Evaluation of scrotal masses.

Scrotal masses can represent a wide range of medical issues, from benign congenital conditions to life-threatening malignancies and acute surgical emergencies. Having a clear understanding of scrotal anatomy allows the examiner to accurately identify most lesions. Benign lesions such as hydroceles and varicoceles are often found incidentally by the patient or physician on routine examination. Epididymitis is bacterial in origin, readily diagnosed on physical examination, and treated with antibiotics. Indirect inguinal hernias usually are palpable separate from the normal scrotal contents and are a surgical emergency if strangulation is suspected based on symptoms of abdominal pain, tenderness, and nonreducibility. Testicular swelling may be caused by orchitis, cancer, or testicular torsion. Orchitis is usually viral in origin, subacute in onset, and may be accompanied by systemic illness. Testicular carcinomas are more gradual in onset; the testis will be nontender on examination. Testicular torsion has an acute onset, often with no antecedent trauma; the involved testis may be retracted and palpably rotated, and will be tender on examination. The swollen testis is always a true emergency. Although history and examination may suggest the diagnosis, testicular torsion can be reliably confirmed only with color Doppler ultrasonography, which must be obtained immediately. If torsion is suspected, surgical consultation should be obtained concurrently with ultrasonography, because the ability to successfully salvage the affected testis declines dramatically after six hours of torsion.