Testicle & Scrotal Problems
There are various conditions that can cause swelling in the scrotal sac. While cancer is understandably a concern, it is relatively rare in comparison to the more common benign swellings, including:
Hydrocele - collection of fluid around the testicle that causes a swelling which is soft but often painless.
Epididymal cyst - a fluid swelling above or behind the testicle along a tube called the epididymis that stores and carries sperm.
Varicocele - enlarged veins in the scrotum due to blood pooling that makes them torturous and stretched out like varicose veins in the leg.
Inguino-scrotal hernia - part of the bowel that pokes through a weak spot in the abdominal muscles in the groin allowing it into the scrotal sac.
Causes and Diagnosis
Usually the swellings occur without obvious cause:
Hydrocele can occur after scrotal trauma or inflammation.
Epididymal cyst usually occurs due to no clear cause but can perhaps occur slightly more common in men who've undergone previous vasectomy.
Varicocele is believed to occur due malfunctioning valves in the veins that control blood flow through the testicles.
Hernias typically develop later in life when muscles weaken or deteriorate due to ageing and strenuous physical activity
The diagnosis is usually made on the basis of history and physical examination plus ultrasound is requested for confirmation. If something untoward like a cancer is detected then this can be treated accordingly.
Treatment
Hydroceles and epididymal cysts are completely benign and nonthreatening. Smaller sized lesions or usually left alone. The only definitive option for treatment is surgical excision, and this is usually only performed if the swelling is large enough that it is causing sufficient bother because of size or discomfort. The surgical approach is performed as a day-case procedure under an anaesthetic where a scrotal incision is made to access the swelling and remove it. Risks include infection, bleeding, pain and recurrence [in the order of 5-10%].
Varicoceles are usually treated with embolisation which is an X-ray guided treatment, which blocks the enlarged vein from the testis using a spring (a coil) and allows the veins to shrink. This treatment is carried out by Interventional radiologists are specialised doctors who perform procedures using imaging machines to show them exactly where to go inside the body. This allows targeted treatment of the abnormal vein from within the vein itself. It is a day case procedure, so you only need to spend a few hours in hospital.
Inguinal hernias can be repaired using surgery to push the bulge back into place and strengthen the weakness in the abdominal wall. This surgery is typically performed by bowels surgeons and is also a day case procedure.