Testicular Lumps

Question 1

Features of epididymal cyst

Answer 1

Single or multiple cysts
May contain clear or opalescent fluid (spermatoceles)
Usually occur over 40 years of age
Painless
Lie above and behind testis
It is usually possible to ‘get above the lump’ on examination

Question 2

Hydrocele

Answer 2

Non painful, soft fluctuant swelling
Often possible to ‘get above it’ on examination
Usually contain clear fluid
Will often transilluminate
May be presenting feature of testicular cancer in young men

Question 3

Testicular tumours

Answer 3

Often discrete testicular nodule (may have associated hydrocele)
Symptoms of metastatic disease may be present
USS scrotum and serum AFP and β HCG required

Question 4

Acute epididymo-orchitis

Answer 4

Often history of dysuria and urethral discharge
Swelling may be tender and eased by elevating testis
Most cases due to Chlamydia
Infections with other gram negative organisms may be associated with underlying structural abnormality

Question 5

Inguinal hernia

Answer 5

If inguinoscrotal swelling; cannot ‘get above it’ on examination
Cough impulse may be present
May be reducible

Question 6

Varicocele

Answer 6

Varicosities of the pampiniform plexus
Usually form during puberty and develop over time
Typically occur on left (because testicular vein drains into renal vein)
May be presenting feature of renal cell carcinoma
Affected testis may be smaller and bilateral varicoceles may affect fertility