Introduction

Learning objectives

Consider every solid testicular mass as potentially neoplastic until proven otherwise.
Know the initial evaluation, including Doppler ultrasound and tumor markers.
Understand why a conventional transscrotal biopsy should not be performed when a tumor is suspected.

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Video lesson

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Video pending upload (embedded YouTube)

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Summary

A solid testicular mass should be considered potentially neoplastic until proven otherwise.

Initial evaluation

examination of both testicles;
testicular ultrasound with Doppler;
urologic referral.

If a tumor is suspected, markers can subsequently be ordered:

AFP;
β-hCG;
LDH.

When to refer?

Every suspicious solid intratesticular mass requires prompt urologic referral.

⚠️ Important

When a testicular tumor is suspected, a conventional transscrotal biopsy should not be performed.

Key concept

Young patient + painless testicular mass = rule out testicular tumor.

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PDF

⬇ Download lesson summary

Downloadable PDF pending upload.

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Practical algorithm

🔴 Urgent referral / emergency

Sudden testicular pain → rule out torsion.
Fever/sepsis + obstructed urinary tract → urgent urinary drainage.
Acute urinary retention → bladder decompression; urgent referral if it cannot be resolved or if complications are present.
Hematuria + clot retention → urgent assessment and management.
Trauma + suspected urethral injury → avoid repeated blind catheterization attempts.

🟠 Priority referral

Solid testicular mass → rule out tumor.
Suspicious renal mass → characterization and urologic evaluation.
Gross hematuria → investigate the cause.
Persistently elevated PSA/suspicious DRE → prostate cancer risk assessment.

🟢 Scheduled referral depending on context

Recurrent UTI → look for a predisposing cause.
Erectile dysfunction → refer if complex, refractory, or with associated pathology.
Urinary incontinence → refer if complex, if warning signs are present, or if initial management fails.

The primary care physician does not need to resolve all urologic pathology. They must know how to perform an initial evaluation, recognize warning signs and, above all, distinguish which patient can wait from the one in whom a delay may compromise an organ, renal function, or even life.

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Clinical case

Content pending upload Progressive clinical case focused on decision-making.

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Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

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References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Testicular mass