Testicular Lumps and Swellings
A testicle lump or swelling is an abnormal mass that can form in or around the testicles, sometimes referred to as a scrotal swelling. Scrotal swellings are relatively common, can occur at any age and have many different causes. Most scrotal lumps are benign or non-cancerous in nature and require no treatment, but they can also indicate a serious underlying medical problem such as testicular cancer.
Evaluation of scrotal lumps requires taking a careful history, an examination and often an ultrasound scan of the scrotum by an experienced ultrasonographer.
Examples of common scrotal lumps include:
This type of testicular lump occurs in about 10-20% of men and are caused by enlarged veins around the testicles similar to varicose veins in the legs. They often become more noticeable after puberty. Varicoceles do not require treatment unless they cause significant symptoms such as a persistent ache in the groin or if they may be affecting fertility. Treatment options include surgical ligation (varicocelectomy) or radiological varicocele embolisation under local anaesthetic.
A Hydrocoele occurs when there is a build-up of fluid in the sac that surrounds the testicle. A small amount of fluid in this sac is normal, but the excess fluid results in a painless swelling of the scrotum.
In infants, a hydrocoele usually occurs because an opening between the abdomen and the scrotum hasn't closed off during development. If it persists for longer than a year after birth, then surgical repair of this opening is usually required. This is called a ligation of the patent processes vaginalis.
In adults, a hydrocoele may occur due to injury or infection in the testicle, but often has no underlying cause. If the hydrocoele becomes very large and uncomfortable, then the hydrocoele sac can be excised and fluid drained as a day case operation.
An epididymal cyst is a fluid-filled lump found in the epididymis, a coiled network of tubes adjacent to the testicle that stores sperm. Epididymal cysts are harmless, benign growths that occur as commonly as 1 in 6 men. If they are not causing a problem or interfering with any physical activity, they can be left alone. If they do enlarge and become uncomfortable, they can be removed with an operation usually performed under a quick general anaesthetic.
Epididymitis and orchitis
As well as forming cysts, the epididymis can sometimes become inflamed and swollen, a condition called epididymitis. It may be caused by a bacterial infection, including sexually transmitted diseases, such as chlamydia and less commonly by a viral infection. If the whole testicle becomes inflamed or infected, it is called orchitis or epididymo-orchitis.
Treatment usually involves a course of antibiotics and anti-inflammatory pain killers. Sometimes the symptoms persist and develop into chronic epididymitis, which can be more challenging to treat.
A hernia occurs when a portion of intestine pushes through an opening or weak spot in the abdomen and groin. An inguinal hernia or femoral hernia might appear as a mass in the scrotum or higher in the groin. An umbilical hernia causes a bulge around the belly button. If a hernia becomes uncomfortable, it might require repair.
In infants, an inguinal hernia occurs because the passageway from the abdomen to the scrotum has failed to close during development. This is called a patent processus vaginalis. If the hernia persists for longer than one year after birth, then a hernia repair, known as herniotomy, is usually required.
Testicular cancer is relatively uncommon, accounting for just 1% of all cancers in men, with around 2,300 men diagnosed each year in the UK. Testicular cancer tends to affect younger men, mostly between 15 and 49 years of age. It is, however, the most common type of cancer to affect men in that age group. Testicular cancers are more common in men with a history of undescended testes as a child, a family history of testicular cancer, or a previous history of testicular cancer.
Typical symptoms of testicular cancer are a painless lump on the testicle or a change in the shape or texture of the testicle. Occasionally it can present with pain or a dull ache in the testicle, scrotum or groin and very rarely tenderness or changes in the male breast tissue.
Evaluation for a suspected testicular tumour involves examining the scrotum and an ultrasound scan of the scrotum. Blood tests called testicular tumour markers might be performed alongside a CT scan of the chest, abdomen and pelvis.
Treatment for testicular cancer is usually very successful, with very favourable outcomes compared to most cancers. More than 98% survive from their cancer for five years after diagnosis.
Treatment almost always includes surgery to remove the affected testicle (radical orchidectomy). This in itself does not usually affect fertility or the ability to have sex. In some cases, chemotherapy or radiotherapy may also be offered to patients in addition to orchidectomy.