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Testicle Lumps - What You Need to Know

Testicle Lumps – What You Need to Know

July 19, 2021 (updated July 20, 2021) Published by

A testicle lump, or testicular lump, is an abnormal mass that can form in the testicles.

The testicles, or testes, are egg-shaped male reproductive organs that hang below the penis in a sac called the scrotum. Their primary function is to produce sperm and a hormone called testosterone.

A testicular lump is a fairly common condition that can have many different causes. Testicular lumps can occur in men, teenage boys, or younger children. They may be located in one or both of the testicles.

Testicular lumps can be a sign of problems with your testicles. They may be caused by an injury, but they can also indicate a serious underlying medical problem.

Not all lumps indicate the presence of testicular cancer. Most lumps are caused by benign, or noncancerous, conditions. These usually require no treatment.

Still, your doctor should examine any changes in your testicles, especially lumps or swelling.

Symptoms of a testicular lump

Nearly all testicular lumps cause noticeable swelling and changes in the texture of your testicle. Other symptoms vary, depending on the underlying cause of your testicular lump:

  • A varicocele rarely causes symptoms. If it does cause symptoms, the affected testicle may feel heavier than the other testicle, or the lump may feel like a small sac of worms.
  • A hydrocele is painless in infants, but it can cause a feeling of abdominal pressure in older boys and men. It also causes visible swelling of the testicles.
  • Epididymal cysts are also generally painless. In some men, one testicle may feel heavier than normal.
  • An infection may cause pain, swelling, or tenderness in one or both of your testicles. It can also cause fever, nausea, and vomiting.

Though it can occur spontaneously, testicular torsion is a condition that’s typically caused by a scrotal injury. It’s a medical emergency. It can be extremely painful and may involve the following symptoms:

  • a fever
  • frequent urination
  • abdominal pain
  • nausea
  • vomiting
  • swelling of your scrotum
  • unusual positioning of a testicle, which may be higher than normal or oddly angled

A lump caused by testicular cancer can produce the following symptoms:

  • a dull ache in your abdomen or groin
  • swelling or tenderness in your breasts
  • heaviness in your scrotum
  • a sudden collection of fluid in your scrotum
  • pain

Types and causes of testicular lumps

There are multiple possible causes of testicular lumps, including injury, birth defects, infection and other factors.

Varicocele

This type of testicular lump is the most common. It occurs in about 15 to 20 percent of men. Enlarged veins in the testicles cause varicoceles. They become more noticeable after puberty, which is when blood flow increases in fully developed testicles.

Hydrocele

A buildup of fluid in the testicles causes a hydrocele. This type of testicular lump occurs in at least 5 percent of newborn males. Premature babies have a higher risk of developing a hydrocele.

Epididymal cyst

An epididymal cyst occurs when the long, coiled tube behind the testicles called the epididymis becomes filled with fluid and can’t drain.

If the cyst contains sperm, it’s known as a spermatocele. This form of testicular lump is very common. It most often resolves on its own.

Epididymitis and orchitis

Epididymitis is an inflammation of the epididymis. A bacterial infection often causes it. This includes some sexually transmitted infections (STIs), such as gonorrhea or chlamydia.

An infection also causes orchitis, which is an inflammation of the testicle. Bacteria or the mumps virus can cause the infection.

Testicular torsion

Testicular torsion occurs when the testicles become twisted, typically due to an injury or accident. This condition most often occurs in boys between the ages of 13 and 17 years old, but it can affect men of all ages.

This is a medical emergency that requires urgent investigation and possible treatment.

Hernia

One type of hernia occurs when part of your bowel pokes through your groin and into the scrotum. This can cause your scrotum to become enlarged.

Testicular cancer

Some lumps indicate the growth of testicular cancer. Only a doctor can determine if a lump is cancerous.

Testicular cancer isn’t common overall, but it’s the most common type of cancer among American men between the ages of 15 and 35.

Diagnosing testicular lumps

Your doctor can properly diagnose the cause of a testicular lump. Make an appointment with your doctor if you notice a lump during a self-exam or you’re experiencing the symptoms described above.

If you’re experiencing symptoms of testicular torsion after an injury, go to an emergency room immediately. If it’s left untreated, testicular torsion can cause testicle death and infertility.

Before your appointment, write down any symptoms you’re experiencing and how long you’ve felt them. Tell your doctor if you’ve had any injuries recently. You should also be prepared to talk about your sexual activity.

Your doctor will put on gloves and physically examine your testicles to note their size and positioning and to check for swelling and tenderness.

Most testicular lumps can be diagnosed during a physical examination. However, your doctor may order other tests to confirm the diagnosis.

These tests may include:

  • an ultrasound, which uses sound waves to create an image of your testicles, scrotum, and abdomen
  • a blood test, which involves testing a sample of your blood for the presence of tumor cells, infections, or other signs of problems
  • an STI screening, in which a sample of fluid is collected from your penis with a swab or from urine to be analyzed in a laboratory for gonorrhea and chlamydia
  • a biopsy, which involves removing a small tissue sample from your testicle with specialized equipment and sending the sample to a laboratory for testing

Treatment for testicular lumps

Your treatment plan will vary, depending on the cause of your testicular lump.

Varicocele

Pain from a varicocele usually subsides without treatment. However, your doctor may prescribe pain medication or advise you to use over-the-counter pain relievers.

In cases of recurring episodes of discomfort, you may need surgery to reduce the congestion in your veins.

The surgery may involve tying off the affected veins or diverting blood flow to those veins through other methods. This causes blood to bypass those veins, which eliminates the swelling.

Hydrocele

Treatment for a hydrocele lump may also involve surgery, but it most often clears up on its own by age 2. The surgery involves making a small incision in the scrotum to drain excess fluid.

Epididymal cyst

An epididymal cyst doesn’t require treatment unless it causes pain or discomfort. You may need surgery. During this procedure, your surgeon will remove the cyst and seal your scrotum with stitches that usually dissolve within 10 days.

Testicular torsion

Testicular torsion requires immediate surgery to untwist your testicle and restore blood flow. Your testicle can die if you don’t get treatment for the torsion within 6 hours.

If your testicle dies, your doctor will have to remove it surgically.

Epididymitis and orchitis

Your doctor can treat infections in your epididymis or testicles with antibiotics if bacteria are the cause. In the case of an STI, your partner may also need to be treated.

Hernia

A hernia is often treated with surgery. Your doctor may refer you to a hernia specialist for treatment.

Testicular cancer

Testicular cancer is treated using surgery, chemotherapy, radiation, and other methods. Your specific course of treatment will depend on how early your cancer is detected and other factors.

Surgical removal of your testicle may help stop the cancer from spreading to other parts of your body.

What is the outlook?

Your outlook will depend on the underlying cause of your testicular lump.

Most cases of testicular lumps aren’t serious or cancerous. Testicular cancer is rare. It’s also highly treatable, and it’s curable if you find it early.

Whether or not men should do monthly testicle self-exams is a controversial issue. There is no good evidence that a self-exam leads to a reduction of mortality from testicular cancer.

Since it’s difficult to figure out the cause of a testicular lump based on your symptoms alone, it’s important to visit a doctor if you notice any changes. Make an appointment with your doctor if you notice any lumps, swelling, or pain in your testicles.

References

Spermatocele Causes Symptoms and Treatments

Spermatocele – Causes, Symptoms & Treatment

July 18, 2021 (updated July 18, 2021) Published by

A spermatocele is an often pain-free benign cyst that occurs close to a testicle. It may also be known as a spermatic or epididymal cyst.

The cyst forms in the epididymis. The epididymis is a coiled tube behind each testicle. The cyst is filled with fluid and may contain dead sperm. Read on to learn more about identifying and treating this condition.

Symptoms

Spermatoceles cannot be seen during a visual exam. That’s because they’re contained within the scrotum. They can be felt, however. A spermatocele feels like a smooth, but separate, firm lump. The lump is found near the top of, or behind, a testicle.

Spermatoceles are most likely to be discovered during your yearly physical when your doctor checks for any signs of a testicular growth. Spermatoceles are benign and only appear in the scrotum. That means they’re not a sign of testicular cancer.

If the cyst grows too large, you may feel discomfort or pain in the testicle. You may also experience heaviness, as well as a feeling of fullness in the testicle.

A mass in your scrotum could signal another issue as well. Talk to your doctor about any unexplained lumps in your scrotum. That way they can rule out more serious causes and come up with a treatment plan.

Do spermatoceles cause infertility?

Doctors don’t consider spermatoceles a cause of infertility. It may reduce the quantity and quality of sperm produced if the spermatocele is large, however. If you’ve been trying to conceive for over a year and are concerned about your fertility, talk to your doctor. There are several possible causes for male infertility. The first step is having a semen analysis to determine the health of your semen.

Causes

Researchers don’t know what causes spermatoceles. Spermatoceles are neither cancerous nor do they increase your risk of testicular cancer.

Diagnosis

A spermatocele can be diagnosed through a detailed examination of the genital area. Your doctor will feel your testicles to search for masses, or areas that are tender or painful to the touch. You can expect to feel some pain when your doctor touches the affected areas.

Your doctor may also do the following tests:

  • Transillumination. By passing a light through the scrotum, your doctor can examine the entire area. Any spermatocele should be clearly seen.
  • Ultrasound. If transillumination isn’t successful, an ultrasound can be used by your doctor to look inside the scrotum to search for a cyst.

Treatment

Spermatoceles aren’t cancerous and are usually pain-free. Most people won’t need treatment. Instead, your doctor will monitor the cyst during regular doctor appointments.

Spermatoceles may require medical attention if they grow too large or begin to cause pain.

Medical therapy

Medical therapy is limited to oral medications to fight pain and reduce swelling. No drug has been developed to cure or prevent spermatoceles.

Minimally invasive therapies

There are two minimally invasive therapies available, but these are rarely used.

  • Aspiration. Your doctor will use a needle to puncture the spermatocele and then drain the fluid.
  • Sclerotherapy. Your doctor will inject an irritating agent into the cyst. This promotes healing and discourages the fluid from accumulating again.

These therapy options have been shown to work, but they aren’t usually recommended. That’s because there’s a risk that the epididymis may be harmed, leading to fertility problems. Another common problem is that the spermatoceles can come back.

Surgical therapy

Surgical therapy known as spermatocelectomy is the most common treatment for asymptomatic spermatocele. The aim is to remove the cyst from the epididymis while, at the same time, preserve the genital system. This surgery is done as an outpatient procedure. That means you won’t need to stay in a hospital overnight. It may be done with either local or general anesthesia, and it’s usually complete in under an hour.

Sometimes part or even all of the epididymis may need to be removed along with the cyst.

Outlook

Most people won’t experience any symptoms from a spermatocele. If you do experience pain or discomfort, spermatocelectomy should provide relief, though there is a risk for complications that may affect fertility. It’s also possible that your spermatocele might come back, even after surgery.

Discuss the risks and benefits of treatment options with your doctor, and let them know about any concerns you have, including the effective treatment will have on fertility.

References

Testicle Biopsy - What You Need to Know

Testicle Biopsy – What you Need to Know

July 18, 2021 (updated July 18, 2021) Published by

What is a Testicular Biopsy?

A testicular biopsy takes a tissue sample from your testicle for laboratory analysis.

The two testicles are the male reproductive organs. They produce sperm and the male sex hormone testosterone. Your testicles are located in your scrotum, which is the fleshy pouch of tissue that hangs under your penis.

A testicular biopsy can be used to:

  • diagnose the location and condition of a lump in the testes
  • diagnose causes of male infertility
  • obtain sperm for in vitro fertilization (IVF)

There are two different procedures for a testicular biopsy.

Percutaneous Biopsy

With a percutaneous biopsy, a thin biopsy needle is inserted through the skin. The needle has a syringe on the end to collect the testicular tissue. This procedure does not require an incision or stitches. It also is called a fine needle biopsy.

A core needle biopsy is a variation on this technique. It uses a hollow, spring-loaded needle to extract a cylinder of cells. This is called a core sample. A core sample is a larger specimen than one from a fine needle biopsy.

Open Biopsy

An open biopsy is also called a surgical biopsy. Your doctor starts by making a cut in the skin. A cut also is made in the testicle. Then a small tissue sample is taken from the opening and stitches are used to close the cuts.

Diagnostic Uses of a Testicular Biopsy

A testicular biopsy is an important tool in diagnosing male infertility. However, it is not the first step. For the initial phase in a fertility evaluation, your doctor will take a health history and order blood tests and a semen analysis.

Semen analysis looks at the quantity and quality of your sperm. The initial semen sample is usually obtained by masturbation.

Semen analysis can identify the following problems:

  • abnormally low levels of sperm
  • poor quality of sperm
  • azoospermia (absence of sperm)

Blood and hormone tests often can identify the causes of low sperm levels. However, when these tests are not conclusive, you may need a testicular biopsy.

A testicular biopsy may be used to:

  • determine whether sperm production problems are caused by a blockage
  • retrieve sperm for use in IVF. This is done if sperm are being made in the testicles but are not present in the semen.
  • diagnose testicular cancer
  • determine the cause of a lump in the testicles

Preparation for a Testicular Biopsy

The preparations required for this test are minimal.

Tell your physician about any prescription or over-the-counter medications you are taking. Discuss whether these medications should be used before and during the test.

Certain drugs may pose a special risk during the procedure. These include:

  • anticoagulants (blood thinners)
  • nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin or ibuprofen
  • any medications that affect blood clotting

If you are receiving general anesthesia, you will need to fast from food and drink for at least eight hours before your test. If you are given a sedative to take at home before the biopsy, you will not be able to drive yourself to the procedure.

Administration of a Testicular Biopsy

A testicular biopsy is usually an outpatient procedure. It may be performed at your doctor’s office or a hospital.

The biopsy typically takes about 15 to 20 minutes. It is performed by a doctor or another trained health professional.

You may be offered a sedative to help you relax for the test. Since you have to stay completely still, some doctors prefer to use general anesthesia instead. With either medication, the biopsy technique remains the same.

You will be asked to lie on your back and the scrotum will be cleaned to remove bacteria. An injection of local anesthesia will numb the skin of the scrotum. You may feel a slight sting.

Open Biopsy

If you are having an open biopsy, the following procedure is typical:

  1. Your physician will make a small incision through the skin.
  2. A tiny, pea-sized amount of testicular tissue is removed.
  3. When the biopsy is taken, you will feel pressure or minor discomfort. You should not feel pain.
  4. Typically, one absorbable stitch closes the cut in the testicle. Another stitch closes your skin. Stitch removal is not necessary.
  5. The same technique is done on the second testicle.

Percutaneous Biopsy

The procedure for a percutaneous biopsy will depend on the type of needle used — a core needle or a fine needle.

  • In both cases, a needle is inserted through the skin of the testicle.
  • If you are having a core needle biopsy, you will hear a loud clicking or popping sound when the tissue sample is being extracted.
  • If you are having a fine needle biopsy, the tissue sample will be drawn out with a syringe.
  • The same technique is done on the second testicle.

Diagnosing Testicular Cancer

Testicular biopsy is rarely used to diagnose testicular cancer. Typically, it is performed when the diagnosis is uncertain. This is because a biopsy, unfortunately, increases the likelihood the cancer will spread.

Your physician is more likely to use ultrasound for cancer diagnosis. Your testicle can also be examined and removed through open surgery. This is called a radical inguinal orchiectomy.

A radical inguinal orchiectomy to diagnose cancer includes the following steps:

  1. Your physician will make a cut in your groin.
  2. The testicles will be removed from the scrotum and examined.
  3. If abnormal tissue is found, a small portion will be taken for analysis.
  4. A pathologist will examine the tissue. This will be done immediately, while you wait.
  5. If the tissue sample is benign (noncancerous), the testicle will be returned to the scrotum.
  6. If the tissue sample is malignant (cancerous), the testicle will be removed. The spermatic cord will be removed as well. This prevents the spread of cancer cells to the rest of the body.

Recovery from a Testicular Biopsy

After your testicular biopsy, you will receive special instructions to help you heal and remain comfortable. Instructions will vary depending on the type of biopsy.

You may be advised to:

  • refrain from sexual activity for one to two weeks
  • wear an athletic supporter for several days
  • keep the site of the biopsy dry, and avoid washing it for several days
  • avoid aspirin for one week
  • use acetaminophen for soreness

It is normal to have swelling, discoloration, and discomfort for a few days. A small amount of bleeding is also common. Your doctor may also warn you about other routine side effects that are procedure-dependent.

Risks of a Testicular Biopsy

A testicular biopsy can help your doctor resolve your infertility problems. It does not carry a risk of erection or fertility problems after the procedure.

Prolonged bleeding and post-procedure infection are two potentially serious risks. However, they are rare. Contact your physician if you experience:

  • bleeding that soaks the bandage at the biopsy site
  • hematoma (a collection of blood under the skin)
  • severe pain or swelling of the scrotum
  • fever or chills

Another possible risk is internal damage to the testicles or nearby areas. This is rare.

Interpreting the Results of a Testicular Biopsy

Your tissue sample will be analyzed under a microscope. The pathologist will identify any defects in sperm production or development.

Your results may show normal sperm development. If you previously had a low or zero sperm count, an obstruction may be the cause of your infertility.

Blockages in the vas deferens have been shown to cause this type of infertility. The vas deferens is the tube that carries sperm from the testicles to the urethra. Surgery may be able to correct the problem.

Additional causes of abnormal results include:

  • spermatocele: a fluid-filled cyst on the ducts of the testicles
  • orchitis: a swelling of the testicles caused by an infection
  • testicular cancer

References

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