| Inguinal hernia | If inguinoscrotal swelling; cannot ‘get above it’ on examination Cough impulse may be present May be reducible |
| Testicular tumours | Often discrete testicular nodule (may have associated hydrocele) Symptoms of metastatic disease may be present USS scrotum and serum AFP and β HCG required |
| Acute epididymo-orchitis | Often history of dysuria and urethral discharge Swelling may be tender and eased by elevating testis Most cases due to Chlamydia Infections with other gram negative organisms may be associated with underlying structural abnormality |
| Epidiymal cysts | Single or multiple cysts May contain clear or opalescent fluid (spermatoceles) Usually occur over 40 years of age Painless Lie above and behind testis It is usually possible to ‘get above the lump’ on examination |
| Hydrocele | Non painful, soft fluctuant swelling Often possible to ‘get above it’ on examination Usually contain clear fluid Will often transilluminate May be presenting feature of testicular cancer in young men |
| Testicular Torsion | Severe, sudden onset testicular pain Risk factors include abnormal testicular lie Typically affects adolescents and young males On examination testis is tender and pain not eased by elevation Urgent surgery is indicated, the contra lateral testis should also be fixed |
| Varicocele | Varicosities of the pampiniform plexus Typically occur on left (because testicular vein drains into renal vein) May be presenting feature of Renal Cell Carcinoma Affected testis may be smaller and bilateral varicoceles may affect fertility |