Scrotal Masses

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These are swellings found in the scrotum.

Cause

Painless Swellings

  • Testicular tumour
  • Inguinoscrotal hernia
  • Hydrocoele
  • Hydrocoele of spermatic cord
  • Spermatocoele/epididymal cysts
  • Varicocoele
  • Epididymal tumours
  • Chronic epididymo-orchitis

Painful Swellings

  • Testicular torsion
  • Acute epididymitis (STI or non-STI related)
  • Acute epididymo-orchitis
  • Strangulated inguinoscrotal hernia
  • Testicular tumour (usually painless except rapidly growing type or tumour necrosis)
  • Varicocoeles are occasionally accompanied by pain/discomfort

Symptoms

  • Swelling and/or pain of scrotum or its contents
  • Sudden onset e.g. torsion of testis
  • Gradual onset e.g. spermatocoele, hydrocoeles
  • Gradual onset becoming suddenly painful e.g. obstructed hernia
  • Fever, may be present in infections e.g. Acute epididymitis and acute epididymo-orchitis

Signs

  • Tender or non-tender swelling restricted to the scrotum (except a hernia which may extend into the inguinal area)
  • Fever may be present in infections
  • Transillumination for cystic swellings e.g. hydrocoeles and spermatoceles
  • Hard swelling e.g. Tumour 

Investigations

  • Ultrasound scan with or without colour doppler
  • Laboratory investigations are tailored towards cause and specific treatment

TreatmentTreatment Objectives

  • To make an accurate diagnosis to ensure appropriate treatment
  • To relieve pain
  • To prevent complications
  • To expedite emergency intervention eg Testicular Torsion

Non-pharmacological treatment

  • Surgery: elective or emergency
  • Emergency surgery within 6 hours is required for testicular torsion to salvage the testis 

Pharmacological treatment

For sexually transmitted infection

Evidence Rating: [B]

  • Ciprofloxacin, oral, 500 mg single dose

And

  • Doxycycline, oral, 100 mg 12 hourly for 10 days

Or 

  • Ceftriaxone, IM, 250 mg single dose

And

  • Doxycycline, oral, 100 mg 12 hourly for 10 days

Referral Criteria

  • Refer all emergency cases and those suspected to be tumours to a urologist or surgical specialist.