Testicle & Fertility Problems
There are various conditions that can cause swelling in the scrotal sac. While cancer is understandably a concern, it is relatively rare in comparison to the more common benign swellings, including:
Varicocele - enlarged veins in the scrotum due to blood pooling that makes them torturous and stretched out like varicose veins in the leg. Varicocele can cause testicle pain and sometimes can lead to infertility by affecting the size and the function of the testicle. This can lead to reduction in the number and motility of the sperms or/and my affect the production of the male hormone which is called Testosterone.
Hydrocele - collection of fluid around the testicle that causes a swelling which is soft but often painless.
Epididymal cyst - a fluid swelling above or behind the testicle along a tube called the epididymis that stores and carries sperm.
Causes and Diagnosis
Usually the swellings occur without obvious cause:
Varicocele is believed to occur due malfunctioning valves in the veins that control blood flow through the testicles.
Hydrocele can occur after scrotal trauma or inflammation.
Epididymal cyst usually occurs due to no clear cause but can perhaps occur slightly more common in men who've undergone previous vasectomy.
The diagnosis is usually made on the basis of history and physical examination plus ultrasound is requested for confirmation. If something untoward like a cancer is detected then this can be treated accordingly.
Treatment
Varicoceles are treated using different minimally invasive procedures including antegrade sclerotherapy which is done by inserting a tiny catheter into the affected veins through a small incision in the upper part of the scrotal skin. Through the catheter, a foam is introduced, which seals the veins shut. As a result, blood flow is redirected through healthier veins, relieving the symptoms associated with varicoceles. Antegrade varicocele sclerotherapy offers numerous advantages over traditional surgical approaches, including a shorter recovery time, reduced risk of complications, and minimal scarring, making it an increasingly popular choice for managing this common condition.
Other minimally invasive treatments also include laparoscopic/ keyhole surgery to tie off the dilated veins through small (< 1cm) incisions in the abdomen. This has the advantage of treating both sides through the same incision in patients with bilateral varicoceles. Microscopic groin approach is another option that allows that identification and ligation of the veins under microscopic guidance.
Hydroceles and epididymal cysts are completely benign and nonthreatening. Smaller sized lesions or usually left alone. The only definitive option for treatment is surgical excision, and this is usually only performed if the swelling is large enough that it is causing sufficient bother because of size or discomfort. The surgical approach is performed as a day-case procedure under an anaesthetic where a scrotal incision is made to access the swelling and remove it.