Swelling of the scrotum or a palpable mass in the scrotum

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What is it about ?

Swelling of the scrotum or the presence of a palpable mass in the scrotum can be explained in different ways:

Fluid buildup in the membrane around the testis (hydrocele)

A hydrocele is a buildup of fluid in the membrane that surrounds the testis. This fluid is visible when the scrotum is exposed to light. Hydrocele usually affects men over 65. Often, the origin of the fluid is not clearly established. A hydrocele can also follow an infection or trauma. It usually doesn’t cause any discomfort, but if the amount of fluid is very large, you may experience pain, pressure, and discomfort.

Until the age of 4, little boys usually still have a passage between the belly and the scrotum, between which the fluid travels back and forth.

Epididymal cyst (spermatocele)

A spermatocele is a small, soft, translucent mass, filled with a fluid (cyst) containing semen, located in the epididymis (above the testis). The cause is a defect in the junction between the testis and the epididymis, for example after a vasectomy (sterilization of the man by incision of the vas deferens). A spermatocele usually does not cause symptoms.

Varicose veins (varicocele)

A varicocele is a dilation of the veins around and above the testicles. They are visibly dilated when the man is standing and disappear when he lies down. If in doubt, the doctor may ask you to blow on your hand (Valsalva maneuver). A varicocele is most often localized on the left testicle.

It usually does not cause symptoms and is discovered by chance. If there are symptoms, it is usually pain and a feeling of heat and pressure in the scrotum. Symptoms can worsen with exertion and at the end of the day.

In most cases, a varicocele is not dangerous. In boys who are growing or going through puberty, however, a varicocele can cause one testicle that is smaller than the other. It is also possible that fertility is reduced.

Groin hernia (inguinal hernia)

An inguinal hernia is the result of a weakening of the stomach wall at the level of the groin canal (inguinal canal). The swelling increases when performing the Valsalva maneuver (breath on the hand) and usually goes away when lying down. Usually, the hernia can easily be pushed back into the stomach.

Testicular cancer

It is the most common type of cancer in young men, although it is still quite rare. Testicular cancer often manifests as a swollen, firm testicle or an opaque lump. Because testicular cancer does not cause symptoms, it is often discovered by chance. Men with an undescended testicle are at a higher risk of testicular cancer.

Where and how often?

Spermatocele and varicocele are relatively common. They affect 1 or 3 in 10 men.
Testicular cancer mainly develops between the ages of 21 and 40, but it is relatively rare. In 2016, 403 new cases were diagnosed in Belgium1. Out of 100 affected men, less than 2 men die within 5 years.

How to recognize it?

Men need to know their body well enough to determine whether or not their scrotum is swollen. The swelling is not always easy to notice. You may be palpating something firm that was not there before, or you may feel pain or a hotter area. The signs (swelling, pain and feeling of heat) may appear after exercise or at the end of the day.

How is the diagnosis made?

The doctor will ask you a few questions first and then examine you. Sometimes the doctor can make the diagnosis after a thorough physical examination. He will look for possible lesions on the outside or inside of the testicles. A trained physician can make this distinction by palpating the lump.

He will then expose the testicle to the light of a flashlight to see if the palpated mass is passing light. This is important in order to estimate the possibility of testicular cancer. Lesions that do not pass light are, until proven guilty, considered testicular cancer.

If necessary, the doctor will prescribe an ultrasound. Ultrasound is the ideal exam to find an explanation for swelling of the scrotum or to identify the nature of the mass palpated in the scrotum.

What can you do ?

See your doctor if you notice swelling and / or a lump in your scrotum. It is also advisable to make an appointment if you experience discomfort or pain in the scrotum area and are worried about it. If you experience severe pain in your scrotum, you should see your doctor as soon as possible.

What can your doctor do?

Treatment of symptoms depends on the cause of the problem. Sometimes it is not necessary to treat. Depending on the size, a hydrocele or a spermatocele can cause symptoms. They can be treated with surgery or a puncture. During the puncture, the doctor aspirates the liquid using a needle, then injects a product to prevent relapses.

A varicocele that does not cause symptoms in an adult does not necessarily need to be treated. On the other hand, treatment is usually put in place when a varicocele is diagnosed during an infertility assessment or in a boy who is growing or going through puberty. The treatment is based on a radiological procedure, involving the insertion of a catheter and the injection of a product to cauterize (sclerose) the varicose veins. The doctor may also ligate some blood vessels.

Surgery is required if there is an inguinal hernia with symptoms or increased risk of compression.

If he suspects testicular cancer, the doctor will refer you as soon as possible to a urologist for further examinations and appropriate treatment.

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