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Scrotal masses

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Screening and diagnosis

Most men discover scrotal masses themselves, either unintentionally or while doing a testicular self-examination to check for lumps.

If you alert your doctor to a scrotal mass, or he or she discovers a lump during a routine office visit, a physical exam and lab tests can confirm an infection or another cause. You may also undergo an ultrasound examination. This painless test passes sound waves through your scrotum to make an image of the contents of your scrotum.


Most scrotal masses require minimally invasive treatment or no treatment at all, but some require more serious procedures.

  • Epididymitis. This usually acute condition can be treated with antibiotics.

  • Spermatocele. Most spermatoceles are small, cause no symptoms and require no treatment. However, sometimes they can grow large enough to cause signs and symptoms such as pressure, pain or swelling in the scrotum and require surgical removal. Draining the fluid by puncturing the spermatocele through your skin may provide temporary relief. But the fluid invariably accumulates again within a few weeks.

  • Hydrocele. Usually, you don't need treatment for a hydrocele unless the scrotum is so swollen that it's uncomfortable.

  • Varicocele. If you have a varicocele and you're infertile, surgically tying off (ligation) the varicocele improves your chances of becoming fertile again.

  • Orchitis. Doctors use antibiotics to treat orchitis associated with bacterial infections. Treatment for orchitis associated with viral infections such as mumps is only by conservative means such as rest and pain-relieving medications.

  • Inguinal hernia. Your doctor may recommend surgery if your hernia is painful or bothersome. Hernias can recur after surgery, but this happens less than 10 percent of the time.

  • Cancer of the testicle. Stage I testicular cancer, in which cancer is found only in the testicle, and stage II testicular cancer, in which cancer has spread to the lymph nodes in the abdomen, are successfully treated in more than 95 percent of cases. Stage III testicular cancer, in which cancer has spread beyond the lymph nodes to other regions of the body, such as the lungs or liver, is successfully treated in about 70 percent of cases.

Generally, doctors use the following treatments for testicular cancer:

  • Radical inguinal orchiectomy. This surgical procedure involves removal of one or both testicles through an incision in the groin. Lymph nodes in the abdomen also may be removed (lymph node dissection). If only one testicle is cancerous and removed, there is a small chance that the other testicle will become cancerous at some time. As a result, your doctor will likely recommend regular follow-up exams with a urologist.

  • External beam radiation therapy. This treatment uses high-dose X-rays or other high-energy radiation to kill cancer cells.

  • Chemotherapy. Chemotherapy is used to kill cancer cells outside the testicle. This drug therapy is usually given by intravenous (IV) infusions, typically in the hospital, several days each month. In some cases, chemotherapy may also be given by intramuscular injection or in pill form. Chemotherapy has made the biggest difference in reducing death from testicular cancer.

  • Bone marrow transplant. In this procedure, some of your bone marrow is removed, treated with drugs to kill any cancer cells and then frozen. You then undergo chemotherapy, with or without radiation, to destroy the remaining cancer cells in your body. This chemotherapy also destroys your remaining bone marrow. The frozen marrow is then thawed and injected back into you through a needle in a vein. This relatively new treatment for testicular cancer has had some promising initial results. Yet it's not routinely recommended by doctors because traditional chemotherapy treatments are typically very successful.

Surgery may be in combination with radiation therapy or chemotherapy or both. Your treatment depends on the type and stage of your cancer. Your age and overall health also are factors in choosing treatment options.


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