scrotal
swelling /enlargement
Overview
Scrotal swelling can be an indicator of several different conditions. The swelling could be due to the accumulation of fluid, abnormal tissue growth, or swelling or inflammation of the testicles or other components within the scrotum.
Any patient displaying signs of scrotal swelling should seek a physician promptly. Even if there isn’t pain or other symptoms, the underlying conditions that lead to scrotal swelling can be very serious. An increase in the scrotum size can be due to cancer or other problems that can have drastic adverse effects on both testicular function and health.
Scrotal swelling often indicates a condition that can adversely affect fertility. In children, scrotal swelling can be a sign of issues that can delay or hinder healthy development during puberty.
Symptoms
Because of the many causes of scrotal swelling, symptoms are diverse. They can include:
- Swelling or unusual lump on the scrotum
- Sudden groin pain
- Tender or swollen testicle
- Redness of the skin
- Vomiting and nausea
- Fever
- Increased frequency of urination
- Blood or pus in the urine
Diagnosis
The diagnosis procedure for scrotal swelling will entail a series of tests and examinations to determine the condition’s underlying cause. These causes are diverse and can include:
- Testicular cancer
- A spermatocele, a cyst in the scrotum
- Epididymitis, inflammation of the epididymis
- Orchitis, inflammation of the testicle
- A hydrocele, an accumulation of fluid around the testicles
- A hematocele, an accumulation of blood around the testicles
- An inguinal hernia, where a portion of the small intestine breaches the abdominal wall
- Testicular torsion, where the spermatic cord becomes twisted
Testing will generally entail a physical exam of the scrotum and groin. The physician can also shine a light through the scrotum to better see the scrotal mass. An ultrasound will reveal more detailed information about the nature of the swelling and condition of the testicles. Urine and blood tests are also commonly taken.
Treatment
Treatment will vary depending on the underlying condition responsible for the scrotal swelling. While most cases of scrotal swelling are due to benign conditions that require little to no treatment, some causes are incredibly severe and will require immediate intervention.
Infections
When the swelling is due to a bacterial infection of the epididymis or testicles, oral antibiotics are the most common treatment. Viral infections can also occur and are generally treated with medication to relieve symptoms.
Benign Scrotal Masses
In cases where swelling is due to a non-cancerous mass or fluid buildup, removal or draining can be necessary where the condition causes significant discomfort or pain. In some cases, there is no need to intervene.
Testicular Cancer
Scrotal swelling could result from cancerous growth. Treatment will vary significantly between individual patients. If cancer has not spread, removing the affected testicle and spermatic cord is the most common course of treatment. Chemotherapy and radiation therapy are also potential treatments.
Hydrocele Repair
Hydroceles are collections of fluid that accumulate in the scrotum around the testicle and can be found in infants, children, and adults. In infants and young children it can involve a hernia resulting from a channel communicating with the abdominal cavity that fails to close after the testicle descends into the scrotum around the time of birth. In older children and adults, it often results from an infection or injury to the scrotum or after prior inguinal surgery such as a hernia repair or varicocele ligation. Hydroceles can resolve spontaneously over time. They can also become uncomfortable and bothersome as they grow in size.
Treatment of hydroceles typically involves surgical removal of the hydrocele sac. This requires a general or spinal anesthesia, takes approximately 30-60 minutes, and is done on an outpatient basis. Surgical correction of hydroceles in infant and young children involves a small incision along the groin with the hernia sac dissected out and repaired while the hydrocele fluid and sac are removed. In teenagers and adults an incision is made along the scrotum. The fluid is removed and the sac is obliterated to avoid recurrent accumulation of fluid. Aspiration is a rarely used treatment for hydroceles. This is a technique in which the fluid is simply removed by placing a needle through the skin with no incision. It can be done under local anesthesia in the office but is associated with a high recurrence rate.
What to expect afterwards:
After surgery it is very common to have swelling of the testicle for several weeks to months. The swelling can be significant depending on the size of the original hydrocele. With larger hydroceles, a drain may be used for several days after surgery to minimize the swelling. After surgery it is important to use a scrotal support and ice regularly. One should avoid vigorous exercise and lifting for at least one to two weeks after surgery. Antibiotic ointment should be applied to the scrotal incision twice a day for the first few weeks.
Spermatoceles (Epididymal Cyst)
Spermatoceles and Epididymal cysts are typically painless and completely benign (not cancerous) cysts that form along the epididymis which sits in back of each testicle. They are filled with sperm and usually sit along the top of the testicle and are distinct from the testicle and epididymis. The exact cause of spermatoceles are not known however they are thought to be due to a blockage of a duct along the transportation of sperm causing back pressure and the formation of a cyst. They are commonly seen in men who have had a vasectomy and have been estimated to occur in 25-30% of all men. They can remain stable in size or they can grown. Reasons for getting them removed generally revolve around discomfort associated with their size as they grow.
Surgery involves a general or spinal anesthetic and a small scrotal incision to access the testicle and spermatocele. The procedure usually takes 30-60 minutes and is performed on an outpatient basis. Risks involve recurrence of the Spermatocele which is rare, infection, bleeding and hematoma formation, as well as potential injury to the testicle.
What to expect afterwards:
After surgery it is important to wear a scrotal support and ice to minimize scrotal and testicular swelling. Bacitracin or Neosporin antibiotic ointment should be applied to the incision twice a day for the first few weeks. It is also important to avoid vigorous exercise or heavy lifting for the first one to two weeks after surgery to minimize swelling.
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FAQ's
For many conditions that lead to scrotal swelling, early detection is key to successful treatment. That being the case, doctors recommend that men carry out a careful self-examination once a month. Generally, the examination should be done while in a warm bath or shower to relax the scrotum. By carefully physically examining the testicles for lumps and swelling, patients can seek medical advice sooner.
There are several critical questions that a doctor can ask to more effectively and quickly diagnose the cause of scrotal swelling. These will include questions about other symptoms and pain you’ve been having. They will also ask if you have had an undescended or retractile testicle that has been corrected through surgery. Further questions can cover any history of sexually transmitted infections and urinary tract infections.
While most cases of scrotal swelling are relatively harmless, it can be an indicator of serious problems. If your scrotal swelling is sudden or accompanied by pain, seek medical attention immediately. It could be a case of testicular torsion, leading to loss of the testicle if not treated quickly. Other issues can still be severe and worsen if untreated, especially in testicular cancer and infections.