Scrotal masses

Answer 1

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.

Futterer 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.

Answer 2

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

Testicular mass; Scrotal growth

Causes, incidence, and risk factors

A scrotal mass can be noncancerous (benign) or cancerous (malignant).

Benign scrotal masses include:

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

Scrotal masses can be caused by:

• Abnormal bulge in the groin (inguinal hernia)
• Diseases such as epididymitis
• Injury to the scrotum
• Testicular torsion
• Tumors

Symptoms

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

Signs and tests

During a physical examination, the health care provider may feel a growth in the scrotum. This growth may:

• Feel tender
• Be smooth, twisted, or irregular
• Feel liquid, firm, or solid
• Be only on one side of the body

The inguinal lymph nodes in the groin may be enlarged or tender on the affected side.

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

• Biopsy
• Ultrasound of the scrotum

Some men with a high risk for testicular cancer may perform monthly testicular self-examination. Any new growth in the testicle or scrotum needs to be checked by your health care provider, even if you don't perform regular self-examinations.

Treatment

A health care provider should evaluate ALL scrotal masses. Hematoceles, hydroceles, and spermatoceles are usually harmless and do not need to be treated.

Sometimes the condition may improve with self-care, antibiotics, or pain relievers. Painful growths in the scrotum need IMMEDIATE medical attention.

A jock strap (scrotal support) may help relieve the pain or discomfort from the scrotal mass. A hematocele, hydrocele, or spermatocele may sometimes need 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.

Have your health care provider examine any scrotal growth as soon as possible.

Complications

Complications depend on the cause of the scrotal mass. For example, varicoceles may lead to infertility.

Calling your health care provider

Call your health care provider if you find a lump or bulge in your scrotum.

Prevention

You can prevent scrotal masses caused by sexually transmitted diseases (for example, epididymitis) by practicing safe sex.

To prevent scrotal masses caused by injury, wear an athletic cup during exercise.

You may perform monthly testicular self-exams if you are at increased risk for developing testicular cancer. See: Testicular self-examination

It is very important that you see a health care provider right away for any scrotal mass.

References

Shaw J. Diagnosis and treatment of testicular cancer. Am Fam Physician. 2008;77:469-474, 475-476.

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010;37:613-626.

Montgomery JS, Bloom DA. The diagnosis and management of scrotal masses. Med Clin North Am. 2011;95:235-244.

U.S. Preventive Services Task Force. Screening for Testicular Cancer: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2011;154:483-486.

Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.

Reviewed By

Review Date: 09/16/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.