Testicular lumps are common
Testicular tumours are rare and need to be excluded
Testicular lumps are found in a variety of conditions:
- Epididymal cysts
- Hydroceles
- Sperm granulomas
- Varicoceles
- Epididymo orchitis
- Inguino scrotal hernias
- Testicular tumours
Testicular ache/pain is a common condition. It can be quite difficult to diagnose the exact cause of the pain. If there is no diagnosis then the patient can be reassured after full examination and investigation.
History
Pain
Testicular pain tends to be located in the testis itself whereas epididymal pain can radiate the groin area. Hydroceles epididymal cysts and varicoceles can present with a dull ache. Sperm granulomas can be very painful and tender. 61% of testicular tumours present with a pain in the testicle but remember these conditions are uncommon. Length of history going back many years is most unlikely to be due to a testicular tumour.
Examination
Lumps
When examining a testicle it is possible to get above the lump in most cases. The exceptions are varicocele and inguino scrotal hernias. Hydroceles and epididymal cysts transilluminate when a light is shone through them. Sperm granulomas are felt in the epididymus or at the site of a vasectomy. Any lump arising from the testis itself may be a tumour.
Investigations
Blood tests
Tumour markers (αfeto protein βHCG and LDH) if a tumour is suspected.
Ultrasound
Ultrasound should be used as an adjunct to clinical examination. It can identify lesions in the testis that are not palpable. Epididymal cysts are easily seen. In hydrocele the testis is often not palpable. The ultrasound may identify an underlying problem. Tumours are seen on ultrasound. Tumours can be differentiated from infections such as epididymo orchitis.
The further management depends on the diagnosis. Refer to the relevant article in the urology article section.
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