Investigations

Patients should be inquired about:

• timing of onset and progression of pain
• history of trauma
• aggravating and alleviating factors
• associated genitourinary and systemic symptoms (1)

Physical examination should include:

• position of the swelling in relation to the scrotum (1)
• consistency of the swelling – fluctuant (hydrocele, spermatocele) or firm ( cancer) (2)
• transillumination – to separate hernia from spermatocele or hydrocele (2)

Few investigations are helpful in the decision-making process. Consider:

• FBC - may help to identify cause of lymphadenopathy
• ultrasound scan - may aid in confirming the presence of a testicular mass and to examine the contralateral testis (3) - however referral is thought to be mandatory in such cases (4). An urgent ultrasound scan should be arranged in the following patients:
  • scrotal mass that does not transilluminate and/or when the body of the testis cannot be distinguished (5)
  • in patients with retroperitoneal or visceral masses without a palpable testicular mass (3)

Sensitivity of detecting a testicular cancer is almost 100% with an ultrasound scan (3).

Reference:

• (1) Tiemstra JD, Kapoor S. Evaluation of scrotal masses. Am Fam Physician. 2008;78(10):1165-70
• (2) Kaufman DS et al. Case records of the Massachusetts General Hospital. Case 6-2007. A 28-year-old man with a mass in the testis. N Engl J Med. 2007 Feb 22;356(8):842-9
• (3) European Association of Urology (2009). Guidelines on Testicular cancer
• (4) Update (20/5/98),5