Scrotal Masses

The abnormal contents present in the scrotum can be termed as scrotal masses. Scrotum of a bag of skin consisting of seven layers which holds testis and related structures that produce store and transport male sex hormones and sperm.

Scrotal masses might be accumulation of fluids, growth of abnormal tissue or normal contents of scrotum which have become swollen and large in size.

Scrotal masses must be examined by doctor even if they are not painful, they might be cancerous can cause dysfunction of testis. To promote recognition, diagnosis and treatment of scrotal masses regular checkups and self-assessment is important. 

Depending on the type of abnormality signs and symptoms of scrotal masses may vary some of them may include:

• unusual lump,
• sudden pain,
• a dull aching pain or feeling of heaviness in the scrotum,
• radiating pain to the abdomen and lower back,
• tender,swollen or hardened testicle,
• tender, swollen or hardened epididymis,
• swelling in the scrotum,
• redness of the skin of the scrotum,
• nausea or vomiting.

If the cause of scrotal mass is caused by infection symptoms might vary a little like:

• fever (hyperthermia),
• urinary frequency,
• pus or blood in the urine.

A number of disorders may cause accumulation of scrotal masses, they include:

• Testicular cancer- a tumor containing abnormal testicular tissue. Which can usually be felt as a lump in the scrotum. Although most of the tumors do not cause any symptoms some men experience pain and swelling.
• Spermatocele- also known as spermatid cyst or epididymis cyst is usually located above the testicle   which is non-cancerous, fluid filled sac.
• Epididymitis- this is inflammation in the epididymis. This inflammation is often caused by some bacteria such as chlamydia. Less commonly, epididymitis is caused by a viral infection or abnormal flow of urine into the testis.
• Orchitis- inflammation of the testicle usually due to viral infection, if bacteria is the cause of orchitis epididymis will also be involved.
• Hydrocele- if there is presence of fluid in between the layers of sac that surrounds testis this condition may be referred as hydrocele.
• Hematocele- occurs when there is presence of blood between the layers of sac surrounding the testis.
• Varicocele- this is enlargement of veins that carry venous blood from the scrotum. This may lead to infertility of the patient.
• Inguinal hernia- it is portion of small intestine which enters the weak spot of the inguinal canal. Usually happens if the passage way from the abdominal cavity to the scrotum is not closed due to improper development.
• Testicular torsion- twisting of a testis along with the nerve supply and blood supply will cause in compression of spermatic cord, blood vessel and can lead to permanent damage caused by tissue hypoxia (low amount of oxygen)

A number of examinations are done to diagnose scrotal masses, they include:

• Physical examination- palpation, checking for rigidity or tenderness.
• Transillumination- a process in which a bright light is passed through scrotum making it easy for the location of masses if they are present.
• Ultrasound- a diagnostic technique which uses sound waves to duplicate the picture of internally located scrotal masses. It will give detailed information about the shape, size and location of scrotal mass.
• Urine test- laboratory analysis of urine will be made to check for the presence of bacteria or virus and check for the presence of blood in the urine.
• Blood test-  elevated levels of certain proteins that are associated with testicular cancer are diagnosed and presence of bacteria and virus in the blood can be detected.
• Computerized tomography-  this scan gives the picture of internal masses if there are any present. 

Scrotal masses produced due infections are treated respectively. If they are caused by bacteria antibiotics are used. If they are caused by virus antiviral therapy is prescribed.  

If there is presence of noncancerous scrotal mass surgical removal, repair or drainage can be done treatment decision can be made based on whether the scrotal mass:

• causes discomfort or pain,
• contributes to increase the risk of infertility,
• becomes infected.

In case of testicular cancer an oncologist might recommend the following:

• Radical inguinal orchiectomy-  it is a surgical procedure to remove the effected testicle and spermatic cord. along with testis lymph nodes can also be removed.
• Radiation therapy-  this therapy includes usage of high energy radiation to kill the cancerous cells that may remain after the removal of affected testicle.
• Chemotherapy- a drug therapy which uses powerful chemicals to kill the cancerogenous cells.

Most of the causes of scrotal masses can’t be prevented because they are related to genetics and developmental anomalies. But some bacterial infections and viral infections can be prevented by maintaining proper hygienic conditions of scrotum and eating hygienic food. 

Alternative and home remedies for scrotal masses include self-assessment.

Examine testicles once a month especially if anyone from the family had testicular cancer. Examination after warm bath or shower the heat relaxes the scrotum and it’s better to examine. Stand in front of the mirror and examine for any scrotal thickening or swelling.  

Check epididymis for swelling. Palpate the testis for any lumps. 

Lifestyle of a man affected with scrotal masses depends on the severity of the case.  

One must examine their testis regularly and they must consult a doctor especially those people who are predisposed to have scrotal masses.

Infertility will cause huge problem in a man’s life at this time he will need strong social and family support.

Risk factors of scrotal masses include: 

• undescended or retractile testicle: an undescended testicle don’t leave the abdomen and enter the scrotum during development. A retractile testicle descends to the scrotum but goes back into the abdomen increasing the risk of testicular torsion, inguinal hernia, testicular cancer.
• Abnormalities of testis present during the birth may increase the risk of scrotal masses. If one testis was affected by cancer, there is a high risk of another testicle to develop scrotal masses.  

Not all of the scrotal masses result in long-term complications. However, any mass that can affect health of testicle can lead to:

• delayed or poor development during puberty,
• infertility.