HEALTH Testicular swellings, lumps and bumps

TAKE A TRIP TO THE DOCTOR?Testicular abnormalities often cause unnecessary worry, as the vast majority are benign.

Testicular swellings, lumps and bumps


Doctor’s Insight
Dr Ronan Clancy

Testicular problems are a common presentation to any GP surgery, and awareness of testicular cancer has increased greatly. This is really important, as full cure is possible but very dependent on diagnosing and treating the condition as early as possible. However, aside from testicular cancer, GPs see a much larger volume of benign (non cancerous) problems on a daily and weekly basis.
Here, I’m going to look at not only testicular cancer, but also the more frequently encountered testicular problems.

Anatomy basics
All location and cause of all testicular problems can be explained using this simple anatomy lesson. The testicles form in within the abdomen of the embryo. They then slowly descend to their final destination within an outpouching of inner abdominal lining (peritoneum) called the Processus vaginalis. It normally closes early in life. Blood vessels, nerves and sperm collecting ducts form the spermatic cord.
The testicles themselves are composed of millions of tiny tubes called seminiferous tubules. Germ cells line these tubules, and with the onset of puberty, chemical impulses from the brain stimulate the germ cells to produce sperm in a process called spermatogenesis.
Maturing sperm are then collected in a collecting system behind each testicle called the epididymis (also a complex collection of tiny tubes) and travel to storage glands called seminal vesicles beside the bladder. Other cells in the testicle, Leydig cells, produce male sex hormones, vital for both spermatogenesis and the development of male sexual characteristics, sexual function and libido.

COMMON SWELLINGS
Epididymal cyst
A small balloon like swelling of the epididymis tubules, usually behind the testicle. This is often not painful but may become large and tender and generally settles itself in time and with anti-inflammatory medication.

Varicocoele
A swelling of the veins in the spermatic cord above the testicle that can feel spongy and may swell to a larger size when standing. Varicocoeles are seen more commonly in the left testicle. They can require surgical correction if troublesome.

Scrotal hernia
As the testicles come from the within the abdomen, there is a connection between the inside of the abdomen and the scrotum. Some of the bowel can move through a small opening called the inguinal ring and slide downwards into the scrotal sac causing swelling and discomfort. This often becomes larger on standing or when straining when coughing, sneezing or lifting heavy objects, for example.
A hernia can often be pushed back up (reduced) into the abdomen. However, if the bowel becomes trapped in the scrotum, it swells causing severe swelling and pain. This requires emergency surgical treatment, as the trapped bowel can die due to loss of blood flow.

Hydrocoele
This is a fluid-filled swelling around the testicle and epididymis caused by an unclosed connection between the abdomen and membrane around the testicle (Processus vaginalis). Fluid from the abdomen accumulates around the testicle causing swelling. Sometimes these are very large swellings and can be uncomfortable. They are generally surgically drained.

MORE-SERIOUS PROBLEMS
Epididymo-orchitis
This is a painful infection of the testicle or epididymus. Often very tender to touch, hot and swollen with redness of the scrotum. It can be accompanied by general unwellness, fevers, nausea, vomiting and dizziness. It is often caused by sexually transmitted infection, which itself carries the risk of infertility.

Torsion
Torsion occurs when a testicle rotates (usually due to trauma) causing a twisting of the spermatic cord and cutting off the blood supply. It is an extremely painful condition and requires emergency surgical correction.

Testicular cancer
Unfortunately, this cancer tends to occur in young men and is the most-common tumour in young and middle aged men. There are three main types: Germ-cell tumours (Seminoma); lymphomas of the testicle; and tumours of the Leydig or Sertoli cells. Typically, cancer develops as a slowly growing and painless lump in the testicle. It may not be noticed for some time. It can, however, cause discomfort or dragging sensations in the scrotum as well as backache. Early detection and treatment of testicular cancer results in complete cure.

ADVICE AND SCREENING
There are many different types of lump or swelling that can occur in the scrotum. These range from simple fluid-filled cysts to sexually transmitted infections to cancer. Therefore, any lump or mass in the testicles or groin, whether painful or not, should be assessed by a doctor.
Men should regularly examine their testicles to get familiar with their normal texture and contours, so that any abnormality will be quickly spotted. Men involved in risky sexual behaviour should consider screening for sexually transmitted infection.
As always, men’s health issues, ranging from testicular lumps, to sexual health and erectile and urinary difficulties, can be assessed by your GP in private, caring and supportive environment.

Dr Ronan Clancy is a GP at the newly opened Clancy Medical Practice, James street, Westport (www.westportgp.ie). He is in practice with Sarah Kavanagh, chartered physiotherapist.

Click here to read ‘Making the most of his second chance’ – an interview with testicular cancer survivor Peter Scully.