Testicular lumps and swellings - Treating testicular lumps and swellings

Treatment for your testicular lump or swelling will depend on the underlying cause. Some lumps may not need to be treated at all if they are not causing any problems.

Treating varicoceles

In most cases, varicoceles do not require treatment. They usually don't cause other symptoms or long-term problems.

Although varicoceles are sometimes associated with infertility, most men's fertility is not affected and there is currently not enough evidence to suggest that treating varicoceles will help improve your chances of fathering a child.

If you have a varicocele that is causing pain or discomfort, taking simple painkillers such as paracetamol and wearing supportive underwear may help initially.

Your GP can refer you to a urologist (a doctor specialising in conditions affecting the urinary system) who can discuss the option of surgery with you if your varicocele is still causing your problems.

Surgery

In many cases, a technique called varicocele embolisation can be used to treat problematic varicoceles.

A tiny tube is inserted into a vein in your groin or neck and X-ray equipment is used to guide it to the affected veins in your testicles. Metal coils or a special liquid are then passed through the tube to block the affected veins. The blood will then bypass the blocked veins, reducing the swelling associated with the varicocele.

Most varicocele embolisation procedures are carried out on an outpatient basis, which means you will not have to stay in hospital overnight. It is usually carried out under local anaesthetic (you'll be awake during the procedure but the affected area will be numbed). 

Varicocele embolisation is a safe and effective procedure, although you may experience some swelling or bruising where the tube was inserted for a few days afterwards. There is also a small risk of infection, which can be treated with antibiotics, and there is a possibility the varicocele could recur later on.

Some varicoceles need surgery to directly tie off or remove the affected veins. This is usually performed under general anaesthetic (where you are asleep) and involves making incisions (cuts) in your groin or abdomen.

Treating hydroceles

Hydroceles in newborn babies usually disappear by the time the baby reaches two years of age. Treatment is usually only needed if they persist for longer than this, or cause pain or discomfort.

Treatment may also be recommended in boys or adults with a hydrocele that is particularly large or is causing any other symptoms. In such cases, you can be referred to a surgeon to discuss your options.

Surgery

A surgical procedure known as a hydrocelectomy is often recommended for hydroceles.  

In children, an incision is made in the groin before sealing the passage between the abdomen (tummy) and the scrotum that allows fluid to flow into the scrotum. In adults, the incision is made in the scrotum, the fluid is drained away and the incision is closed using dissolvable stitches.

Both procedures are usually carried out under general anaesthetic and most people will be able to return home soon after having the operation.

You may experience some discomfort, swelling, and fluid seepage from the wound after the procedure, but this should only last for a few days. Taking simple painkillers and wearing supportive underwear may help reduce any discomfort in the meantime.

As with a varicocele embolisation, there is a small risk of infection after a hydrocelectomy and there is a possibility the hydrocele could recur.

Treating epididymal cysts

Epididymal cysts don't normally require treatment because they are usually harmless and don't cause other symptoms. However, if you have a cyst that is getting bigger or is causing any pain or discomfort, you may be referred to a urologist to discuss the possibility of surgery.

Surgery

A procedure to remove an epididymal cyst is carried out under general anaesthetic and involves removing the cysts through a small incision in your scrotum that is sealed with dissolvable stitches.

In some cases, it may also be necessary to remove the epididymis (a coil-like structure behind the testicles that helps to store and transport sperm) to prevent another cyst from forming.

As with other procedures, you may experience some discomfort, swelling, and fluid seepage from the wound for a few days after the procedure, but this should only last for a few days. Taking simple painkillers and wearing supportive underwear may help reduce any discomfort.

There is also a small risk of the wound becoming infected and there is a chance of cysts recurring if the epididymis is not removed.

Treating epididymo-orchitis

As epididymo-orchitis is often thought to be caused by bacterial infections, such as sexually transmitted infections (STIs) and urinary tract infections (UTIs), treatment will usually involve a 10-14 day course of antibiotic tablets.

If your GP suspects epididymo-orchitis has occurred as a complication of a mumps infection, antibiotics are not used because mumps is caused by a virus.

In these cases, the swelling and pain in the testicles will usually resolve within a week or two. Wearing supportive underwear, applying cold or warm compresses to your testicles and taking simple painkillers may help reduce discomfort in the meantime.

Treating inguinal hernias

You may be referred to a surgeon to discuss the option of having an operation to push the bulge back into place and strengthen the weakness in the abdominal wall.

This operation will be carried out urgently if there are signs that the blood supply to the tissue forming the lump has become interrupted (strangulated), because this can cause the affected tissue to die.

There are two ways that an inguinal hernia repair can be performed:

• open surgery – where one cut is made to allow the surgeon to push the lump back into the abdomen
• keyhole (laparoscopic) surgery – a less invasive but more difficult technique where several smaller cuts are made, allowing the surgeon to use various special instruments to repair the hernia

There are advantages and disadvantages to both methods. The type of surgery you have will depend on which method suits you and your surgeon’s experience. With both types of surgery, you should be able to go home the same day or the day after.

An inguinal hernia repair is a routine operation with very few risks. Although it is not uncommon for a hernia to recur at some point after surgery.

Read more about inguinal hernia repair.

Treating testicular torsion

If you have testicular torsion, you will need surgery as soon as possible to untwist the testicle. Permanent injury to the testicle can occur within hours of having testicular torsion, which may affect your fertility or result in the loss of your testicle.

Surgery for testicular torsion is carried out under general anaesthetic. The surgeon will make an incision in your scrotum before untwisting the spermatic cord (the cord that supplies the testicles with blood). The testicle (or testicles) will then be stitched to the inside of the scrotum to prevent the spermatic cord twisting again.

The longer you wait before having surgery, the higher the risk that your surgeon will not be able to save the trapped testicle. Research has found that when men have surgery within six hours of testicular torsion occurring, nine out of 10 twisted testicles will be saved. However, if the surgery is delayed for 24 hours, only one out of 10 twisted testicles will be saved.

If it is not possible to save the affected testicle, the surgeon will need to remove it and seal the spermatic cord. In these cases, another operation can be carried out at a later date to fit a replacement artificial (prosthetic) testicle.

Treating testicular cancer 

If you have been diagnosed with testicular cancer, you will be cared for by a team of clinicians, who will help decide the best treatment for you.

This will depend on factors such as the specific type of testicular cancer you have and how far it had spread before it was diagnosed.

Surgery to remove the affected testicle will be recommended in most cases and this may sometimes be followed by a course of chemotherapy or radiotherapy.

If you want, you can have a prosthetic testicle inserted into your scrotum so that the appearance of your testicles is not greatly affected.

In rare cases where it is necessary to remove both testicles, you will become infertile. However, you may be able to bank your sperm before the operation to allow you to father children in the future.

Read more about treating testicular cancer.