Scrotal masses

Definition

A scrotal mass is a lump or bulge that can be felt in the scrotum, the sac that contains the testicles.

See also:

• Hydrocele
• Orchitis
• Seminoma
• Sertoli-Leydig cell tumor
• Testicular cancer
• Varicocele

Alternative Names

Hematocele; Spermatocele

Causes, incidence, and risk factors

A scrotal mass can be benign (generally harmless) or malignant (cancerous). Benign scrotal masses include:

• Varicocele -- a varicose vein along the spermatic cord
• Hydrocele -- fluid collection in the scrotum
• Hematocele -- blood collection within the scrotum
• Spermatocele -- a cyst-like mass within the scrotum that contains fluid and dead sperm cells

Scrotal masses can be caused by inflammatory or infectious diseases (for example, epididymitis), physical injury to the scrotum, herniation (inguinal hernia), or tumors.

Symptoms

• Painless or painful bulge or lump within the scrotum (testicle lump)
• Infertility
• Enlarged scrotum

Signs and tests

During a physical examination, the doctor may feel a mass within the scrotum and make note of its features:

• Tender or non-tender
• Uniform, smooth, twisted, or irregular
• Fluctuant (feels liquid), firm, or solid
• Typically only on one side

The inguinal lymph nodes in the groin may or may not be enlarged or tender on the affected side.

The following tests may be performed to help diagnose a scrotal mass:

• Ultrasound of the scrotum
• Biopsy on masses that are surgically removed

To discover any lumps as early as possible, all men should perform testicular self-examination each month.

Treatment

ALL scrotal masses should be evaluated by a primary health care provider. Hematoceles, hydroceles, and spermatoceles are usually harmless and do not require treatment. Sudden, temporary conditions may respond to local comfort measures and, in some situations, antibiotics or pain relievers.

A scrotal support (jock strap) may provide some relief of the pain or discomfort associated with the scrotal mass. A hematocele, hydrocele, or spermatocele may occasionally require surgery to remove the collection of blood, fluid, or dead cells.

Expectations (prognosis)

Most conditions that cause scrotal masses can be easily treated. Even testicular cancer has a high cure rate with early diagnosis and treatment. Nevertheless, any scrotal mass should be examined promptly by a qualified doctor.

Complications

Complications depend on the underlying reason for the scrotal mass. For example, varicoceles may lead to infertility.

Calling your health care provider

Call your health care provider if you find any kind of lump or bulge within your scrotum.

Prevention

Scrotal masses linked to sexually transmitted diseases (for example, epididymitis) may be prevented by practicing safe sex.

Scrotal masses resulting from injury may be prevented by wearing an athletic cup during exercise.

You should perform monthly testicular self-exams if you have an increased risk for developing testicular cancer. These exams have not been shown to improve survival or change the outcome of testicular cancer if you are NOT at increased risk. It is very important that you see a medical provider immediately with any scrotal mass.

References

Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007.

Fütterer JJ, Heijmink SWTPJ, Spermon JR. Imagine the Male Reproductive Tract: Current Trends and Future Directions. Radiologic Clinics of North America. Jan 2008; 46(1).

U.S. Preventive Services Task Force. Screening for Testicular Cancer: Recommendation Statement. Rockville, MD: Agency for Healthcare Research and Quality; February 2004.