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Testicular Mass

Most testicular masses are benign and the majority of them prove to be a hydrocele, a spermatocele, a varicocele, an inguinal hernia, or epididymitis; however, they can be testicular cancer. Hydroceles, the most common benign testicular mass in an adult, and spermatoceles are collections of fluid in the scrotal sac. A varicocele is an enlargement of the veins that drain the testicles and can increase the risk of infertility. An inguinal hernia is an out-pouching of abdominal contents that descend into the scrotum. Epididymitis is inflammation of the epididymis (a structure attached to the testicle) usually caused by a sexually transmitted disease or a urinary tract infection. Testicular cancer can occur at any age, although it occurs most frequently between the ages of 18-40.

Signs and symptoms

  • Hydrocele and spermatocele are generally soft, painless scrotal swellings, which can rapidly change size as the fluid enters or leaves.
  • Varicoceles are soft scrotal swellings, more prominent while standing or exercising. Sometimes, varicoceles may cause a sensation of heaviness, or a dull ache.
  • Epididymitis presents as testicular discomfort and swelling, and may include pain with urination.
  • Inguinal hernias may or may not be painful. They are soft and usually enlarge with coughing or straining.
  • Testicular cancer can present with or without pain. The mass usually feels firm and arises from the testicle. Occasionally, testicular cancer may appear with symptoms of metastasis , which could include cough, shortness of breath, or weight loss. Monthly testicular self-exams are recommended for every man between the ages of 18-40 years old.

Diagnosis

  • Hydroceles and spermatoceles are diagnosed by "transillumination," a technique in which a bright light is applied to the scrotum. This type mass illuminates behind the light, solid masses do not. Testicular ultrasound is used to confirm the diagnosis.
  • Varicoceles are diagnosed by ultrasound, which identifies the blood filled veins.
  • Epididymitis is diagnosed by urinalysis and physical exam. Sometimes ultrasound of the testicle is performed.
  • Inguinal hernias are identified by physical exam. Upon coughing or straining, the hernias bulge more prominently in the scrotum.
  • Diagnosis of testicular cancer can be made by measuring several substances in the blood (called "markers") which may indicate the presence of certain cancers, and scrotal ultrasound to confirm the presence of a mass.

Treatment

  • Hydroceles and spermatoceles if small, required no treatment. If they are large or painful, surgery may be necessary to drain the fluid.
  • Varicoceles may be treated by surgery to tie off the affected veins.
  • Epididymitis is treated with antibiotics, as it is usually caused by an infection.
  • Inguinal hernias are repaired by surgery.
  • Testicular cancer treatment depends upon the type of cancer. Treatment always involves surgery to remove the affected testicle. Further treatment may include observation with strict follow-up, chemotherapy, or radiation.
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