MENS HEALTH MATTERS:All lumps should be clinically examined without any delay, but many are harmless, writes THOMAS LYNCH
Q I am 34 years old and recently noticed a lump in my scrotum. I was worried about this and saw my GP. He says that it is an epididymal cyst. What does this mean and will I need to have anything done about it?
A Epididymal cysts are fluid filled cysts that arise in the part of the testicle called the epididymis. They are filled with clear fluid and are not associated with cancer and generally do not require any treatment.
They usually develop in adults around the age of 40 and are rare in children. They are commonly found by men when examining their testicles routinely for lumps. The prevalence in the general population is difficult to estimate but cysts have been found in as many as 30 per cent of asymptomatic patients having scrotal ultrasound (scrotal scans) for other reasons.
Patients usually present having noticed a lump. This often causes a great deal of anxiety and clinical examination can usually reassure the patient.
It is usually possible to distinguish an epididymal cyst by careful examination and they can be felt as separate round swellings above or sometimes behind the testicle which readily distinguishes them from testicular tumours which arise from the testicle itself.
If there is any doubt then an ultrasound examination will define the problem but more often that not careful examination is all that is required. They are often multiple and may be present on both sides.
The majority of men with epididymal cysts do not require any treatment and explanation and advice is all that is usually required. The main indications for treatment are when the swellings are large enough to be noticeable, or if there is pain or discomfort.
For most men the best treatment is operative removal. Occasionally, cysts can be drained by needle puncture under a local anaesthetic. In the majority of patients the fluid gathers again and for this reason most surgeons do not recommend needle puncture except for men who are unfit for surgery.
The operation is usually performed using general anaesthesia but can be performed using local if preferred. After the operation there is a small chance that further cysts may develop.
The risks of all scrotal surgery include bleeding and infection. Another very rare problem is persistent post-operative pain (this may also occur after vasectomy and indeed most scrotal and testicular operations); it is often difficult to know exactly what has caused the pain but it may be damage to the blood supply, trapping of nerves in scar tissue or inflammation against sperm.
A special risk of epididymal cyst surgery is blockage of the epididymal duct and this could lead to fertility problems. If you are considering having children then you should delay surgery until after your family is complete.
Q I am 65 years old and my doctor sent me to the hospital for a chest X-ray with suspected pneumonia. The report said that I had “spot” on the lung due to asbestos exposure in the past and recommended a CAT scan of my chest. Should I be worried?
A People who work with asbestos frequently develop areas of “calcification” (chalky deposits on the lining of the lung; the pleura). These areas have a characteristic appearance on X-ray which can be detected by your doctors. The nature of the pleural abnormalities can be more clearly seen by the CT (or CAT) scan that has been recommended. CT confirms that the areas of calcification lie in the lining of the lung rather than in the lung itself.
CT can also reveal additional abnormalities that are occasionally associated with asbestos exposure such as a condition called interstitial fibrosis (which causes interference with normal lung function) and occasional tumours on the pleura called mesotheliomas.
This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin with a contribution from Dr Jim Meaney, consultant radiologist, St James’s Hospital, Dublin