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How to do Testicular Self-Examination:Nursing Case Study

Wednesday, 5 March 2014

In the research entitled Testicular Self-Examination in Young Adult Men, Wynd (2002) stated that “testicular cancer is the leading cause of cancer death in men between the ages of 15 and 35 years. Treatment is likely more successful if the disease is treated early and promptly” (Smeltzer, et al., 2008). Testicular cancer occurs in 3 out of 100,000 men between the ages of 15 and 19 in the United States. It is the second most common cancer seen during the teen years and the most common cancer in guys 20 to 35 years of age.

The early the detection is done, the very curable the stage becomes, “allowing a 95 percent survival rate.” It “drops to 75 percent if the cancer spreads before being detected” (Microsoft Encarta Premium 2007 and www.everyman-campaign.org). Because testicular cancer is a significant killer of teenage boys and grown men, doctors recommend monthly self-examination. But it’s sad to say that only few men do this.
testicular self examination
Testicular Self-Examination (TSE) is a regular, monthly procedure recommended for detecting early signs of tumors, testicular cancer, or other abnormalities in the male testes (testicles). Everyone should know what the function of his body part is, and why and how it does so. Do not follow those who take it for granted. Don’t you realize that Bible supports this by saying: Each one of us is wonderfully made by God our Creator and Savior (King David). My body and your body are the temple of The Holy Spirit, God’s residence (Apostle Paul). We should and have to take care of it. God is the owner and we are the managers (God).

Purposes, Indications, and Contraindications

Purposes:
1. Exploration and Therapeutics. Keep in mind that the point is not to find something wrong, it is to learn what everything feels like so that you will know if something changes. All men of all ages (NO MAN IS EXEMPTED), as early as possible, are advised to perform TSE. By doing this each month, males will become familiar with what is normal for them.

2. Detection. To promote early detection and treatment for testicular cancer, TSE is highly recommended to begin during adolescence. When diagnosed early, testicular cancer is completely curable. Then, men’s testicles should be examined by a doctor if they notice any of the following:
  • a lump in one testicle
  • pain or tenderness
  • blood in sperm during ejaculation (a small amount once is not necessarily cause for worry and rarely is caused by testicular cancer)
  • build-up of fluid in the scrotum
  • a change in the size of one testicle or the relative sizes of the two
Indications:
1. Ages 15-44. Highest incidence in young men ages 20 to 34. These are the most common ages when testicular cancer is diagnosed; more frequently in the young and middle-aged than in elderly men.

2. Undescended testis at birth. This is the most significant risk factor; may increase the risk of testicular cancer by five to ten times.

3. Family history. Inherited genetic factors are important in testicular cancer. Having a father, brother or son (first-degree relative) who has had testicular cancer increases the risk of getting the disease. If a man has a brother affected with testicular cancer, he is up to 10 times more likely to also get the disease than a man without any family history. This risk is exceptionally high when compared to other cancer types.

4. Previous testicular cancer (orchiectomy). To examine the remaining testicle monthly. Having had testicular cancer before increases the risk of developing cancer in the other testicle. However, cancer in both testicles is extremely rare.

5. Race and ethnicity. Testicular cancer is most common in Caucasian men in US and UK. With the exception of New Zealand Maoris, the disease is rare in non-Caucasian populations.

6. Trauma in the past. Causes such falling from the height, bicycling, motor-biking, or testicular herniation or other related abnormalities.

No contraindication has been reported.

Normal Values & Normal Findings
Location: Epididymis, testes, and spermatic cord are located bilaterally, covered by scrotal sac (as a whole is called scrotum).

Scrotal Sac
  • Skin: hair bearing and loosely mobile; relaxes or retracts in response to temperature changes (thickness); non-tender.
  • Sebaceous cysts/glands: present (small bumps on scrotal skin)
  • Color: deep-pigmented with coarse-appearing surfaces (except posterior: rugae, hairless).
  • Testicles (Testes): Size/Dimensions
  • Testes lie freely in the scrotum, are oval shaped, and measure 4-5 cm in length, 3 cm in width, and about 2 cm in thickness, and weighs around 12 g.
  • Testicles (Testes): Appearances
  • Present: two, inside the sac; equal in size, one testicle may appear (and stay) (slightly) larger than the other and one may lower; mildly sensitive but non-tender to moderate compression; smooth and ovoid (egg-shaped); movable.

Epididymis
Must be found; an irregular cordlike structure (tubular, comma-shaped structure which collapses when gently compressed between fingers and thumbs) on the top and at the back of the testicle that stores and transports sperm; smooth and non-tender.
  • Spermatic Cord and Vas Deferens
  • Spermatic cord contains vas deferens, arteries and veins. Vas deferens is a smooth cord-like structure. They extend upward from the epididymis; non-tender and discretely palpable from the epididymis to the external inguinal ring.
Procedure
Unlike the Breast Self-Examination (BSE) in women, the Testicular Self-Examination (TSE) is conducted in steps and parts since the testicles are portions of complex external male reproductive organs; enclosed in a sac and have attachments.

There are the FOUR simple GUIDELINES and STEPS.

(1) Regular self examination will help you become more aware of the normal feel and size of your testicles so that any abnormalities can be spotted early on. The principles for testicles are, first, examine each testicle separately, feeling for lumps, and then compare them to see whether one is larger than the other.

(2) Do once a month, at a convenient time such as the first of the month or your birthdate every month, it’s easier to remember and develop a schedulized and organized manner. A thorough examination may be easier, and it is best performed, during/after a warm bath or shower when both hands and scrotum are warm as the scrotal skin relaxes and are loosen, and its contents can be felt most easily.

(3) Most lumps found on the testicles are benign but if there are any changes in size, shape or weight, a physician or urologist should be seen and consulted for checkup (testicular examination).

(4) Starting by standing in front of a mirror, on relaxed and calm condition.

Here’s what to do orderly in FOUR simple STEPS: 

(1) Hold p-e-n-i-s out of way, support the scrotum in the palm of your hand and become familiar with the size and weight of each testicle. Look for any swelling on the skin of the scrotum. One testicle may appear larger than the other, and one may lower, which is usually normal.

(2) Examine one testicle at a time. Use both hands for each testicle by gently rolling it between your thumbs and the first two fingers (forefingers and middle fingers), placing the fingers under the testicle while the thumbs are placed on top. Gently feel for lumps, swellings, or changes in firmness. Look for a small lump about the size of a pea on the front or the side of the testicle. Not all lumps are cancerous, but if you do find one, consult your physician at once.

(3) A natural rope-like structure, the epididymis, is situated along the back of the testicle. Each testicle has an epididymis at the top which carries sperm to the p-e-n-i-s. Don’t panic if you feel this - it’s normal. Learn what it feels like so that you do not confuse it with an abnormal mass.

There are possible questions that can be asked by the patient who is taught in the TSE. Possible Situations for DRE:

“What! A digital stuff or a finger into my butt? Look, I’m still a virgin.”

“Mmm, is the procedure painful?”

“Hey, easy… Ouch! How long will this test take place?”

“Nurse Tina, what should I do/prepare prior to my digital rectal exam?”

“What should I do and shouldn’t do before and after this procedure?”

“Can I eat and drink before I come here to do this?”

Interpretation & Significant Findings

Regular self examination will help you become more aware of the normal feel and size of your testicles so that any abnormalities can be spotted early on.

  • A lump in either testicle
  • Any enlargement of the testicle
  • A feeling of heaviness in the scrotum
  • A dull ache in the abdomen or groin
  • A sudden collection of fluid in the scrotum
  • Growth or tenderness of the upper chest
INSPECTION for SCROTUM:
Scrotal lesions, or scrotal redness (generalized or localized/isolated), are considered abnormal and may indicate an infection. Excessive differences between the right and left sides are an abnormal finding (size, shape, and characteristics).

PALPATION for SCROTUM:
Feeling heaviness; tenderness or edema; unchanged with temperature changes; color inconsistence; and lesions.

PALPATION for TESTES:
Absence of any testis may be reported. Testes are not distended into the sac or are enlarged (unilaterally or bilaterally), markedly tender, nodular, irregular, or fixed.

PALPATION for EPIDIDYMIS:
Determine its position in relation to the testes (proximal or distal); whether it can be moved with fingers; and if disappears when lie down; tender, irregular placement, enlargement, induration, or nodules.

PALPATION for VAS DEFERENS:
Tenderness; tortuosity; thickened or beaded area; or induration.

Summary of TSE and Its significant Findings

References
Anderson, Douglas M. (Chief Lexicographer). (2002). Mosby’s Medical Dictionary, 6th Edition. Missouri, USA: Mosby, Inc.

Hecht, Frederick and Shiel, Jr., William C. (Co-Editor-in-Chiefs). (2003). Webster’s New WorldTM Medical Dictionary, 2nd Edition. New York, USA: MedicineNet.com and Wiley Publishing, Inc.

Nettina, Sandra M. (Editor). (2001). The Lippincott Manual of Nursing Practice, 7th Edition. Philadelphia: Lippincott Williams & Wilkins.

Smeltzer, Suzanne C., et al. (2008). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing (11th Ed., Vol. 2). Philadelphia: Lippincott Williams & Wilkins.

Thompson, June M., et al. (1989). Mosby’s Manual of Clinical Nursing, 2nd Edition. Missouri, USA: The C.V. Mosby Company.

Wilson, Susan F. and Giddens, Jean F. (2005). Health Assessment for Nursing Practice, 3rd Edition. Philadelphia, USA: Mosby, Inc.

“Testis.” Microsoft® Encarta® 2007 [DVD]. Redmond, WA: Microsoft Corporation, 2006.
http://www.kidshealth.org/teen/expert/s-e-x_health/expert_testicles.html
http://www.everyman-campaign.org/testicular/self-examination.html


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