Testicular Swelling and Lumps

A swollen or enlarged testicle, or a lump in the scrotum, has many possible causes and most are benign. The common ones are a hydrocele, which is fluid around the testicle; an epididymal cyst; a varicocele, which is enlarged veins; an inguinal hernia extending into the scrotum; and infection of the epididymis or testicle.

The reason every lump should be examined is that testicular cancer, although uncommon, is the most frequent cancer in men aged 15 to 40 and usually presents as a painless lump or a firm enlargement of the testicle itself. It is among the most treatable cancers. An ultrasound scan settles the question quickly and reliably.

Symptome

• A painless swelling of one side of the scrotum that may vary in size through the day
• A soft, smooth, separate lump above or behind the testicle, typical of an epididymal cyst
• A feeling like a bag of worms above the testicle, usually on the left, more obvious when standing
• A hard lump within the testicle, or a testicle that feels heavier and firmer
• A dragging sensation or dull ache in the scrotum or groin
• A swelling that enlarges on coughing and goes back when lying down, suggesting a hernia
• Painful, red, hot swelling with fever, suggesting infection
• Swelling of the whole scrotum on both sides along with swollen legs

Ursachen und Risikofaktoren

A hydrocele forms when fluid collects in the sac around the testicle; in adults it may follow injury, infection or have no cause, and in babies it reflects an open channel from the abdomen. Epididymal cysts and spermatoceles are harmless fluid sacs. Varicoceles result from faulty valves in the testicular veins; one that appears suddenly on the right or in an older man warrants a kidney scan. Epididymo-orchitis is caused by sexually transmitted infections in younger men and urinary bacteria in older men; mumps can inflame the testicle. Testicular cancer is linked to an undescended testicle, family history and previous cancer in the other testicle. Heart, liver or kidney failure cause generalised scrotal swelling.

Wie es diagnostiziert wird

• Examination: Standing and lying, including whether the lump is part of the testicle or separate from it, and whether light shines through it, as it does with fluid.
• Scrotal ultrasound with Doppler: The decisive test. It distinguishes solid from fluid-filled lumps, inside from outside the testicle, and assesses blood flow.
• Urine tests and STI swabs: When infection is suspected.
• Tumour markers: AFP, beta-hCG and LDH blood tests, taken before surgery when ultrasound shows a solid testicular mass.
• CT of chest, abdomen and pelvis: Staging if cancer is confirmed.
• Semen analysis and hormones: When a varicocele is found in a man with fertility concerns.

Behandlungsmöglichkeiten

• Reassurance and observation: Small hydroceles, cysts and symptom-free varicoceles need no treatment.
• Hydrocele repair: A day-case operation through the scrotum for large or uncomfortable hydroceles. Draining with a needle is temporary and risks infection.
• Excision of an epididymal cyst: Only for cysts that are large or painful, and approached cautiously in men who want children because of possible blockage.
• Varicocele treatment: Microsurgical ligation or radiological embolisation for pain, a shrinking testicle in adolescents, or abnormal semen in a couple with infertility.
• Antibiotics: For epididymo-orchitis, with rest, scrotal support and treatment of partners when an STI is the cause.
• Hernia repair: Open or laparoscopic mesh repair.
• Radical inguinal orchidectomy: Removal of the testicle through a groin incision for suspected cancer, ideally within a week or two, with sperm banking offered first. Further treatment depends on pathology and staging.

Wenn es dringend ist

Sudden severe pain in a testicle, with or without swelling, nausea or a testicle riding high, may be torsion: go to the nearest emergency department immediately, as the testicle can be lost within about 6 hours. Also seek same-day care for a hot, red, very painful scrotum with fever, a hernia that becomes painful and will not go back, or swelling after an injury.

Reisen nach Türkiye zur Behandlung

Have any new lump scanned locally first; it is quick and should not wait for a trip. If a solid mass is found, surgery should happen promptly near home rather than being delayed by travel. Planned day-case operations for a hydrocele, varicocele or hernia are a reasonable purpose for a visit, needing around 4 to 7 days, with no heavy lifting for 2 to 4 weeks afterwards. Expect swelling and bruising for a few weeks after hydrocele surgery.

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