The first step of diagnosing is history taking, during which it should be clarified, how long the lesion exists, whether it was accompanied by fever or pain initially, was the affected area exposed to a trauma, how rapidly its growth was, what complaints are caused by it currently, underwent the patient any surgery recently, had the patient a hernia or disorder of testicular descending previously, etc. During physical examination the scrotum should be held with both hands, it should be palpated thoroughly while the patient is in a supine position; the checking should include the status of the other testis, the closure of the hernial orifices, the size of the mass, its tenderness on pressure, the feasibility of its ballottement, its shape, etc.
It is essential to make examination while the patients exerts abdominal pressing, as it can be checked if the mass in the scrotum increases upon the Valsalva maneuver or any bowel appear in the hernial orifice. It is useful to repeat this latter part of the examination also with the patient in a standing position. Earlier attempts were made to obtain a diagnosis by transilluminating the swollen scrotum with a strong lamplight, as in case of a hydrocele a dim light went through the thin skin of the scrotum and the clear fluid within it. Currently this method is not used any more due to its unreliability. Scrotal ultrasound examination, however, is an essential part of the assessment. During it the testis should be sought in the hypoechogenic fluid, and the structure and circulation of the testis and epididymis should be checked. The above are usually sufficient for establishing the exact diagnosis and making a therapeutic plan.
