Testicular Lump Evaluation and Care in Singapore

• Men who have discovered a lump, swelling, or mass in the testicular area during self-examination
• Patients experiencing testicular pain, heaviness, or discomfort alongside a palpable mass
• Individuals with a family history of testicular cancer requiring assessment of new findings
• Men with sudden onset of scrotal swelling or asymmetry
• Patients with previously diagnosed testicular conditions requiring follow-up evaluation
• Young men between 15-40 years old, the age group most commonly affected by testicular conditions
• Individuals with risk factors such as undescended testicles or previous testicular problems

• Sudden severe testicular pain with swelling (possible torsion)
• Rapidly growing or changing lumps
• Associated symptoms like fever, nausea, or vomiting
• Testicular trauma followed by persistent swelling
• Any new testicular finding in men with a history of testicular cancer

Certain medical conditions may require modified evaluation approaches. Patients with bleeding disorders may need special preparation for potential biopsies. Those with active infections should have these treated before elective procedures. Men with severe anxiety about examination can discuss sedation options with their urologist.

While many men may feel embarrassed or anxious about seeking evaluation, MOH-accredited urologists are trained to provide sensitive, confidential care. Early evaluation improves treatment outcomes and provides peace of mind through accurate diagnosis.

For benign conditions like simple cysts or small varicoceles causing no symptoms, active surveillance may be appropriate. This involves regular ultrasound monitoring and physical examinations to track any changes. Patients are educated on self-examination techniques and when to report concerns. This approach avoids unnecessary intervention while ensuring close observation of the condition.

Hydroceles (fluid collections around the testicle) and large spermatoceles can be treated through aspiration, where fluid is drained using a needle under ultrasound guidance. Sclerotherapy involves injecting a sclerosing agent after aspiration to reduce recurrence. This minimally invasive approach is performed under local anaesthesia and offers quick recovery, though recurrence rates vary depending on the condition treated.

Surgical removal is indicated for solid masses, symptomatic cysts, or when malignancy cannot be ruled out. Procedures include spermatocelectomy (cyst removal), hydrocelectomy (hydrocele repair), and tumour excision. These surgeries are typically performed through small scrotal incisions under general or regional anaesthesia. The approach prioritises complete removal while preserving testicular tissue and function when possible.

Varicoceles can be treated through various approaches including open surgery (inguinal or subinguinal approach), laparoscopic repair, or percutaneous embolisation. Each technique has specific indications based on varicocele grade, patient factors, and fertility considerations. Microscopic techniques allow for preservation of testicular arteries and lymphatics, reducing complications.

Modern evaluation relies on high-resolution scrotal ultrasound with Doppler capability to assess blood flow. Surgical procedures utilise operating microscopes for precise dissection, harmonic scalpels for reduced bleeding, and specialised retractors for optimal visualisation. Laboratory testing includes tumour markers (AFP, beta-HCG, LDH) and hormone assessments when indicated.

Before any intervention, patients undergo comprehensive evaluation including medical history review, physical examination, and diagnostic testing. Blood tests assess overall health, tumour markers, and hormone levels if relevant. Ultrasound imaging provides detailed visualisation of the lump and surrounding structures. Patients receiving surgery are instructed on fasting requirements, typically nothing by mouth after midnight before the procedure.

Medication adjustments may be necessary, particularly for blood thinners which might need temporary discontinuation. Patients arrange transportation home after procedures requiring sedation or general anaesthesia. Pre-operative antibiotics may be prescribed to reduce infection risk. Shaving of the surgical area is usually performed at the hospital.

For diagnostic procedures like ultrasound-guided biopsy, local anaesthesia is administered before needle insertion. The process typically takes 15-30 minutes with minimal discomfort. Surgical procedures begin with anaesthesia administration – either regional (spinal) or general depending on the specific surgery and patient factors.

Surgical excision procedures generally take 30-60 minutes. The surgeon makes a small incision, carefully identifies the abnormality, and removes it while preserving surrounding healthy tissue. Bleeding vessels are cauterised, and the incision is closed in layers. For varicocele repair, the surgeon identifies and ligates the dilated veins while preserving arteries and lymphatics.

Following surgery, patients recover in a monitored area until fully awake. Ice packs are applied to reduce swelling and discomfort. Pain medication is administered as needed. Most patients can go home the same day after demonstrating stable vital signs and ability to urinate.

Surgical specimens are sent for pathological examination to confirm diagnosis. Patients receive detailed discharge instructions including wound care, activity restrictions, and warning signs to monitor. A scrotal support is provided to minimise discomfort during recovery. Follow-up appointments are scheduled before discharge.

Initial recovery focuses on pain management and swelling reduction. Ice packs should be applied for 20 minutes every 2-3 hours while awake. Pain medication is taken as prescribed, typically transitioning from stronger medications to paracetamol within 1-2 days. The scrotal support should be worn continuously except during bathing.

Activity is limited to gentle walking and rest. Patients should avoid lifting, straining, or strenuous activity. The surgical site is kept dry for the first 24 hours, then gentle washing is permitted. Some bruising and swelling are normal and expected. Warning signs requiring immediate medical attention include excessive bleeding, severe pain, fever, or inability to urinate.

Gradual activity increase is encouraged while avoiding heavy lifting (over 5kg) and strenuous exercise. Most patients return to desk work within 3-5 days. The scrotal support continues during daytime activities. Swelling typically peaks at day 2-3 then gradually improves.

Follow-up appointment occurs 5-7 days post-surgery for wound check and pathology results discussion. Sutures, if non-absorbable, are removed at this visit. Sexual activity should be avoided until cleared by the urologist, typically after 2 weeks. Mild discomfort during this period is managed with over-the-counter pain relievers.

Complete healing typically occurs within 4-6 weeks. Return to full activities including sports and heavy lifting is gradual, guided by comfort level. Fertility parameters, if affected, are reassessed after 3 months as sperm production cycles require this duration for changes to manifest.

Long-term follow-up depends on the diagnosis. Benign conditions may require annual check-ups, while other conditions need more frequent monitoring. Patients are educated on self-examination techniques to monitor for recurrence or new problems. Hormone levels may be monitored if testicular tissue was removed.

Temporary swelling and bruising around the surgical site affect most patients, typically resolving within 1-2 weeks. Mild to moderate pain is expected but well-controlled with prescribed medications. Some patients experience temporary numbness around the incision due to superficial nerve irritation, which usually improves over several weeks.

Minor bleeding or fluid accumulation (seroma) at the surgical site occurs in some cases. These typically resolve spontaneously or with simple drainage. Temporary reduction in sperm count may occur after varicocele repair but generally improves within 3-6 months.

Infection occurs in less than 2% of cases and is usually managed with antibiotics. Rarely, surgical drainage may be required. Haematoma formation (blood collection) occasionally requires evacuation if large or symptomatic. Testicular atrophy is a rare but serious complication, more common with varicocele repair than simple excisions.

Recurrence rates vary by condition – hydroceles and spermatoceles may recur in 10-15% of cases over several years. Chronic pain affects a small percentage of patients and may require additional treatment. Injury to surrounding structures including blood vessels or vas deferens is rare with experienced surgeons using proper technique.

Risk minimisation is achieved through careful patient selection, meticulous surgical technique, and appropriate post-operative care. MOH-accredited urologists employ established protocols and modern equipment to ensure patient safety. Pre-operative planning and intraoperative decision-making prioritise preservation of testicular function while achieving treatment goals.