What are scrotal masses. How can they be identified. What causes scrotal masses. What are the symptoms of scrotal masses. How are scrotal masses diagnosed. What treatment options are available for scrotal masses. When should you seek medical attention for a scrotal mass.

What Are Scrotal Masses and How Do They Develop?

A scrotal mass is a lump or bulge that can be felt in the scrotum, the sac containing the testicles. These masses can be either benign (noncancerous) or malignant (cancerous). Understanding the nature of scrotal masses is crucial for proper diagnosis and treatment.

Scrotal masses can develop due to various reasons, including:

• Fluid accumulation
• Cyst formation
• Blood collection
• Hernias
• Infections
• Tumors

The development of a scrotal mass often depends on the underlying cause. For instance, a hydrocele forms when fluid accumulates around the testicle, while a varicocele occurs due to enlarged veins within the scrotum.

Common Types of Benign Scrotal Masses

Several types of benign scrotal masses exist, each with its unique characteristics:

Hydrocele

A hydrocele is a collection of fluid surrounding the testicle. It’s common in newborn infants and typically resolves on its own within a few months after birth. The main symptom is a painless, swollen testicle that feels like a water-filled balloon. Hydroceles are usually harmless and only require treatment if they cause discomfort or grow excessively large.

Spermatocele

A spermatocele is a cyst-like mass that forms within the epididymis, the tube that carries sperm from the testicle. It contains fluid and dead sperm cells. Spermatoceles often don’t require treatment unless they grow too large or cause discomfort.

Varicocele

A varicocele is a varicose vein along the spermatic cord. It can cause a feeling of heaviness or discomfort in the scrotum, especially after standing for long periods.

Epididymal Cyst

An epididymal cyst is a swelling in the epididymis. It’s usually painless and may not require treatment unless it grows large or causes discomfort.

Malignant Scrotal Masses: Understanding Testicular Cancer

While many scrotal masses are benign, it’s crucial to be aware of the possibility of testicular cancer. Testicular cancer is relatively rare but is the most common cancer in young men aged 15-35.

Symptoms of testicular cancer may include:

• A painless lump or swelling in either testicle
• A feeling of heaviness in the scrotum
• A dull ache in the lower abdomen or groin
• Sudden fluid collection in the scrotum

Early detection is key in treating testicular cancer successfully. Regular self-examinations and prompt medical attention for any unusual changes in the testicles are essential.

Identifying Symptoms of Scrotal Masses

Recognizing the symptoms associated with scrotal masses is crucial for early detection and treatment. The primary symptoms include:

• An enlarged scrotum
• A lump in the testicle, which may be painless or painful
• A feeling of heaviness in the scrotum
• Discomfort or pain in the testicle or scrotum

Is pain always present with scrotal masses? Not necessarily. Some scrotal masses, such as hydroceles and spermatoceles, are often painless. However, others, like epididymitis or testicular torsion, can cause significant pain.

Can scrotal masses affect fertility? In some cases, yes. Certain conditions, such as varicoceles, can potentially impact sperm production and fertility. However, many benign scrotal masses do not affect fertility.

Diagnostic Procedures for Scrotal Masses

When a scrotal mass is suspected, healthcare providers employ various diagnostic techniques to determine its nature and severity:

Physical Examination

During a physical exam, the healthcare provider will carefully palpate the scrotum to assess the mass. They may note characteristics such as:

• Tenderness
• Texture (smooth, twisted, or irregular)
• Consistency (liquid, firm, or solid)
• Location (whether it’s on one or both sides)

Ultrasound

An ultrasound of the scrotum is often the first imaging test performed. It can help differentiate between solid and fluid-filled masses and provide valuable information about blood flow within the testicle.

Biopsy

In some cases, a biopsy may be necessary to determine if a mass is cancerous. This involves removing a small sample of tissue for laboratory examination.

Additional Tests

Depending on the suspected cause, other tests may be ordered, such as:

• Urine culture to check for infections
• Blood tests to check for tumor markers in cases of suspected testicular cancer
• CT scans or MRIs if further imaging is needed

How accurate are these diagnostic procedures? Ultrasound, when combined with physical examination, can accurately diagnose most scrotal masses. However, in some cases, additional tests may be necessary for a definitive diagnosis.

Treatment Options for Scrotal Masses

The treatment for scrotal masses varies depending on the underlying cause, size of the mass, and associated symptoms. Here are some common treatment approaches:

Watchful Waiting

For many benign scrotal masses that aren’t causing symptoms, a “watch and wait” approach may be recommended. Regular check-ups can monitor for any changes.

Medication

In cases of infection, such as epididymitis, antibiotics may be prescribed. Pain relievers can help manage discomfort associated with some scrotal masses.

Surgical Intervention

Surgery may be necessary for certain conditions:

• Hydrocelectomy: Surgical removal of a hydrocele
• Spermatocelectomy: Removal of a spermatocele
• Varicocelectomy: Surgical correction of a varicocele
• Orchiectomy: Removal of a testicle, typically in cases of testicular cancer

Supportive Care

Using a scrotal support or jock strap can help relieve pain and discomfort associated with some scrotal masses.

Is surgery always necessary for scrotal masses? No, many benign scrotal masses can be managed conservatively without surgery. However, surgical intervention may be recommended if the mass is causing significant discomfort, affecting fertility, or if cancer is suspected.

Prevention and Self-Care for Scrotal Health

While not all scrotal masses can be prevented, there are steps men can take to maintain scrotal health and detect problems early:

Regular Self-Examinations

Performing monthly testicular self-exams can help detect any changes or abnormalities early. Here’s how to do it:

1. Examine the testicles after a warm shower or bath when the scrotum is relaxed.
2. Gently roll each testicle between your thumb and fingers, feeling for any lumps or changes in size or texture.
3. Check the epididymis, the tube running along the back of each testicle, for any swelling.

Maintaining Overall Health

General health practices can contribute to scrotal health:

• Maintain a healthy weight
• Exercise regularly
• Eat a balanced diet
• Avoid smoking
• Practice safe sex to prevent sexually transmitted infections

Protective Measures

Taking precautions during physical activities can help prevent traumatic injuries to the scrotum:

• Wear appropriate protective gear during sports
• Use a jockstrap or athletic supporter during high-impact activities

How effective are self-examinations in detecting scrotal masses? Regular self-examinations can be highly effective in detecting changes in the testicles and scrotum. Many testicular cancers are first discovered by men themselves or their partners during self-examinations.

When to Seek Medical Attention for Scrotal Masses

While many scrotal masses are benign, it’s important to know when to seek medical attention. Here are some situations that warrant a visit to a healthcare provider:

• Discovery of a new lump or swelling in the testicle or scrotum
• Sudden onset of scrotal pain or swelling
• Changes in the size or texture of an existing scrotal mass
• Persistent discomfort or heaviness in the scrotum
• Any changes noticed during self-examination

Is immediate medical attention always necessary for scrotal masses? While not all scrotal masses require emergency care, it’s best to have any new or changing scrotal mass evaluated promptly by a healthcare provider. Some conditions, such as testicular torsion, require immediate medical attention to prevent permanent damage to the testicle.

By understanding the various types of scrotal masses, their symptoms, and appropriate responses, men can take proactive steps in maintaining their scrotal health. Regular self-examinations, coupled with prompt medical attention when needed, can lead to early detection and successful treatment of scrotal masses, including potentially life-threatening conditions like testicular cancer.

Scrotal masses Information | Mount Sinai

Testicular mass; Scrotal growth

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

A hydrocele is a collection of fluid inside the area of the scrotum, surrounding the testicle. Hydroceles are common in newborn infants and normally resolve after a few months after birth. The main symptom is a painless, swollen testicle, on one or both sides, which feels like a water-filled balloon. Hydroceles are usually not dangerous, and they are usually only treated when they cause discomfort or embarrassment, or they get so large that they threaten the blood supply of the testicle.

A spermatocele is a cyst-like mass that forms within the epididymis. It is usually filled with fluid and dead sperm cells. A spermatocele can be left untreated unless it is growing too large or causing the individual discomfort.

The male reproductive system, viewed from a sagittal section.

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

Causes

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 sperm cells
• Varicocele — a varicose vein along the spermatic cord
• Epididymal cyst — a swelling in the duct behind the testes that transports sperm
• Scrotal abscess — a collection of pus within the wall of the scrotum

Scrotal masses can be caused by:

• Abnormal bulge in the groin (inguinal hernia)
• Diseases such as epididymitis or orchitis
• Injury to the scrotum
• Testicular torsion
• Testicular cancer
• Infections

Symptoms

Symptoms include:

• Enlarged scrotum
• Painless or painful testicle lump

Exams and Tests

During a physical exam, 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 on the same side as the growth may be enlarged or tender.

The following tests may be done:

• Biopsy

• Urine culture
• Ultrasound of the scrotum

Treatment

A provider should evaluate all scrotal masses. However, many types of masses are harmless and do not need to be treated unless you are having symptoms.

In some cases, the condition may improve with self-care, antibiotics, or pain relievers. You need to get medical attention right away for a growth in the scrotum that is painful.

If the scrotal mass is part of the testicle, it has a higher risk of being cancerous. Surgery may be needed to remove the testicle if this is the case.

A jock strap or scrotal support may help relieve the pain or discomfort from the scrotal mass. A hematocele, hydrocele, spermatocele, or scrotal abscess may sometimes need surgery to remove the collection of blood, fluid, pus or dead cells.

Outlook (Prognosis)

Most conditions that cause scrotal masses can be easily treated. Even testicular cancer has a high cure rate if found and treated early.

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

Possible Complications

Complications depend on the cause of the scrotal mass.

When to Contact a Medical Professional

Contact your provider if you find a lump or bulge in your scrotum. Any new growth in the testicle or scrotum needs to be checked by your provider to determine if it may be testicular cancer.

Prevention

You can prevent scrotal masses caused by sexually transmitted diseases by practicing safe sex.

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

Germann CA, Holmes JA. Selected urologic disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 89.

Sommers D, Winter T. The scrotum. In: Rumack CM, Levine D, eds. Diagnostic Ultrasound. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 22.

Last reviewed on: 7/26/2021

Reviewed by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Testicular Cancer: Diagnosis | Cancer.

Net

Approved by the Cancer.Net Editorial Board, 08/2022

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

How testicular cancer is diagnosed

There are many tests used for diagnosing testicular cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

If you develop a testicular lump or something else that could be testicular cancer, it is important to see your primary care doctor. After this visit, your doctor may refer you to a urologist for more tests. A urologist is a doctor who specializes in treating testicular cancer and other conditions of the urinary tract.

A physical examination and an ultrasound are usually the first tests performed. If they show an abnormality that appears to be a tumor, then blood tests are done. In addition, the testicle may need to be surgically removed to look for signs of cancer. More details on each test are below.

Physical examination. The doctor will feel the testicles for any sign of swelling, tenderness, or hardening. The doctor will also feel the abdomen, neck, upper chest, armpits, and groin for evidence of enlarged lymph nodes, which may indicate that a cancer has spread. The breasts and nipples will also be examined to look for growth, and the legs will be examined for swelling. Leg swelling can be from blood clots in veins in the legs, pelvis, or abdomen.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. The sound waves produced by the ultrasound bounce off tissue in the scrotum. The echoes of the sound waves produce a series of images called a sonogram. These images of the testicle help the doctor find any tumors or other abnormalities. If there is a tumor large enough to be seen on an ultrasound, then the sonogram will show the size, location, and solidness of the tumor. A solid tumor inside the testicle is very likely to be cancerous.

Blood tests/tumor markers. The levels of serum tumor markers are measured before surgery to remove a testicle. Tumor markers are substances made by a cancer that are found at abnormally high levels in the blood of some people with cancer. Different types of cancer make different tumor markers. For testicular cancer, serum tumor marker levels are used to find out the cancer’s stage (see Stages) and to confirm whether a tumor is a pure seminoma (see Introduction). The following tumor markers are used to help stage and plan treatment for testicular cancer:

• Alpha-fetoprotein (AFP). The AFP level is often, but not always, elevated in people with non-seminoma. AFP is not made by seminomas, so an increased level of AFP is a sign that the tumor is not a pure seminoma.

• Beta human chorionic gonadotropin (beta-hCG). Beta-hCG is often, but not always, elevated in people with seminoma or non-seminoma. However, beta-hCG levels above 1,000 IU/L generally indicate that the cancer is a non-seminoma and not a seminoma.

Elevated levels of these tumor markers may indicate testicular cancer or another type of cancer. However, it is possible to have testicular cancer and have normal tumor marker levels. It is also possible to have elevated levels of these markers without having cancer.

Other tumor markers that may be used for testicular cancer include:

• Lactate dehydrogenase (LDH). LDH is only used to determine how much chemotherapy to give for metastatic non-seminoma (see Types of Treatment). This is because many other cancers and non-cancerous conditions can increase LDH levels. LDH is not used to find testicular cancer.

• Placental alkaline phosphatase (PLAP). PLAP is another tumor marker doctors may test for, although it is not commonly measured.

AFP, beta-hCG, and LDH levels will be tested regularly before and during the active treatment period to monitor the cancer. These tumor markers will also be tested at regular times during follow-up care (see the Follow-up Care section) after treatment is completed.

Learn more about ASCO’s recommendations for tumor markers in adults with germ cell tumors. (Please note that this link takes you to a different ASCO website.)

Orchiectomy/surgical pathology tests. If testicular cancer is suspected, a surgeon will perform a radical inguinal orchiectomy. During this surgery, the entire testicle is removed through an incision in the groin. Then, a pathologist will examine very thin slices of tissue from the testicle under a microscope to diagnose the type of cancer. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. For testicular cancer, the pathologist determines if the tissue from the testicle contains cancer cells. If it does, the pathologist determines what type of cancer cells they are. Most testicular cancers are germ cell tumors, which are divided into 2 categories: seminoma and non-seminoma (see the Introduction for more information). If a person has only 1 testicle to begin with or the diagnosis is uncertain, the surgeon may remove only a small sample of tissue from the testicle. The testicle may still need to be removed if there are cancer cells. If the tissue sample does not show cancer, it may be possible to repair the damage from the tissue removal and replace the testicle in the scrotum during the same surgery. However, this procedure is very rarely done.

Other tests

If cancer is found, other tests will be needed to determine the stage of the cancer and find out if it has spread to other parts of the body (see Stages). Usually, doctors recommend imaging tests of the abdomen, pelvis, and chest. Imaging tests show pictures of the inside of the body. Images of the brain or bones are not as common but may be needed for some patients. This can include patients who have cancer that has spread widely, those who have a type of non-seminoma called choriocarcinoma, and those who have very high tumor marker levels of AFP or beta-hCG (see above).

X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A chest x-ray is used to determine the stage of the cancer and for follow-up screening. If a more detailed picture of the lungs is needed, the doctor may recommend a chest CT scan (see below). But in many situations, an x-ray is preferred because it uses less radiation.

Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image of the body. This can help doctors find any abnormalities or tumors. If a tumor is visible on the CT pictures, the scan can be used to measure the tumor’s size. Often, a special dye called a contrast medium is given before the scan to provide a clearer image. Some dyes are injected into a patient’s vein, while others are given as a pill or liquid to swallow. Many times, both types of dye are given before a CT scan because they help your health care team see different parts of the body. A CT scan can be used to evaluate the abdomen, pelvis, chest/lungs, brain and other areas. A CT scan of the brain is rarely needed for testicular cancer because it is uncommon for this type of cancer to spread to the brain. However, if a scan of the brain is needed, MRI (see below) is generally preferred because the bones of the skull interfere with the ability of CT scans to show certain parts of the brain.

Magnetic resonance imaging (MRI) scan. An MRI scan uses magnetic fields to create a 3-dimensional picture of the inside of the body. An MRI can be used to measure the tumor’s size. For testicular cancer, MRI scans have recently begun to be used as an alternative to CT scans for imaging the abdomen and pelvis in patients who prefer to avoid CT scans, particularly for those undergoing surveillance for stage I seminoma. This depends on whether an MRI scanner is available as well as a radiologist with expertise in interpreting MRI scans. MRI scans are generally preferred to CT scans for examining the brain or the spine. A contrast medium is given before the scan to create a clearer picture. This dye is injected into a patient’s vein. For testicular cancer, CT scans (see above) are used more often than MRI scans for viewing the abdomen and pelvis because accurately reading MRI scans of the abdomen and pelvis requires more experience than reading CT scans. When MRIs of the abdomen are needed, contrast medium may be given as a pill or liquid to swallow.

MRI scanning of the brain and/or spine is used only in specific situations. For instance, an MRI of the brain might be recommended if a patient has symptoms or changes on a physical exam that suggest that the cancer may have spread to the brain. In addition, brain MRIs are often recommended for poor-risk metastatic testicular cancer (see Stages) with very high serum tumor markers or if the cancer has spread to the liver, to the bones, or extensively to the lungs. Spine MRI scans are only ordered if there is reason to suspect that the cancer has spread to the spine, which is not common in testicular cancer. Your doctor will explain which test is appropriate for you.

Positron emission tomography (PET) or PET-CT scan. PET scans are not generally used for testicular cancer. When PET scans are done, they are usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use more energy than healthy tissue, it absorbs more of the radioactive sugar. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects the sugar to produce images showing where the cancer is in the body. Studies of PET scans have shown that they are not helpful for diagnosing or staging testicular cancer and should not be used at these times. However, they can be helpful in cases of metastatic pure seminoma that does not entirely disappear after chemotherapy. In such instances, if a PET scan is planned, it should not be done until at least 6 weeks after chemotherapy ends.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Occasionally, a biopsy may be taken from the lung, retroperitoneum, or other location in the body if it appears that cancer may have spread.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

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Testicular Cancer – Stages ›

Testicular hydrocele in boys: before and after photos

Surgical treatment at the MedicaMente clinic in Korolev gives a good prognosis with timely treatment and eliminates the hydrocele problem in a child, preserves all testicular functions (spermatogenic and hormonal) and eliminates the risk of complications . The recovery period after surgical treatment of hydrocele in boys is quite short and, as a rule, passes without complications.

Hydrocele in a child (photo)

case study 1

Dropsy of the testis in a boy

Dropsy of the testicle in a boy (as it looks in the photo before the operation)

Dropsy of the testis in a boy

Dropsy of the testicle in a boy (photo after surgery). Seam no more than 2 cm. No need to remove

In the photo: how dropsy of the testicles looks like in a boy before and after treatment

The main symptom is a mild swelling and enlargement of the scrotum in a child. Surgical manipulation was performed through inguinal access. Intradermal suture no more than 2 cm, self-absorbable. You don’t need to shoot. The boy no longer experienced unpleasant procedures after surgical treatment.

Dropsy of the testicular membranes (hydrocele) in a 5-year-old boy, photo

case study 2

Hydrocele in a 5 year old child

Hydrocele in a 5-year-old child in the photo before surgery

Hydrocele in a 5 year old child

Hydrocele in a 5-year-old child. Cosmetic postoperative suture. No need to shoot

Hydrocele in a 5 year old child

Hydrocele in a 5-year-old child. Photo of the suture after the operation in relation to the phalanx of the index finger

In the photo: dropsy of the testicular membranes in a 5-year-old boy. Photo of a postoperative cosmetic suture (no need to remove). The size of the seam is the width of the phalanx of the index finger (15-17 mm).

Diagnosis Hydrocele on the right, was made to the baby at 1 year old, confirmed by ultrasound data at 1 and 2 years old. Parents took time with the operation, as nothing bothered the boy. Over the last month after the disease, the child’s scrotum volume has increased significantly, pain has appeared. The family lives 70 km from the city of Korolev. On the advice of friends who performed an operation in our medical center on their child for an inguinal hernia, the parents turned to us for help. On examination by a pediatric urologist-andrologist, an ultrasound scan of the scrotum was performed, the diagnosis was made: Large hydrocele on the right. Surgery is recommended as soon as possible. After passing the tests, the boy was hospitalized with his parents in a hospital. Before the operation, the parents were warned that the postoperative swelling of the scrotum would be quite long (up to 4-6 months), since the scrotum tissues are currently very stretched. The boy was taken to the operating room. Anesthesia and surgery were performed. The operation lasted 27 minutes, passed without technical difficulties. A non-removable cosmetic suture was applied to the wound (the size of the suture is the width of the phalanx of the index finger) and a prolonged blockade was performed. In this case, the patient was additionally applied a compression bandage on the scrotum to reduce postoperative edema. Parents came for examination 1 time in 7 days for one month, then 1 time per month. All postoperative examinations were free of charge.

Dropsy testis in a child (photo)

case study 3

Dropsy of testicular membranes 6 years

Dropsy of the testicular membranes in a 6-year-old child (photo before surgery)

Dropsy of the testicles 6 years

Dropsy of testicular membranes in a 6-year-old child. Postoperative scar

Dropsy of the testicles 6 years

Dropsy of testicular membranes in a 6-year-old child. Photo after the operation. Self-absorbable suture, no need to remove

In the photo: how dropsy of the testicle looks like in a child of 6 years (left). Photo of a postoperative cosmetic suture (self-absorbable, no need to remove).

Parents made an unusual request to take a photo of the cause of the disease in order to know for sure that the disease will not recur. Such a request was denied by a number of clinics and the Central City Hospital. Since we have a video and photo recording of the operation, it was not difficult for us to fulfill this request of the parents, given that this is included in our standard of medical care. In a planned manner, the baby was hospitalized in a hospital. Performed surgical treatment. A standard photo fixation of the course of surgical treatment was performed. A cosmetic suture was applied, a blockade of the postoperative field was performed. In the postoperative period, the parents are shown a photograph in which the crossed vaginal process of the peritoneum is located on two clamps (the cause of dropsy of the testicular membranes in a boy). The message during surgery is disconnected, the fluid will no longer accumulate in the membranes of the scrotum. The baby was discharged from the hospital after 3 hours.

Find out how the operation works

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Karen Gagikovich

Experience 15 years

Candidate of Medical Sciences, member of the European Association of Urology and the Russian Society of Oncourologists

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Hydrocele (scientific name hydrocele) is a collection of fluid in the area between the testicle and scrotum. It is possible that the disease develops independently or appears as a concomitant underlying disease – tumors of the appendages and testicles, inflammation, hydatitis, etc. The main symptoms of a hydrocele are expressed in an external increase in the scrotum and the presence of a feeling of fullness inside.

Diagnosis of dropsy of the testicles is based on ultrasound of the scrotum, laboratory tests for PCR and sexually transmitted infections, spermograms, tumor markers. Surgery for hydrocele is performed only if the disease impairs the quality of life and spermatogenesis.

Dropsy of the testicle in literal translation means protrusion of water. Hydrocele is a common pathology in terms of urology. Men of any age are at risk. The development of hydrocele in men occurs as a pathology after two years of age. Older men are much more likely to suffer from pathology than younger ones.

Symptoms and signs

Symptoms of dropsy of the testicle directly depend on the amount of accumulated fluid. The smaller the amount of fluid, the less pronounced the signs of the disease. A significant accumulation of fluid is accompanied by an asymmetric increase in the scrotum, tightness of the skin and a change in the usual color.

Palpation shows a homogeneous and painless structure of the testicles, but there are a number of difficulties in determining the contours. In the case when the amount of liquid becomes more than 500 ml, there are pains of a pulling nature, discomfort during physical exertion.

As the volume increases, dropsy of the testicles in men affects erectile functions and the process of urination. Communicating hydrocele decreases after sleep. A multichamber hydrocele in men looks like an hourglass.

Reactive pathology is clinically manifested in the form of the underlying disease. In the case of torsion of the vessels, severe pain, redness of the skin and an enlarged scrotum appear.

General symptoms of testicular hydrocele:

• swelling of the testicles;
• severe soreness;
• hyperemia of the skin, an increase in the lymph nodes of a regional type – in the later stages of the pathology;
• violation of palpation.

Causes of occurrence and development

The causes of dropsy of the testicle depend on the type of pathology. Congenital pathology is associated with non-closure of the vaginal process. Acquired pathology is associated with an imbalance of products and fluid reabsorption. The reactive form accompanies other pathological processes.

Common causes of hydrocele:

• inflammation – orchitis, orchiepididymitis and other inflammatory diseases cause disturbances in blood and lymph circulation due to which there is sweating and accumulation of fluid between the membranes of the testicle;
• post-traumatic conditions – injuries, bites and burns violate the integrity of the lymphatic and blood vessels, which cause disruptions in the natural outflow of fluid. Complications occur as a result of the addition of a secondary bacterial infection. In this case, the reasons are the removal of the hydrocele, surgery in the groin area;
• tumors – advanced stages of malignant neoplasms put pressure on the vessels and cause asymmetry of the scrotum;
• deposited fluid and diseases associated with it – disorders of the cardiovascular system, kidney disease, liver failure causes a secondary form of pathology.

Routes of infection and risk factors

The mechanism of formation of dropsy of the testicles in adults is still a subject of debate. Some of the possible routes of infection are:

• increased secretion of the mesothelium of the serous fluid;
• violations in the development of the lymphatic tract, both congenital and acquired;
• disturbed microcirculation;
• incorrect absorption.

The physiological hydrocele of the testis is determined by the peculiarities of the anatomical structure of the age-related character. These features include non-filling of the opening of the peritoneal layer during the descent of the testicles into the scrotum. The situation is aggravated by the imperfect work of the lymphatic system and a possible increase in pressure in the abdominal cavity with severe crying or against the background of constipation.

Classification

Andrologists and urologists identify types of pathology with the formation of free fluid in the scrotum according to the following criteria:

• localization – unilateral and bilateral;
• medical official classification – delimited (encapsulated), infected, unspecified and others;
• in size – small, large, giant, medium and others;
• course form – acute and chronic;
• the process of emergence – physiological appears from birth, communicating and non-communicating congenital, primary and secondary acquired.

In the process of examination under ultrasound, the division of the cyst into separate chambers or saturation with calcium can be detected, which indicates the course of inflammatory processes.

Complications

Among the complications, the following cases are most common:

• impaired spermatogenesis – against the background of testicular tissue compression and circulatory disorders;
• testicular atrophy – against the background of a prolonged course of the disease;
• orchitis – against the background of periodic mechanical damage during sexual intercourse or physical exertion;
• infection – against the background of the reproduction of pathogenic microflora;
• dermatitis – impaired microcirculation dries the skin of the scrotum;
• violation of sexual and urinary functions – against the background of a gigantic size of the liquid.

When to see a doctor

What to do with dropsy of the testicles? If you find yourself experiencing discomfort in the scrotum, you need to contact a specialist and exclude self-diagnosis, and even more so self-treatment.

Treatment of dropsy of the testicles has a priority due to reduced fertility. The main emphasis of doctors is on the early detection of the disease.

Treatment of dropsy of the testicles is the responsibility of a urologist or andrologist. You can make an appointment and choose a doctor on the website, by calling +7 (495) 775-73-60 or from the administrators at the clinic at the address: Moscow, 2nd Tverskoy-Yamskoy lane, 10.

Diagnosis

The success of hydrocele treatment depends on the success and timeliness of the diagnosis. Timely diagnosis can increase the chances of successful treatment of dropsy of the testicles in men.

To make a preliminary diagnosis, the following diagnostics are carried out:

• physical examination and imaging to detect underlying pathologies;
• specialist consultation to rule out tuberculosis;
• surgeon’s consultation to rule out a hernia of the inguinal-scrotal type.

Additional diagnostic examinations:

• Ultrasound – cause of appearance and assessment of size;
• sonogram – specification of sizes and contours, the presence of a tumor, the condition of the lymph nodes and appendages;
• CT and MRI in the presence of a tumor;
• PCR assays;
• laboratory tests for KLA and OAM;
• spermogram;
• HCG and AFP tumor markers;
• other laboratory tests.

At the stage of diagnosing the disease, it is important to distinguish between inguinal hernias, testicular tumors and dropsy. For this, ultrasound is used. A complete analysis of morphological studies allows you to confirm the final diagnosis.

Treatment

The absence of symptoms and effects on fertility in pathology suggest dynamic monitoring of the course of the disease. This situation can be resolved by the body itself.

Reactive types of pathology disappear along with the provocative factor against the background of correctly selected therapy for the underlying disease.

Operations of dropsy of testicles are shown in the presence of the deposited liquid. Removal of dropsy of the testicles is carried out by the following methods of surgical intervention:

• classic. The hydrocele is removed by suturing the free cavity of the testicle by various methods;
• minimally invasive operations on hydrocele.