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Scrotal and testicular conditions include benign masses, infections, testicular torsion, and testicular cancer. Common palpable benign scrotal masses include spermatocele, varicocele, and hydrocele. Most patients with these masses require no treatment. Some varicoceles are associated with impaired fertility, probably due to an increase in scrotal temperature that leads to testicular hyperthermia, oxidative stress, and reduced spermatogenesis. Patients with documented infertility or scrotal pain should be referred to a urology subspecialist for consideration of surgical management. Epididymitis and epididymo-orchitis are caused by infection with Neisseria gonorrhoeae, Chlamydia trachomatis, or enteric bacteria. Antibiotics and supportive measures (eg, scrotal elevation, bed rest) are recommended for management of acute epididymitis. Testicular torsion is a urologic emergency that requires rapid surgical exploration and orchidopexy to reduce the risk of testicular loss due to ischemia. Salvage rates exceed 90% when surgical exploration is performed within 6 hours of symptom onset. Testicular cancer commonly manifests as a painless, incidentally discovered mass in a single testis. Ultrasonography is recommended to confirm the diagnosis. The recommended primary intervention for a suspected malignant testicular tumor is radical inguinal orchiectomy.

Case 3. Stephen is a 22-year-old man who is an avid runner and is in good health. He recently noticed a painless lump in the left testicle and is worried that he has cancer. He has no other symptoms. He is sexually active with one female partner. They typically use condoms but not consistently. He has fathered no children.

Scrotal and testicular conditions include benign masses, infections, testicular torsion, and testicular cancer. Few effective tools exist to raise awareness of testicular conditions and encourage patients to seek evaluation for scrotal and testicular symptoms.

Although there is a lack of consensus guidance regarding testicular self-examination, clinicians should instruct men to be familiar with the appearance and texture of the scrotum and testes and to seek timely medical evaluation in the case of suspected abnormality.77 Efforts to increase awareness of testicular self-examination may produce positive health behavior choices in young men.78

Benign Scrotal Masses

Spermatocele

A spermatocele is one of several types of palpable benign scrotal findings that patients or their intimate partners may detect, or that may be noted during a clinical examination. Spermatoceles, which are clinically indistinguishable from epididymal cysts, are found in up to 30% of adult men.79,80 They are less common in children and adolescents (5% to 20%).81

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