, pathological/cicatricial (e.g. BXO) in adults.

Relief of scrotal pain on elevating the testis, suggesting epididymo-orchitis rather than torsion (in which elevation gives no relief).

The double fold of skin covering the glans penis, tethered ventrally by the frenulum and separated from the glans by the preputial sac.

The peritoneal pouch drawn down with the descending testis; a persistently patent processus predisposes to an indirect inguinal hernia, often accompanying an undescended testis.

Removal of the whole testis with high ligation of the spermatic cord through a groin incision; the diagnostic and first therapeutic step for a testicular tumour.

A normally descended testis intermittently pulled up by the cremasteric reflex that can be coaxed into the scrotum and stays there; a normal variant, not cryptorchidism.

Surgical removal of the para-aortic nodes, used in selected NSGCT cases, especially for chemoresistant residual masses such as teratoma.

A hydrocele arising in response to an underlying problem (infection, trauma, or a testicular tumour); its cause must be treated and a tumour excluded before reassurance.

A germ-cell tumour that is highly radiosensitive and chemosensitive; a pure seminoma NEVER raises AFP but may modestly raise beta-hCG.

Shed epithelial cells and secretions accumulating in the preputial sac; chronic retention is a risk factor for carcinoma penis.

Cryopreservation of semen offered before treatment of a testicular tumour, because the disease and its treatment can impair fertility.

The predominant histological type of penile cancer (>95%), arising from the epithelium of the glans or inner prepuce.

The commonest testicular tumour in men over 60, an age-related exception to the young-man rule for germ-cell tumours.

Regular self-palpation of the testes to detect a lump early; mandatory lifelong advice for men with a history of undescended testis because their cancer risk persists after surgery.

Twisting of the spermatic cord strangling the testicular blood supply; a surgical emergency with best salvage within about 6 hours, presenting with sudden severe pain, a high-riding testis and an absent cremasteric reflex.

A scrotal needle/incisional biopsy of a testicular mass — ABSOLUTELY CONTRAINDICATED because it can seed tumour and divert lymphatic drainage to the inguinal nodes.

A bedside test in which light passes through a fluid-filled swelling such as a hydrocele, which lights up, but not through a solid mass like a tumour.

The closed serous sac (a derivative of the processus vaginalis) investing the testis; an imbalance of its fluid secretion and absorption causes a hydrocele.

A testis whose descent has arrested along its normal path, lying anywhere from the abdomen to the superficial inguinal ring rather than the scrotum.

An absent or atrophic testis, typically due to an antenatal vascular accident, confirmed by blind-ending vessels at laparoscopy.

Dilatation and tortuosity of the pampiniform venous plexus, almost always left-sided, felt as a 'bag of worms' and a treatable cause of subfertility.