Q: I have a problem with an enlarged testicle. Fortunately, it doesn’t cause me any pain or symptoms, but my GP thinks it’s due to fluid and has booked me in for an ultrasound scan. What is the cause and remedy? N-oneme and address provided.
Dr. Scurr replies: What you’ve described is almost certainly a hydrocele, a type of swelling in the scrotum caused by a build-up of fluid.
Although it inevitably alarms those affected – patients often fear it is a sign of testicular cancer – rest assured that hydroceles are not sinister.
What triggers them is not clear, but it may be associated with an injury or an infection.
The build-up of fluid happens slowly. The fluid itself is like the kind in blisters, medically known as serum. It fills the space between the two layers of a membrane called the tunica vaginalis, which encloses the testicle and the spermatic cord (which in turn connects the testicles to the abdominal cavity).
Dr. Scurr answers your health problems
The tunica vaginalis is a remnant from early development, left over from when the testicle forms as the fetus develops. It migrates from the stomach down into the scrotum, but you won’t feel it unless fluid fills the potential space between the two layers.
An enlarged testicle may be a hydrocele – a type of swelling in the scrotum caused by a build-up of fluid
What triggers a hydrocele is not clear, but it may be related to an injury or an infection
This fluid can completely or partially surround the testicle.
The first step in diagnosing a hydrocele is transillumination, where a doctor shines a torch behind the swollen mass. If the entire fluid-filled structure glows brightly, this confirms that it is a hydrocele. An ultrasound scan will confirm this.
The condition usually does not resolve itself naturally. But there is no need to treat it, let alone urgently, unless its size becomes a nuisance or causes discomfort.
In the past, doctors removed the fluid with a needle under local anesthesia, but since the fluid usually accumulates again, this is only a stopgap measure. The only cure is surgery under local or general anesthesia to remove the tunica vaginalis – a simple operation performed as a day case.
Q: Almost every time I go for a walk in strong winds, my face gets hot and very red. I take metformin and dapagliflozin for type 2 diabetes and candesartan for blood pressure. Can my medication sensitize my skin? I am 75. John Smith, Bognor Regis.
Dr. Scurr replies: None of the medications you are taking are known to cause skin sensitization. Rather, your symptoms are characteristic of a common skin condition called rosacea.
Facial flushing is a typical problem and is often triggered by exposure to extreme temperatures, ultraviolet light and exercise.
Rosacea is thought to be caused by abnormalities in the blood vessels of the face and a reaction to microscopic mites commonly found on the skin.
The fact that your only symptom is a facial rash when exposed to cold suggests that the rosacea is mild. The increased blood flow to the skin that causes the redness can also cause the warm sensation you describe.
In more severe cases, patients may develop inflammatory spots (papules) and some of these may develop into pus-filled pimples, even if you have been spared this.
Prominent, enlarged blood vessels on the cheeks and near the nose may also become visible over time.
My feeling is that you should accept this symptom and not try to change your medication.
You mentioned in your longer letter that you have a review with your GP – this would be a good time to discuss your skin; they will be able to examine you properly and confirm my speculative diagnosis.
I note that you live by the sea and I would recommend that you protect your skin even in the winter when you are out walking. Applying an SPF30 cream can help reduce facial redness when you’re out and about.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email: drmartin@dailymail.co.uk — include your contact details. Dr. Scurr cannot enter into personal correspondence. Answers should be taken in a general context and always consult your own GP with any health problems.
In my opinion… Don’t punish patients who are forgetful
An old friend has been treated with the antidepressant fluoxetine (brand name Prozac) for two years.
Every month his GP issues a repeat prescription for it along with other regular medicines. And as the prescription charge is £9.65 per item, he sensibly signed up for a prescription payment certificate. This is a season pass of sorts which, at £31.25 for three months covering all NHS prescriptions, is a real saving.
But my friend recently failed to renew the certificate when it was overdue and continued to receive repeat prescriptions: these were filled at his usual pharmacy where he ticked ‘box F’ on the form to indicate he had a certificate.
The bureaucracy has now caught up with him with a fine of £270 plus £31.25 for each month’s season ticket arrears (ie £363.75 in total).
Is this really fair for a patient who is being treated for chronic depression – and can be forgetful – when there are no prescription charges in Wales or Scotland?
Patients in England, you have been warned.