Scrotal lumps in children: all you need to know

In one of our latest articles here below, Miss Marie-Klaire Farrugia, a renowned and highly experienced consultant paediatric urologist, reveals the most common causes of scrotal lumps in children, and reveals when lumps and swelling in the scrotum is considered a medical emergency.  

How common are scrotal lumps or swellings in children?

Lumps or swellings in the scrotum are very common and are usually of no concern.

What are the causes of scrotal lumps?

This depends on the location. Small cystic lumps in the scrotal skin sometimes appear in older boys. If the entire scrotum swells up or looks bigger than the contralateral side, this is usually due to a hydrocele (fluid surrounding the testis which is usually painless) or a hernia (loop of bowel prolapsing into the scrotum via a small communicating tube in the groin, which can be painful).

Occasionally, there can be a visible swelling resembling a bag of worms that tends to develop in peri-pubertal or teenage boys. This likely indicates a varicocele. Boys normally describe a dragging sensation in the area. Lumps felt within or close to the testicle may be due to innocuous cysts (epididymal cysts) or benign or malignant tumours.

When is scrotal swelling considered a medical emergency?

A sudden onset of scrotal swelling, especially when associated with pain and/or redness in the area, is a medical emergency and requires prompt attendance to an emergency department to exclude testicular torsion.

Can scrotal lumps become cancerous?

Testicular lumps in children are not commonly cancerous, but when they are, they develop that way from the start. Benign cysts or lumps do not become cancerous.

Is treatment always needed for scrotal lumps?

Some conditions may improve spontaneously or may only need monitoring. However, it is always best to seek expert advice in case the lump does indeed need urgent management. An acute onset of swelling and pain is an emergency.

What are the different types of treatment available?

This depends on the diagnosis. Small lumps in the skin in older boys may require minor surgery, which can be done under local anaesthetic. Hydrocoeles in babies often resolve spontaneously and most of them do not require treatment.

Persistent hydrocoeles after the age of three can be fixed by day-case surgery. Hydrocoeles developing in older boys should be investigated with an ultrasound scan to check for an underlying cause. They are likely to require surgical intervention.

Hernias do not resolve spontaneously, and are at risk of getting stuck, especially in infants. They will therefore require surgical repair. Varicoceles can be monitored with annual ultrasound scans, and only require intervention if they become painful, or if they cause a delay in the growth of the testicle.

Varicoceles may be fixed by interventional radiology techniques or keyhole surgery. Epididymal cysts are usually harmless and do not require intervention or monitoring. A lump that resembles a tumour requires urgent investigation with blood tests and scans in a centre of expertise, and surgery is likely to be required once the diagnosis is confirmed.

A suspected testicular torsion is an emergency, as a twisted testicle can only be salvaged if operated on and untwisted within six hours of the onset of symptoms.

Miss Marie-Klaire Farrugia is a distinguished consultant paediatric urologist. To book an appointment with her today, visit her Top Doctors profile.