Scrotal masses

Overview

Scrotal masses refer to abnormalities that occur in the scrotum, which is the bag of skin located behind the penis. This area contains structures responsible for producing, storing, and transporting sperm and male sex hormones. Scrotal masses can occur due to an accumulation of fluids, abnormal tissue growth, or swollen and inflamed normal contents of the scrotum.

It is crucial to get examined by a doctor if you notice any scrotal masses, regardless of whether or not you are experiencing pain or other symptoms. This is because scrotal masses could be cancerous or caused by a condition that affects testicular function, such as infertility in men.

Therefore, regular self-examinations and doctor check-ups of the scrotum are necessary for the prompt recognition, diagnosis, and treatment of scrotal masses.

Symptoms

The signs and symptoms of scrotal masses can differ based on the specific type of abnormality. However, they may include:

• Nausea
• Vomiting
• Abnormal lump on the scrotum
• Pain that appears unexpectedly
• A heaviness or dull ache in the scrotum
• Tender, swollen, or stiffened epididymis, the sperm-transporting, comma-shaped tube that is located above and beneath the testicle.
• The scrotum appears to have a reddish skin, swollen, or hard
• Painful sensation flowing through the lower back, abdomen, or groin

The following signs and symptoms could potentially be present if an infection is the source of the scrotal mass:

• Bloody urine
• Pus in the urine
• Frequent urination
• Fever

If you experience sudden pain in your scrotum, seek emergency medical attention. In some cases, a testicle may need immediate treatment to prevent irreversible harm.

Consult a medical professional if you feel a lump in your scrotum, even if it isn’t painful or tender, or if you experience any other symptoms related to a scrotal mass.

Scrotal lumps are more common in children. If your child exhibits signs of a scrotal mass, or if you are concerned about their genital development, or if one of their testicles is “missing” due to an undescended or retractile testicle which may increase the risk of developing scrotal masses later in life, it is important to seek medical advice.

Causes

A scrotal lump or other anomaly in the scrotum can be caused by a number of conditions, including:

• Testicular cancer. Testicular cancer is a type of tumor that develops from abnormal testicular tissue and is typically characterized by the presence of a painless lump in the scrotum. While some men may experience swelling or discomfort, most tumors do not produce noticeable symptoms. It’s important to consult a doctor if you detect any new lumps in your scrotum.
• Spermatocele. which is also called epididymal cyst or spermatic cyst, refers to a fluid-filled sac in the scrotum that is usually located above the testicle. This condition is typically painless and benign, meaning it is noncancerous.
• Epididymitis. Is the inflammation of the epididymis, which is a comma-shaped structure located behind and above the testicle, responsible for storing and transporting sperm. The most common cause of epididymitis is a bacterial infection, including sexually transmitted ones like chlamydia, but it can also result from a viral infection or abnormal urine flow into the epididymis.
• Orchitis. Refer to the inflammation of the testicle, typically caused by a viral infection such as mumps. However, if orchitis results from a bacterial infection, it may also infect the epididymis.
• Hydrocele. Hydrocele is a condition where there is a buildup of excess fluid between the layers of a sac surrounding the testicles, resulting in painless swelling of the scrotum. In infants, hydrocele is caused by the failure of the opening between the abdomen and scrotum to close properly during development, while in adults, it is usually caused by an imbalance in the production or absorption of fluid, often due to scrotal injury or infection.
• Hematocele. A hematocele is a condition characterized by the accumulation of blood between the layers of the sac that encloses each testicle. This condition is commonly caused by physical trauma, such as a direct impact to the testicles.
• Varicocele. Varicocele is a medical condition where the veins inside the scrotum become enlarged. These veins are responsible for carrying blood that is low in oxygen from the testicles and epididymis. It is worth noting that varicocele tends to occur more frequently on the left side of the scrotum. This is due to differences in the way blood flows on each side. If left untreated, varicocele may result in infertility.
• Inguinal hernia. Inguinal hernia is a medical condition that happens when a part of the small intestine protrudes through a weak spot or opening in the tissue that separates the abdomen and groin. In infants, this condition is commonly caused by the incomplete closure of the passageway from the abdomen to the scrotum during development. The manifestation of an inguinal hernia can be seen as a lump or mass either in the scrotum or in the upper groin area.
• Testicular torsion.  The twisting of the spermatic cord is a painful condition that occurs when the bundle of blood vessels, nerves, and the tube responsible for carrying semen from the testicle to the penis becomes entangled. If left untreated, this condition can cut off the blood supply to the testicle, which may result in the loss of the affected testicle. Symptoms of this condition include an enlarged, higher-than-normal testicle that may be positioned sideways.

Risk factors

Due to the diverse sources of scrotal abnormalities, there are different risk factors for scrotal masses. Important risk elements include:

• Undescended or retractile testicle: During fetal development or the first few months of life, an undescended testicle does not exit the abdomen and enter the scrotum. In the case of a retractile testicle, the testicle moves into the scrotum but may then move back up to the abdomen. Both undescended and retractile testicles can increase the risk of testicular torsion, inguinal hernia, and testicular cancer.
• Congenital abnormality: Abnormalities present at birth in the testicles, penis, or kidneys can increase the risk of developing testicular cancer and scrotal masses in later life.
• Testicular cancer in the pass: You run a higher risk of developing cancer in the other testicle if you’ve already had cancer in one testicle. If your father or sibling has had testicular cancer, your risk of developing the disease is further increased.