About scrotal lumps & inflammation
Most lumps found in the scrotum are not cancer. Fluid-filled cysts (hydroceles and epididymal cysts) are very common, especially as men get older. Varicose veins within the scrotum (varicocele) are also common.
All scrotal lumps should be checked by a doctor to make sure they are not cancer.
A side view showing the main parts of the male reproductive system
Hydroceles & varicoceles
What is a hydrocele?
A hydrocele is a swelling in the scrotum caused by a build-up of fluid around the testes.
This is the most common cause of swelling around the testes in older men, although it can happen at any age and sometimes follows injury or inflammation. Hydroceles are usually painless but gradually increase in size and can become very large.
In younger men hydroceles may very rarely be a sign of an underlying testis cancer; an ultrasound scan can check for cancer in the testis.
During the development of the male embryo, the testes move down from the abdomen into the scrotum, after which the link between the abdomen and scrotum closes. In some young patients, a hydrocele may occur when the link between the abdomen and the scrotum has not closed properly.
In older men, hydroceles are not dangerous. The usual reason for treatment is because the size of the swelling becomes embarrassing or because of an aching discomfort.
How is a hydrocele treated?
If the hydrocele causes bother with discomfort or size then a minor operation will correct it. It is possible to drain the fluid with a syringe, but the fluid nearly always comes back again. Surgery has a better outcome than draining a hydrocele as there is a lower risk of recurrence (the hydrocele happening again).
What is a varicocele?
A varicocele is a swelling of the veins (varicose veins) above the testis. It affects about three in every twenty men and is usually on the left side. Varicoceles first appear at puberty and can sometimes cause discomfort. Varicoceles can affect fertility but this is not always the case. The benefits of treating varicoceles are not clear and are still being researched.
How is a varicocele treated?
A varicocele can be treated by a small operation. A small incision is made in the groin and the vein is tied. Alternatively, the vein can be tied (ligated) inside the abdomen using key-hole surgery. Another option is to plug the source vein (embolisation). This is done by a radiologist in the X-ray department through a small needle puncture into a vein in the groin. A very small tube is then threaded into the source vein and is blocked with an expanding plug or special glue.
Epididymal cysts & epididymitis
What is an epididymal cyst?
Epididymal cysts are very common and happen at all ages. They are fluid-filled cysts arising from the outflow duct of the testis (the epididymis). They are most often felt as a pea-sized swelling at the top part of the testis but they can become larger. An experienced doctor can usually diagnose an epididymal cyst from a careful genital examination as they are separate from the testis. If there is any doubt, the best test is an ultrasound scan.
Epididymal cysts are not dangerous and there is no higher chance of cancer or any other problem. They may cause bother with size or discomfort.
How is an epididymal cyst treated?
A small operation is done to remove the cyst(s). This is done through an incision in the scrotum. Great care has to be taken in younger men and men of reproductive age because the operation to remove an epididymal cyst can cause scar tissue to form. This can block the outflow duct of the testis, stopping the transport of sperm.
Epididymal cysts can be drained with a syringe under local anaesthetic. However, this is not recommended because the cysts can return and there is a risk of infection each time they are drained.
What is epididymitis?
Epididymitis is the painful inflammation or swelling of the epididymis (the outflow duct of the testis). The epididymis runs most of the way around the testis, so pain from epididymitis is felt in the testis generally. It can be very difficult to tell if the pain and swelling is coming from the epididymis, the testis, or both.
What causes epididymitis?
Epdidiymitis happens after a viral or bacterial infection. In younger men this is most often sexually transmitted infections such as chlamydia or gonorrhoea. In older men this is most often with bacteria that cause urinary tract infection such as E. coli. Other causes of epididymitis include inflammation against sperm and this can happen after injury or vasectomy. The problem is also sometimes seen in cyclists because of injury from the saddle.
How is epididymitis treated?
Antibiotic medicines are normally given to clear the infection and may need to be taken for up to six weeks. However, if the pain is severe and does not get better, treatment can be difficult.
Although it is simple to do an operation to remove the painful part of the epididymis, this does not always work. The pain can come back in the part of the epididymis or testis that is left behind. For this reason, before having surgery it is best to try non-surgical treatments such as a long course of antibiotics.
Removal of an epididymis from one side is the same as having a vasectomy on that side. This is important for a man to think about if he wants to father children in the future.
Orchitis & torsion of the testis
What is orchitis?
Orchitis is inflammation of the testes. The most common cause of orchitis is mumps virus but it can be caused by other viruses and, much more rarely, by bacteria.
How does mumps affect the testes?
Mumps can damage sperm production, particularly if the infection happens after the age of eight to nine years (when sperm producing cells are starting to grow). This damage can lead to male infertility, so immunising young boys against mumps is recommended.
How is orchitis treated?
The main treatment is rest and pain medicine. Although antibiotics are often given they probably don’t help much. Antiviral treatment has been reported to help in some cases.
What is torsion of the testis?
Torsion of the testis happens when the testis twists in the scrotum. The twisting of the testis cuts off the blood supply to the testis causing swelling. Unless the condition is treated quickly the testis dies.
What causes torsion of the testis?
Testicular torsion is most common in teenagers or young adults. In some men the testis is not securely attached to the wall of the scrotum, making it more likely to twist and block the blood supply. For this reason, if there is a testicular torsion, both testes should be fixed with surgery to stop the same thing happening on the other side.
Torsion can be triggered by physical and sexual activity. It may happen at night, and sudden severe testis pain at night should be checked at the nearest hospital straight away. The first few hours are vital if the testis is to be saved.
How is torsion of the testis treated?
Torsion of the testis is a medical emergency and needs immediate surgery to relieve the pain and to ‘save’ the testis.
Without a blood supply, the testis will die after six to eight hours. The longer the testis is without a blood supply, the lower the chance of being able to save the testis. During surgery the other testis should also be fixed in position to stop it twisting.