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Scrotum and scrotal lumps

The scrotum is a loose skin sac situated behind the penis. It holds the testicles which form part of male reproductive system, and they are suspended in their position by the spermatic cord. The testicles are responsible for sperm and testosterone production and they require a cooler temperature than the inside of human body for optimal function. Scrotal lumps can develop at any age. Whenever you feel a lump or swelling, you must immediately seek medical attention in case of any serious underlying condition.

Awareness about scrotum and testicles

The testicles should feel smooth in scrotum. Attached to the back of each testicle is a coiled tube known as the epididymis which transports the sperm. Periodically you should check the scrotum for any scrotal lumps or swelling, even if you don’t have any pain or tenderness. Any changes, any tenderness or any swelling should be a cause for concern and should not be ignored. There are a number of conditions associated with lumps in scrotum, some painful and others not. Many lumps are benign (i.e non-cancerous) but seeking prompt medical advice is the correct step. Some conditions will need urgent medical attention and so should not be neglected, including cancer, infections and testicular torsion (twisting).

More about scrotal lumps

What are the signs and symptoms you must be looking for? These can be:
•    An increased firmness in testicles/heaviness in scrotum.
•    Lumps in any one testicle.
•    Pain or discomfort in testicles or scrotum.
•    Swelling or fluid collection in scrotum.
•    Any changes or differences between the testicles.
•    Pain/ache in lower abdomen/groin area.
•    Enlarged or tender breasts.
Any of the symptoms and/or any lump, even if it is painless, must be seen by your physician. The physician will check for inflammation, hernia formation or torsion of the testicle, and if needed, refer urgently to specialty care.

Different types of scrotal lumps

•    Spermatocele/epididymal cyst – when there is a cyst formation on epididymis; happens mostly in middle-age men.
•    Hydrocele – when there is fluid accumulation around the scrotum in the tissue layers; can occur after an infection or an injury.
•    Varicocele – this is when enlarged veins affect the testicles. It is more common on the left side, and commonly occurring due to blockage in the veins or failure of their valve function.
•    Testicular torsion – can occur suddenly when a testicle gets twisted, blocking its blood supply; the condition can be very painful and needs immediate medical attention and treatment to prevent permanent damage.
•    Testicular cancer – although most scrotal lumps are benign, lumps arising in the testicles themselves are very frequently cancerous. Cancer accounts for about 4% of scrotal lumps, and usually presents as a painless lump. The possibility of cancer always needs investigation, for early treatment, and must never be ignored.
•    Epididymo-orchitis – infection of the epididymis and testicle needs prompt treatment with antibiotics to prevent permanent damage, and investigations to rule out other underlying conditions.

Treatment plan

A urologist investigates scrotal lumps. Treatment for scrotal lumps will depend on the nature of the underlying cause. Before treatment, he will do a:
•    Physical exam.
•    Check all your present symptoms and signs.
•    Check your past medical history.
•    Order various tests, like blood and urine tests, ultrasound etc.
After diagnosing the underlying cause, he will recommend a treatment plan that may include antibiotics, medications or surgery depending on the diagnosis. Reaching for highly qualified and experienced urologists like Mr. Mark Feneley is the first correct step.