investigations

Last reviewed 01/2018

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: