MEN'S HEALTH MATTERS:Fluid swellings in the scrotum are usually hydrocoeles or epididymal cysts
Q ABOUT A year or more back I noticed one testicle was as big as a tomato. My GP said there was nothing to worry about. Some months later it seemed to grow again as it is now as big as an orange. There is no pain but the size of it is a nuisance. Perhaps you might deal with this problem in an article soon. I am 77 years old.
A The vast majority of scrotal swellings are benign. It is highly likely that the scrotal swelling in your case is a cystic or fluid-filled swelling. Fluid swellings in the scrotum are usually of two types.
A hydrocoele is a collection of fluid that surrounds the testis within an envelope of tissue called the tunica vaginalis, which normally surrounds the testis.
Secondly, an epididymal cyst arises as a separate structure from the testis usually just above it. It sometimes gives the impression of a second testis on that side if it grows to be large enough. Neither of these swellings are dangerous in that they are neither cancerous nor develop into a cancer.
The management is dependent on the degree of symptoms caused by the swellings. In the majority of cases, aspiration of fluid from the scrotum is not recommended as inevitably the fluid reaccumulates and aspiration has the potential of introducing infection.
Surgical intervention is usually reserved for those that are painful or that have become so large as to get in the way or cause embarrassment. The recommended treatment for epididymal cysts is excision and for hydrocoeles is to remove the sac and to rearrange it in such a way as to prevent a reaccumulation of fluid.
No surgical procedure is without risk and complications such as post-operative haem- atoma (a collection of blood) or infection are the most common following any scrotal surgery.
Anyone who notices a new scrotal swelling which has not previously been diagnosed should seek a medical opinion at the earliest opportunity. Not all scrotal swellings are cystic or fluid filled and more serious pathology such as testicular cancer should be ruled out.
Q I have a corn between my little toe and the next toe for the past two years, which is painful. I have also got an area of very thickened rough skin just outside my little toe on the same foot. Why are they there and what can I do about them?
A A corn is an area of thickened skin, which is usually painful and inflamed. The area of hard skin on the other side of your toe I will assume is painless and so is called a callus. A corn is usually macerated and peeling.
Corns and calluses are a reaction by the skin to continued pressure or friction. On the side of the foot, they usually arise as a result of tight shoes and between toes they are due to the toes being compressed together. You can also develop them on the hands because of weight lifting or holding work tools, etc.
Treatment is aimed at trying to relieve the pressure to the skin that is affected. The first step is to wear comfortable well-fitting shoes. We tend, as adults, to forget to get our feet measured, width as well as length.
This is commonly done for children ensuring the shoes fit properly. Recently narrower pointed footwear for men have become more fashionable and are much more likely to cause problems.
There are protective mechanisms such as a corn plaster or cushions, which can spread the pressure more evenly around the area. It may also help to separate the toes using soft cotton, web spacers, etc.
If you have painful fissures, the application of a thick ointment such as petroleum jelly may help. Very occasionally you can get a secondary infection. If it is a bacterial infection then use an antibiotic ointment or an anti-fungal cream if you have a secondary fungal infection (athletes foot). If you've got a very painful fissure, the pain is due to the air in contact with the deeper parts of the skin.
One of the most useful techniques that I have found is using surgical glue, which is essentially super glue, which seals the fissure. Nail glue has also been reported to be useful.
If it is the thickness of the skin that is causing discomfort, filing down the callus with either a pumice stone or a file can help. This is made a little easier if you first soak the area in warm water. There are also specially designed corn trimmers and specially formulated creams which contain either salicylic acid or urea or lactic acid to help reduce the skin thickness.
I would advise attending a chiropodist as they can treat these effectively, and offer more tailored advice. Very occasionally there is an underlying problem with either the shape of the foot bones or a protruding bone, which can cause a persistent problem despite these interventions. If that is the case, referral and treatment by an orthopaedic surgeon could also be considered.
• This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Mr Ron Grainger, consultant urological surgeon, St James's and Tallaght hospitals, Dublin and Dr Patrick Ormond, consultant dermatologist and dermatological surgeon, St James's Hospital, Dublin