Scrotal Masses

Introduction to Scrotal Masses

Scrotal masses are swellings found in the scrotum. Let us abbreviate this condition to SM.

Causes of Scrotal Masses

The causes of scrotal masses will be discussed under types of SM which are:

  1. Causing of painless SM
  2. Causes of painful SM

1. Painless Swellings 

The causes of painless SM include the following:

  1. Testicular tumour
  2. Inguinoscrotal hernia
  3. Hydrocoele
  4. Hydrocoele of spermatic cord
  5. Spermatocoele/epididymal cysts
  6. Varicocoele
  7. Epididymal tumours.
  8. Chronic epididymo-orchitis

2. Painful Swellings 

The causes of painful SM include the following:

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

Symptoms of Scrotal Masses

The symptoms of SM include the following:

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

Signs of Scrotal Masses

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

Investigations

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

Treatment for Scrotal Masses

Treatment objectives

The following are the treatment objectives of SM:

  1. To make an accurate diagnosis to ensure appropriate treatment
  2. To relieve pain
  3. To prevent complications
  4. 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

A. 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 of SM and those suspected to be tumours to a urologist or surgical specialist.