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Re: Question for Paul B.

Written by Paul B. at 13 Sep 2001 10:54:27:

As an answer to: Question for Paul B. written by Will at 13 Sep 2001 05:38:30:

> He is 12 but as no visible signs of puberty onset.

The first sign of puberty in a boy is the enlargement of the testes. This is estimated using an instrument called, not surprisingly, an "orchidometer". When I say "estimated", I give a clue to the somewhat curious nature of the instrument, nothing more or less than a plastic wheel whose spokes carry different size, calibrated analogues which you simply compare to the ones under scrutiny. I don't have one, nor am I even sure where to get one (though maybe I saw one advertised a while back and considered it . . .) but then I'm not a specialist paediatrician.

> Questioning him he said the discomfort was always there, however my mother didn't think to ask if there were any
> times of relief like a sit in a warm bath, different knickers, in his pyjamas, etc.

Good point.

> She palpated him and noticed that one testicle was roughly double the size of the other and was quite tender
> when touched - the smaller one is giving the discomfort.

The concern here is in regard to the possibility of sub-acute or recurrent torsion where the testicle becomes twisted on its blood supply, cutting it off at least in part. As a sudden and complete event, this causes severe pain with vomiting, but lesser/ chronic degrees may not be so dramatic, but the repeated or partial damage might result in shrinkage.

The classical sign is "bell-clapper" testes (but do you know what a bell clapper really looks like?) which lie horizontally rather than vertically, but I'd certainly defer to examination by a specialist surgeon, and yes, it is not uncommon in pre-pubertal boys as well as pubertal ones.

Torsion is particularly important as the other testis may need fixing (down) to prevent the same damage.

> No visible abrasions or bruising on the scrotum and the boy had no recollection of a traumatic incident.

Well, he'd have probably been checked at the time if this were the case, one might assume.

> No irregular or hard shapes on the testicle that bothers to indicate a growth of any sort.

Cancer is a risk of young men, but generally post-pubertal - it sort of has to be "switched on" to develop a cancer.

> He says he has had the discomfort for some time.

Could be consistent with torsion, or maybe other things - maybe not diagnosable. He certainly needs examination and an ultrasound, most likely specialist referral.

> My comment was ... to bring him round to her GP for a check.

Absolutely.


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