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Definition
The term scrotal mass means that a distinct mass can be felt within the scrotum, as
opposed to a general swelling of the scrotum.
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What is going
on in the body?
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:
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sebaceous,
or epidermal, cyst
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hydrocele
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hematocele
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spermatocele
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testicular
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 hematocele is a collection of blood around the testicle. Hematoceles are often more
painful than a hydrocele. It's 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.
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.
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What are the
signs and symptoms of the condition?
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, or sudden bleeding
into the mass.
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What are the
causes and risks of the condition?
Hydroceles, spermatoceles, and hematoceles can be triggered by surgery on the groin or
scrotum.
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How is the condition
diagnosed?
Usually a healthcare provider 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 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 drains out of the veins and a 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.
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What are the
long-term effects of the condition?
Epidermal cysts, hydroceles, and spermatoceles are benign lesions. They are important only
if they bother the person because of size or pain.
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.
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What are the
treatments for the condition?
Epidermal cysts, hydroceles, and spermatoceles can be removed with a simple operation on
the scrotum. 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 or other procedures to tie off the veins. Removal
of the testicle, or a radical orchiectomy, is the treatment for a testicular tumor.
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What are the side
effects of the treatments?
There are possible side effects with any surgery. These include bleeding, infection, and
reactions to the drugs used 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.
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What happens
after treatment for the condition?
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.
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