Testicular Lumps: Causes, Concerns, and Treatment Options - Urology

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When it comes to testicular lumps, it's essential to approach the situation with a clear understanding of potential causes, concerns, and treatment options. Based on your description, you have noticed a firm, round lump on your right testicle that feels different from the left, which is soft. You also mentioned a history of proteinuria, but no other significant symptoms such as pain, cough, or fever.


Possible Causes of Testicular Lumps
1. Epididymal Cysts: These are fluid-filled sacs that can develop in the epididymis, which is located at the back of the testicle. They are usually benign and painless.

2. Testicular Torsion: This is a medical emergency where the spermatic cord becomes twisted, cutting off blood supply to the testicle. This typically presents with severe pain and swelling, so it seems less likely in your case since you report no pain.

3. Orchitis: Inflammation of the testicle, often due to infection. This can cause swelling and tenderness, which you do not seem to have.

4. Varicocele: This is an enlargement of the veins within the scrotum, which can sometimes feel like a lump but is usually described as a "bag of worms."
5. Tumors: Testicular cancer is a possibility, especially if there is a firm lump that feels different from the surrounding tissue. Testicular cancer can present without pain, which aligns with your description.


Concerns and Next Steps
Given your concern about testicular cancer, it is crucial to consult a healthcare professional for a thorough evaluation. The following steps are typically recommended:
1. Physical Examination: A healthcare provider will perform a physical exam to assess the lump and check for any other abnormalities.

2. Ultrasound: This imaging test is often the first step in evaluating a testicular lump. It can help differentiate between solid masses and fluid-filled cysts.

3. Blood Tests: Tumor markers such as alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) can be measured. Elevated levels of these markers can indicate the presence of testicular cancer.

4. Biopsy: If imaging and blood tests suggest a malignancy, a biopsy may be performed. However, in the case of suspected testicular cancer, the standard approach is often surgical removal of the affected testicle (orchiectomy) for both diagnosis and treatment.


Treatment Options
If a diagnosis of testicular cancer is confirmed, treatment typically involves:
1. Surgery: The primary treatment for testicular cancer is the surgical removal of the affected testicle. This is often done through an inguinal approach.

2. Chemotherapy: Depending on the stage of cancer, chemotherapy may be recommended to eliminate any remaining cancer cells.

3. Radiation Therapy: This may be used in certain cases, particularly for specific types of testicular cancer.


Prognosis
The prognosis for testicular cancer is generally very good, especially when detected early. The survival rate for localized testicular cancer can be over 95%. Even in cases where the cancer has spread, treatment options are available, and many patients achieve remission.


Conclusion
While your symptoms may cause concern, it is essential to seek medical advice promptly. A healthcare provider can perform the necessary evaluations to determine the nature of the lump and guide you through the appropriate steps. Early detection and treatment are key to a favorable outcome in cases of testicular cancer. Remember, not all lumps are cancerous, and many conditions are treatable.