The testicles are glands that produce sperm and the hormone testosterone. Non-cancerous (benign) lumps can develop in the testicles for a number of reasons.
A hydrocele is a swelling of the sac (scrotum) that contains a testicle, caused by an accumulation of excess fluid in the surrounding membrane. It can occur on one or both sides. Hydroceles may be present at birth (congenital hydrocele), are most common in infants, but can occur at any age.
A varicocele causes swelling due to swollen veins within the scrotum. They commonly occur in teenagers or young adults. It almost always affects the left testicle and affects 10-15% of men, with up to 40% of infertile men having been found to have a varicocele.
An epididymal cyst (spermatocele) is a fluid filled swelling of the epididymis. The epididymis is a coiled tube, on top of and behind the testicles, which stores and then carries sperm away from the testicles. The cysts are usually small, do not usually cause pain and are harmless. Numerous cysts may develop along the epididymis. Epididymal cysts are common, especially in men over the age of 40.
Torsion of the testicle occurs when the testicle twists around the spermatic cord, cutting off blood supply to the testicle, causing acute pain and swelling. This is common in teenage boys, but can affect men of any age. Unless it is reversed urgently by surgery it can result in death of the testicle.
In many cases the cause of hydroceles is unknown. Although they are sometimes linked to infection, inflammation or minor injury. They may also occur because of previous operation on the testicles or groin. In infants they can occur in association with an inguinal hernia in the groin. Very rarely, hydroceles occur because of testicular cancer.
The cause of epididymal cysts and varicocele is unknown.
Most testicles are well supported in the scrotum and cannot twist. Torsion of the testicle is more common in people whose testicles lie abnormally in the scrotum.
A hydrocele causes visible swelling of the scrotum, heaviness, softness to touch. Although it is not normally painful it may be uncomfortably large.
Varicoceles usually cause no symptoms but may cause aching or discomfort. A varicocele may affect fertility due to the reduced circulation of blood in the testicular area.
Epididymal cysts are usually painless, but they may become tender and may be considered large and unsightly.
A testicular torsion causes sharp pain and swelling, sometimes causing nausea and vomiting. It is serious and needs immediate treatment.
The GP will identify a hydrocele by shining a light through the scrotum to illuminate the fluid causing the swelling. An ultrasound scan may be advised to exclude other testicular disorders.
The diagnosis of a varicocele is usually by physical examination of the scrotum while the man is standing up. It will usually disappear when the man lies down. A scrotal ultrasound may be used to confirm the presence of a varicocele. The varicocele is said to feel like a ‘bag of worms’.
An epididymal cyst grows above and behind the testicle. Physical examination will nearly always give a clear diagnosis.
Torsion of the testicle presents as swollen, inflamed and painful. This requires urgent surgical exploration.
Treatment of the hydrocele largely depends on age and level of discomfort, and it is common to be referred to a urinary system specialist (urologist) for a decision.
In infants hydroceles may subside by age 6 months without any treatment.
In adults they may cause no problems or risks so can be left alone.
Antibiotics may be given if the hydrocele appears to be caused by an infection.
A minor operation may be performed in hospital to empty the scrotum membrane of excess fluid (aspiration, also known as a hydrocelectomy).
Suspected testicular cancer requires further tests and specialist advice.
Infants with a hernia also present have an operation to repair the hernia, and at the same time close the passage through which the testicles descend, which may have been allowing fluid to pass into the hydrocele.
Most people with a varicocele do not require any treatment. Surgery may be advised if the varicocele is causing discomfort or fertility is an issue. This involves either tying off the enlarged veins or injecting a special chemical substance into the veins to block them. The procedures are usually performed as day cases under a general anaesthetic, and take approximately 45 minutes to perform. There is a chance of re-occurrence after the procedure and further treatment may be needed.
Epididymal cysts are harmless, and usually small and painless and no treatment is usually needed. If, however, a cyst becomes uncomfortable, then surgical removal may be advised.
Torsion of the testicle usually comes on suddenly and requires surgery within approximately six hours of onset in order to restore blood flow and save the testicle. Treatment involves an operation to untwist the testicle and then to fix it in position, to prevent it from becoming twisted again. The other testicle is usually fixed at the same time
source NHSDirect 151204