Home > Adults > Urology >

Scrotal Swellings & Testicular Lumps & Pain

Checked: 23-11-2021 by Vicky Ryan Next Review: 23-11-2022

Principles of Management - Testicular Lumps

Consider 2WW Urology referral for Non-painful enlargement or change in shape or texture of the body of the testis.

Always perform transillumination to exclude benign epididymal cyst(s). Consider a direct-access ultrasound scan for an unexplained or persistent scrotal swelling that does not transilluminate, or if the body of the testis cannot be easily distinguished on examination.

CKS has comprehensive guidelines and includes advice on assessment and management of suspected testicular cancer, testicular torsion, varicocele, hydrocele and epididymo-orchitis.

Please note, referral to consider surgery for Epididymal Cysts and Hydroceles (once malignancy has been excluded) requires Prior Approval. See link to INNF policies below;

Hydroceles in Patients over 16 years of Age

Epididymal Cysts (The criteria for prior approval is: a cyst that is at least 3 times the length of the contralateral hemi-scrotum based on clinical examination. Where there are bilateral cysts, these should be considered against what the size would have been in normal anatomy)

Principles of Management - Testicular Pain

Acute testicular pain - pain may be due to infection or torsion and should be treated or referred as appropriate (see above link to CKS guidelines).

Testicular Torsion - if torsion is suspected then please refer to local Emergency Department.

Chronic testicular pain can have a variety of causes. Exclude cancer by requesting an USS as 5% of testicular cancers present with pain.

Consider infection and treat with oral antibiotics if suspected. Refer to the BNSSG Antimicrobial Prescribing Guidelines.

If there is still no improvement then manage pain with oral analgesia and consider treatment of any underlying mental health problems if present. Amitriptyline may also be worth a try. The sexual health clinic runs a clinic for chronic pelvic pain in men or a referral to pain clinic may be considered if criteria for referral are met.

Referral to Urology is usually unnecessary as surgery is very rarely indicated. Epididectomy or denervation are possible but only in a very selected group of patients.

Microlithiasis

There are guidelines from the European Society of Urogenital Radiology which have been discussed with local radiologists and urologists. The below approach has been suggested:

If testicular USS shows microlithiasis and there are no additional risk factors then reassure and do not rescan as there is no evidence to show it is beneficial in picking up early cancers. Patients should still be advised to undertake monthly self examination.

If microlithiasis is found in men under 55 and is associated with any risk factors then advice is to scan annually (until age of 55). Risk factors include a personal or family history of germ cell tumor, maldescent, orchidopexy and testicular atrophy. Men in this group should also undertake monthly self-examination.

In men over the age of 55 the risk of testicular cancer is considered low and therefore USS screening is not advised, however self-examination should still be encouraged.

If microlithiasis is associated with a testicular mass then refer 2WW.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.