Archive for the ‘scrotal mass’ Category

When There’s a Problem In the Jewel Sack-Scrotal Pain

September 1, 2012

Every man has taken one in the jewel box that bends him over in excruciating pain and discomfort. Fortunately, most of the pain goes away in a few minutes. However, the scrotum and its contents are very vulnerable to injury and disease. This blog will describe the most common conditions affecting men “down there”.

The scrotum is located outside the rest of the body in order to keep the testicles a few degrees cooler than the rest of the body. This is intended to keep the testicles which contain the sperm factories just the right temperature for sperm production.

Normal Anatomy of the Scrotum

The testicles have two functions: 1) sperm production and 2) testosterone production. Testosterone is the male hormone responsible for developing male characteristics like a deep voice, a beard, and the all-important sex drive.

Evaluation of the painful scrotum
Your doctor will take a careful history and find out how long the pain or swelling has been present. The doctor will want to know if the pain is associated with trauma like a soccer ball or someone’s foot to the “vital parts.” The association of pain and swelling with a fever is a sign of infection and inflammation. A physical exam will be conducted and a light may be used to see if there is excess fluid in the scrotum. This is followed by a urine exam and an ultrasound of the scrotum. This makes use of high frequency sound waves that are sent from a transducer and then reflected back to the transducer to be processed by a computer and then projected onto a computer screen. This test will usually diagnose most of the conditions that cause pain and swelling the scrotum.

Torsion

torsion of the testicle

This occurs when the testicle twists and inside the scrotum and cuts off the blood supply to the testicle. Although torsion of the testicle can occur at any age, it is most common in young boys and young men between the ages of 12 and 18. The chief compliant is the sudden onset severe pain in one testicle. It usually begins after exercise but can occur when the boy is at rest or even awaken the boy from sleep. The physical exam reveals that the testicle is painful to touch and drawn up high in the scrotum. The diagnosis is confirmed by the ultrasound exam. Immediate surgery is required in order to save the testicle. If surgical treatment is delayed beyond 4 hours, it is less likely that the testicle can be saved. Although torsion only occurs in one testicle, the urologist will always repair the opposite testicle so that torsion cannot occur on the opposite side in the future.

Testicular cancer

Testis Tumor


Most men with scrotal swelling worry about testicular cancer, it is actually relatively uncommon with only 7000 new cases diagnosed each year. The disease usually affects young men between the ages of 15-40. The cause is not known but it is much more common in males who have a testicle that has not descended into the scrotum at the time of birth. The man with testicular cancer usually notices a hard lump on the scrotum. The lump is usually painless. The diagnosis is confirmed with a blood test looking for tumor markers, beta HCG and alpha feto-protein, and a scrotal ultrasound. The treatment is to remove the testicle and the cancer. Testicular cancer has a very high cure rate. All men should learn to do a testicle self exam at least once a month. Any suspicious lumps or bumps should be brought to the attention of a physician.

Orchitis

Orchitis is an inflammation of the testicle that is associated with pain and fever and swelling. Mumps is the most common cause. It is not very common thanks to the use of vaccination in young boys. Mumps orchitis is caused by a virus and there is no treatment except bed rest, anti-inflammatory medication, and pain medication.

Epididymitis

This is a inflammatory condition involving the gland and ducts that are behind the testicle and are responsible for allowing sperm to mature until they are ready to enter the semen. It is usually a bacterial infection that starts in the urine or the prostate and then backs up and goes down the vas to cause an infection in the epididymis. The problem may be accompanied by burning on urination and a urethral discharge. Men may also have a fever.

The diagnosis is made with a physical examination, a urine test which may show evidence of infection. The treatment is bed rest, a scrotal support or tight jockey underwear to support the scrotum, antibiotics and anti-inflammatory medication.

Hydrococele

hydrococele


A hydrococele is a swelling that takes place slowly over time. Usually months or even years. A hydrococele is a collection of fluid around the testicle, which remains entirely normal. A doctor can easily make the diagnosis by simply transilluminating the scrotum with a bright flashlight held up against the scrotum. The diagnosis can be confirmed with an ultrasound examination.

The treatment is usually surgical procedure which is brief operation, done on a one day stay basis and most men can return to all activities two weeks after the operation.

Spermatococele

Spermatococeles are fluid filled cysts in the epididymis. Spermatococeles are usually painless swellings that can also be diagnosed by tranillunination. Surgery is the treatment of choice if the spermatococele causes discomfort because of its size or if it is cosmetically unacceptable.

Varicocele

varicocele


Varicoceles consist of dilated network of veins in the spermatic cord. This problem is common and occurs in 15% of men and occurs most commonly on the left side. It usually causes minimal discomfort but can be associated with infertility. Treatment consists of surgically tying off the abnormal veins or using a coil placed by a radiologist to occlude the abnormal veins.

Bottom Line: A lump or bump down there should get a man’s attention. Most scrotal conditions can be easily diagnosed in the doctor’s office or with a scrotal ultrasound. Most cases are not serious and prompt treatment will nearly always put a man back in action.

When It Really Hurts Down There-Epididymitis

June 3, 2012

When men experience a painful testicle, it can be frightening and a source of not only pain but anxiety as most men associate the testicles with pleasure and reproduction. This article will discuss a common cause of pain in the scrotum and what treatment options are available.
Epididymitis is an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. Pain and swelling are the most common signs and symptoms of epididymitis. Epididymitis is most common in men between the ages of 14 and 35.
Epididymitis is most often caused by a bacterial infection or by a sexually transmitted disease (STD), such as gonorrhea or chlamydia. In some cases, the testicle also may become inflamed.
Epididymitis symptoms include: Testicle pain and tenderness, usually on one side, painful urination, painful intercourse or ejaculation, chills and fever, a lump on the testicle, discharge from the penis especially if the cause is from a STD, and discoloration of the semen.

Location of the epididymis

Location of Epididymis On Top and Behind the Testicle

Causes
Epididymitis has a number of causes, including: STDs, particularly gonorrhea and chlamydia, are the most common cause of epididymitis in young, sexually active men. Boys, older men and homosexual men are more likely to have epididymitis caused by a nonsexually transmitted bacterial infection. For men and boys who’ve had urinary tract infections or prostate infections, bacteria may spread from the infected site to the epididymis. Rarely, epididymitis is caused by a fungal infection. Epididymitis may be caused by urine going backward into the epididymis. This is called chemical epididymitis and may occur with heavy lifting or straining.

Diagnosis
Your doctor will do a physical exam, which may reveal enlarged lymph nodes in your groin and an enlarged testicle on the affected side. Your doctor also may do a rectal examination to check for prostate enlargement or tenderness and order blood and urine tests to check for infection and other abnormalities.
Other tests your doctor might order include: STD testing. This involves obtaining a sample of discharge from your urethra. Your doctor may insert a narrow swab into the end of your penis to obtain the sample, which is then tested for the presence of bacteria or other infectious organisms. The results can be used to select the most effective antibiotic for treatment.
Ultrasound imaging is a noninvasive test, which uses high-frequency sound waves to create images of structures inside your body and is used to rule out conditions, such as twisting of the spermatic cord (testicular torsion) or a testicular tumor. Your doctor may use this test if your symptoms began with sudden, severe pain.
A nuclear scan of the testicles is also used to rule out testicular torsion, this test involves injecting trace amounts of radioactive material into your bloodstream. Special cameras then can detect areas in your testicles that receive less blood flow, indicating torsion, or more blood flow, supporting the diagnosis of epididymitis.

Treatment
Epididymitis caused by a sexually transmitted infection (STI) or other infection is treated with antibiotic medications. If you have significant pain, you will probably receive an anti-inflammatory medication. Your sexual partner will also need treatment.
When you’ve finished your medication, it’s a good idea to return to your doctor for a follow-up visit to be sure that the infection has cleared up. If it hasn’t, your doctor may try another antibiotic. If the infection still doesn’t clear, your doctor may do further tests to determine whether your epididymitis is caused by something other than a bacterial infection or an STD.

To ease your symptoms, try these suggestions: Bed rest-depending on the severity of your discomfort, you may want to stay in bed one or two days. Mild relief will occur if you place a folded towel under your scrotum. Wear an athletic supporter or jockey underwear. A supporter provides better support than boxers do for the scrotum. Apply cold packs to your scrotum. Wrap the pack in a thin towel and remove the cold pack every 30 minutes. Don’t have sex until your infection has cleared up. Ask your doctor when you can have sex again.

Bottom Line: Epididymitis is a common cause of scrotal pain. Epididymitis is usually a result of an infection and can be successfully treated with antibiotics. See your doctor whenever you have scrotal pain or you find a lump or bump in your scrotum.

An Unkind Twist of Fate-Testis Torsion

June 2, 2012

There are very few surgical emergencies in medicine but one of them is torsion of the testicle. Testicle torsion is caused by the twisting of the spermatic cord, which causes a loss of blood flow to the testicle and a lack of life-sustaining oxygen to the testicular tissue. Torsion is the most common cause of testicle loss in adolescent males.
Causes
The cause of the majority of cases is the result on not having the testicle anchored to the bottom of the scrotum. As a result the testicle is allowed to twist more easily, resulting in compromise of the blood supply to the testicle. This can occur spontaneously or may be associated with blunt trauma to the testicle. This anatomic defect is present in both testicles.

Normal testis on left and torsion on the right

Torsion of the testis with loss of blood supply and oxygen to the testicle


Symptoms
Testicular torsion is characterized by excruciating one-sided testicular pain with sudden swelling. Men may also have nausea and vomiting.
Testicular torsion is seen most frequently in the 12-18-year-old age group, and most cases occur in men under 30 years of age. However, it can occur at any age, including in newborns.
Getting help
Testicular swelling and pain should be evaluated immediately. The diagnosis is easily made with a scrotal ultrasound. Once the diagnosis of torsion is confirmed, immediate surgery is indicated. There is about a six-hour window for the testicle to be salvaged; surgical treatment within this time frame is associated with a 100% salvage rate for the testicle. After six hours, the salvage rate decreases, and if surgical repair is performed after 24 hours, the testicle is no longer salvageable. The surgeon, usually a urologist, will untwist the spermatic cord and which will improve the blood supply to the testis. The testis is then anchored to the bottom of the scrotum and the opposite testicle is also surgically secured to the bottom of the scrotum since the condition frequently affects both testicles.
Bottom Line: Testicle torsion is a surgical emergency. With early diagnosis the testicle can be saved by surgically securing the testicle to the bottom of the scrotum.

An Ouch In the Pouch-Acute Scrotal Pain and What To Do About It

June 2, 2012

Perhaps the most sensitive area on a man’s body are his eyeballs located between his ears and those two jewels (testicles) located between his legs. The testicles are low hanging fruit and are easily injured or can become easily infected.

Acute scrotal pain can be a medical emergency and needs the attention of a doctor. The most common causes are testicular torsion and epididymitis.

Torsion 
is the technical name for twisted testicles, which happens when 
your testicles twist around the blood supply to the testicle cut off its source of oxygen. Unless this is treated within a few hours, there is a risk of losing the testicle. For this reason, men with the acute onset of testicular pain should see their doctor or go to an emergency room. The diagnosis is made by doing a scrotal ultrasound which can test the blood supply to the testis. If there is torsion, the treatment is surgery to untwist the blood supply and then secure the testicle so that a repeat torsion will not recur.

Epididymitis is 
the inflammation of the epididymis at the back of the testicle 
where the sperm is stored, as well as orchitis which is the 
inflammation and swelling of the testes. The diagnosis can be confirmed with an examination and the scrotal ultrasound to be sure there is no torsion. Treatment usually consists of anti-inflammatory medication and antibiotics.

One other benign condition that causes acute scrotal pain is “blue balls”. This a common condition in young adults and is caused by temporary fluid congestion in 
testicles as a result of prolonged sexual stimulation. Relief usually occurs when the man ejaculates and relieves the congestion in the testicles

Bottom Line: Acute scrotal pain is a serious condition and needs medical attention to be sure that the man does not have a torsion, which may result in loss of the testicle.

Testicle Self Exam-Now You Can Perform The Exam To Michael Jackson’s “Man in the Mirror”

December 2, 2010

Testis cancer is the most common malignancy in men between the ages of 20-40.  A monthly exam can identify a tumor when it is confined to the testicle and is nearly 100% curable.  Check out this very entertaining video and make it a point to perform a monthly testicle self exam.

http://www.kevinmd.com/blog/2010/11/testicular-exam-sung-michael-jackson.html