Dr. CARLO BRAVI
Consultant Urologist and Andrologist
Robotic and Minimally Invasive Urological Surgeon
Testicular and Scrotal Lumps
A testicular or scrotal mass may be caused by several conditions, most of which are benign. However, any new lump, swelling or change in the testicle should be assessed promptly to exclude testicular cancer or another condition requiring treatment.
Dr Carlo Bravi offers private urology and andrology consultations in Northampton and London for patients requiring assessment of a testicular lump, scrotal swelling, discomfort or an abnormal ultrasound finding.
When Is a Testicular Lump an Emergency?
Sudden severe testicular pain requires urgent medical assessment because it may be caused by testicular torsion. This occurs when the spermatic cord twists and interrupts the blood supply to the testicle.
Testicular torsion is a surgical emergency. If you develop sudden severe pain, particularly when accompanied by swelling, nausea or vomiting, you should attend an emergency department immediately rather than wait for a routine consultation.
Common Causes of Testicular and Scrotal Lumps
A lump or swelling does not necessarily indicate cancer. Possible causes include:
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Epididymal cyst or spermatocele: a fluid-filled swelling arising near the epididymis, which is usually benign.
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Hydrocele: a collection of fluid around the testicle that may cause painless enlargement or heaviness.
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Varicocele: enlarged veins within the scrotum, sometimes associated with discomfort, testicular size differences or fertility concerns.
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Epididymitis or orchitis: inflammation or infection that may cause pain, swelling, redness or fever.
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Inguinal hernia: tissue from the abdomen passing into the groin or scrotum, sometimes becoming more noticeable when standing, coughing or straining.
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Testicular torsion: twisting of the spermatic cord causing sudden pain and requiring emergency treatment.
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Testicular tumour: commonly presents as a firm lump or change within the testicle and may be painless.
It is not usually possible to determine the cause reliably by touch alone. Clinical examination and ultrasound are often required.
How Are Testicular and Scrotal Lumps Assessed?
Assessment begins with a discussion of when the lump or swelling appeared, whether it has changed and whether it is associated with pain, urinary symptoms, infection, injury or fertility concerns. A physical examination helps establish whether the abnormality appears to arise from within the testicle or from surrounding structures.
A scrotal ultrasound is often the most useful initial investigation. It can distinguish between solid and fluid-filled abnormalities, assess blood flow and help determine whether the lump is located within or outside the testicle. Depending on the findings, additional investigations may include urine testing, blood tests and tumour markers such as AFP, beta-hCG and LDH. If a testicular tumour is suspected, CT imaging may be required as part of further assessment and staging.
Can a Painless Lump Be Serious?
Yes. Some testicular tumours present as a painless lump, firmness or change in the size or shape of a testicle.
Most scrotal abnormalities are not cancer, but pain alone cannot distinguish benign from potentially serious conditions. A new lump should therefore be assessed even if it causes no discomfort.
Treatment options
If a scrotal or testicular mass is found and needs treatment, management is generally surgical (peno-scrotal surgery). The specific approach depends on whether the condition is benign or potentially malignant.
Dr Bravi tailors each procedure to ensure optimal outcomes with minimal recovery time.
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Benign conditions (such as hydroceles, cysts, or varicoceles) are usually treated with minimally invasive peno-scrotal surgery, often performed as day cases, aimed at relieving swelling or discomfort with minimal downtime and excellent cosmetic outcomes. Procedures for selected benign conditions are described on the peno-scrotal surgery page.
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Suspicion of testicular cancer warrants a radical orchidectomy (full removal of the testicle).
Early evaluation and accurate diagnosis are key to selecting the appropriate surgical approach and achieving the best possible result.
What Happens After Investigation?
The next step depends on the clinical examination and ultrasound findings. If the abnormality appears benign and is not causing significant symptoms, observation may be appropriate. If infection is suspected, further tests and medical treatment may be recommended.
Patients with an indeterminate or suspicious testicular lesion may require tumour-marker blood tests, additional imaging and prompt discussion of surgical treatment. Your results and recommended next steps will be explained during consultation or at an arranged follow-up appointment.
When Should You Arrange an Assessment?
You should seek medical assessment if you notice:
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A new lump within or around a testicle
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A change in testicular size, shape or firmness
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Persistent scrotal swelling or heaviness
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Ongoing discomfort or tenderness
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A lump that is growing or changing
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An abnormality identified on ultrasound
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Concerns about a varicocele, hydrocele or epididymal cyst
Sudden severe testicular pain should be treated as an emergency and assessed immediately.
Arrange a consultation with Dr. Bravi
If you have noticed a testicular lump, scrotal swelling or another change and would like an assessment, Dr Carlo Bravi offers private urology and andrology consultations in Northampton and London.
Arrange a consultation to discuss your symptoms, examination and any ultrasound or test results already available.
This page provides general information and does not replace individual medical advice. Sudden severe testicular pain requires emergency assessment.