The term scrotal mass means that a distinct mass can be felt within the scrotum, as opposed to a general swelling of the scrotum.
A variety of masses can occur in the scrotum, most of them benign or noncancerous. Testicular cancer is always a consideration, so any new scrotal mass should be evaluated.
The common kinds of masses are the: sebaceous, or epidermal, cysthydrocele herniahematocelespermatocelevaricoceletesticular tumor
A sebaceous cyst is a collection of sloughed material from the skin surface. These cysts are usually clearly within the wall of the scrotum rather than inside the scrotum. But sometimes they are deep and may appear to be another kind of mass. The cysts, sometimes called epidermal cysts, are benign. The only problem is that they may be uncomfortable or become infected.
A hydrocele is a collection of fluid around the testicle. A hydrocele is benign, and is important only in terms of the person's comfort. A hernia is a loop of bowel protruding from the abdomen into the scrotum. If the bowel travels to the scrotum and twists or cannot return into the abdomen it can lead to death of the bowel loop, a condition very dangerous to the patient.
A hematocele is a collection of blood around the testicle, which can often be more painful than a hydrocele. It is important to find the underlying cause of a hematocele.
A spermatocele is an outpouching of tissue from the epididymis. This is the name for the soft-coiled tubes along the back of the testicle that contain sperm. Spermatoceles are also called epididymal cysts. They are usually much smaller than hydroceles, and are benign. They do not need to be treated unless the person has symptoms. A varicocele is an enlargement, or dilation, of the veins that drain the scrotum. A varicocele may cause pain or infertility.
Testicular tumors are another kind of scrotal mass. Testicular cancer is mainly a disease of young men, but it can occur in any age, even in children. Any solid mass within the testicle is considered malignant until proven otherwise. There are a few testicular tumors that are benign.
Most scrotal masses, including testicular tumors, develop without symptoms. They are first noticed as painless masses. The main exception is the hematocele, which often develops quickly after surgery or trauma. Hematoceles can cause quite a bit of discomfort.
Large scrotal masses may create a heavy or dragging sensation. Some, such as hydroceles, can grow so large that the usual clothes cannot be worn. Sudden pain with a mass in the scrotum suggests infection of the mass, sudden bleeding into the mass, or trapping of a loop of bowel.
Hydroceles, spermatoceles, and hematoceles can be triggered by surgery on the groin or scrotum. Some of these masses may be present since birth or may develop with age.
Usually a healthcare professional can tell which kind of scrotal mass is involved by doing a physical exam. An epidermal cyst is not mobile, and its location within the skin of the scrotum can be felt. A hydrocele is usually located behind and above the testicle.
Both hydroceles and spermatoceles, which are located along the epididymis, can be transluminated. This test is done in a darkened room. A bright light is shone onto the skin of the scrotum. If the light can be seen passing through the mass, the mass is probably filled with fluid. A hernia cannot be transilluminated, but the loop of bowel can usually be pushed temporarily back into the abdomen.
A hematocele will not transluminate because the blood is opaque. A varicocele feels to the doctor like a "bag of worms" when the person is standing. When the person lies down, the blood usually drains out of the veins and the varicocele is no longer apparent. A testicular tumor is usually a hard mass within the testicle that cannot be transluminated. If there is any doubt, an ultrasound of the scrotum can be done. Ultrasound is very reliable for determining the kind of mass.
Epidermal cysts, hydroceles, and spermatoceles are benign lesions. They are important only if they bother the person because of size or pain. Hernias are benign but pose a risk of entrapment and death of a loop of bowel. Varicoceles can cause discomfort, but more commonly they cause infertility in men.
Hematoceles themselves are benign. If the bleeding that causes them is not due to trauma or surgery, the cause must be found. An underlying disease, such as a testicular tumor, could be the source of the bleeding. Solid masses in a testicle are assumed to be malignant testicular tumors until proven otherwise. These tumors can spread to other parts of the body very easily, but modern treatments provide a very high rate of cure.
Epidermal cysts, hydroceles, hernias, and spermatoceles can be removed with a simple operation on the scrotum or the groin. This procedure can be done on an outpatient basis in a same day surgery center.
Treatment of hematoceles depends on the underlying cause and the person's symptoms. Surgery may be done for drainage, or the treatment may be conservative, with just elevation and bed rest. Varicoceles can be treated with surgery to tie off the veins or other procedures to occlude the veins. Removal of the testicle, or a radical orchiectomy, is the treatment for a testicular tumor.
Surgery can be complicated by bleeding, infection, or reactions to the drugs used for anesthesia and to control pain. Operations on the scrotum often cause mild but nagging discomfort for several weeks afterward because the scrotum swells. This swelling is often difficult to get rid of because of the way the scrotum hangs down. It is very unusual for scrotal surgery to cause erectile dysfunction or urinary incontinence.
After scrotal surgery, infection or bleeding into the tissues of the scrotum is not uncommon. These problems can be managed easily, but they often cause the person to be somewhat disabled for several weeks. This is one of the main reasons that elective surgery on the scrotum is avoided unless the person has severe symptoms.