Penile and Testicular Problems
CONDITIONS
Written and Medically Reviewed by Mr Ivo Dukic, Consultant Urologist | Last updated: 5/07/2026
Lumps, swellings, pain and skin changes affecting the penis, scrotum and testicles are among the most common reasons men seek a urology opinion. Most are benign and straightforward to treat, but the only way to be certain is to have a proper examination and ultrasound scan, where needed.
I am Mr Ivo Dukic, a Consultant Urological Surgeon based in Birmingham. I offer rapid-access private assessment and treatment for the full range of penile and scrotal conditions — including circumcision for foreskin problems, hydrocele surgery, removal of epididymal cysts, and treatment of varicocele — typically with an appointment within 7 days, with ultrasound scans typically the same week.
This page explains the common conditions I treat, how they are assessed, and the treatment options available, so you can make an informed decision about your care.
When to see a urologist about a penile or testicular problem
You should arrange a specialist assessment if you notice any of the following:
A new lump or swelling in the scrotum or on a testicle
A tight foreskin that will not retract, or recurrent inflammation of the foreskin or glans
Pain in a testicle, the scrotum, or the penis that is persistent or recurrent
A feeling of heaviness or a "bag of worms" texture in the scrotum
Changes in the skin of the penis, or difficulty with the foreskin during sex
Concerns about fertility, particularly where a scrotal swelling is present
A sudden, severe, painful swelling of one testicle — particularly in a younger man — is a medical emergency (possible testicular torsion) and should be assessed immediately in a hospital emergency department, not in an outpatient clinic. For everything else, a planned specialist review is the right pathway.
How penile and testicular problems are assessed
A thorough assessment is the foundation of good treatment. In clinic I take a detailed history, examine you carefully, and — where a scrotal lump or swelling is present — arrange a scrotal ultrasound. Ultrasound is the single most useful investigation for scrotal conditions: it reliably distinguishes a hydrocele from a cyst, a varicocele from a solid lump, and, most importantly, confirms whether a swelling is arising from the testicle itself or from the structures around it [1].
Because my practice is supported by on-site imaging at my hospital sites, in most cases, I can arrange or perform the scan the same week. So that you get rapid reassurance rather than a prolonged period of waiting and worry.
Where the history points to a penile or foreskin problem, examination is usually sufficient to plan treatment, with swabs or blood tests arranged if infection or a skin condition is suspected.
Foreskin problems and adult circumcision
The foreskin is a common source of trouble in adult men. The problems I most often see are:
Phimosis — a foreskin too tight to retract fully over the glans, which can interfere with hygiene, urination and sex, and sometimes cracks or splits
Recurrent balanitis — repeated inflammation or infection of the glans and foreskin, sometimes linked to diabetes or a skin condition
Balanitis xerotica obliterans (BXO / lichen sclerosus) — a scarring skin condition that progressively tightens the foreskin and can narrow the urinary opening
Paraphimosis — a retracted foreskin that becomes trapped behind the glans (an urgent problem)
A tight frenulum — the band under the glans tearing or restricting movement during sex
Treatment options for foreskin problems
Not every foreskin problem needs surgery. Depending on the cause, options include:
Topical treatment — for milder phimosis or an inflammatory skin condition, a course of steroid cream combined with gentle stretching can loosen the foreskin and may avoid surgery altogether
Frenuloplasty — a small procedure to release a tight or short frenulum while preserving the foreskin
Circumcision — surgical removal of the foreskin, which is the definitive treatment for BXO, recurrent balanitis, and phimosis that has not responded to conservative measures
Preputioplasty — a foreskin-preserving alternative to circumcision in selected cases, widening a tight foreskin without removing it
Adult circumcision is a day-case procedure performed under local or general anaesthetic depending on your preference and clinical suitability. Most men return to desk-based work within a few days and to full activity, including sex, at around four to six weeks. I discuss the technique, anaesthetic choice, healing and realistic recovery expectations in detail before proceeding.
Further information from the British Association of Urological Surgeons.
Hydrocele and hydrocoele surgery
A hydrocele is a collection of fluid within the sac that surrounds the testicle. It usually presents as a painless, soft swelling on one or both sides of the scrotum that can gradually enlarge over months or years. Hydroceles are not dangerous in themselves, but a large one can become heavy, uncomfortable, and awkward, and can make examination of the underlying testicle difficult.
An ultrasound confirms the diagnosis and, crucially, checks that the testicle beneath the fluid is normal [1].
Treatment options for hydrocoele
Watchful waiting — a small, symptom-free hydrocele in an otherwise well man does not have to be treated. If it is not troubling you, monitoring is entirely reasonable.
Aspiration and sclerotherapy — the fluid is drained with a needle and a sclerosant is injected to discourage it from returning. This avoids an incision and can suit men who are unfit for surgery, but recurrence is more common than with surgery, and often multiple repeat treatments are needed [2].
Hydrocele repair (hydrocelectomy) — the definitive treatment. Through a small scrotal incision, the sac is opened and either excised or turned inside-out and stitched behind the testicle (the eversion or Jaboulay technique), or plicated (the Lord technique). Modern minimal-manipulation approaches aim to reduce swelling and speed recovery, with low recurrence rates [3,4].
Hydrocele surgery is a day-case procedure. The commonest after-effects are temporary scrotal swelling and bruising; wearing supportive underwear and avoiding heavy lifting for a couple of weeks helps recovery. I explain which technique suits your hydrocele and why, and what to expect afterwards.
Further information from the British Association of Urological Surgeons
Epididymal cysts and spermatoceles
An epididymal cyst is a fluid-filled swelling arising from the epididymis — the coiled tube that sits behind and above the testicle and carries sperm. When the fluid contains sperm, the cyst is called a spermatocele. Both are very common, benign, and unrelated to cancer. They are often discovered incidentally, either by the man himself or during a scan performed for another reason.
Ultrasound distinguishes an epididymal cyst from other scrotal swellings and confirms its harmless nature [1].
Treatment options for epididymal cysts
Reassurance and observation — the great majority of epididymal cysts need no treatment at all. Once cancer has been excluded and the diagnosis is clear, many men are happy simply to leave a small, painless cyst alone.
Excision (removal of the cyst) — offered when a cyst becomes large, uncomfortable, or bothersome. It is a day-case procedure through a small scrotal incision. It is worth knowing that surgery near the epididymis carries a small risk of affecting sperm transport on that side, which is a relevant consideration for younger men who may wish to father children — I always discuss this before recommending removal [5].
For most men, the key value of a consultation is a confident, ultrasound-backed reassurance that the lump is a harmless cyst — and a clear plan only if it is genuinely causing trouble.
Varicocele and varicocele treatment
A varicocele is an enlargement of the veins that drain the testicle, rather like varicose veins in the leg. It classically produces a soft, "bag of worms" swelling in the scrotum, most often on the left side, which is more noticeable on standing and settles when lying down. Varicoceles are common, affecting roughly one in seven men.
Many varicoceles cause no symptoms and need no treatment. However, treatment is worth considering where a varicocele causes a persistent dragging ache, where it is associated with impaired semen quality in some men who may be trying to conceive, or where it is causing a testicle to grow more slowly in an adolescent [6].
Assessment involves examination (standing and lying) and a scrotal ultrasound. Where fertility is a concern, a semen analysis is arranged.
Treatment options for varicocele
The aim of every technique is the same — to block off the abnormal veins so that blood no longer pools around the testicle. The main options are:
Microsurgical varicocelectomy — the veins are tied off through a small groin (subinguinal) incision using an operating microscope, which allows the surgeon to preserve the testicular artery and lymphatic channels. This is regarded by both the European Association of Urology and the American Urological Association as the reference standard, because it has the lowest recurrence rate and the lowest rate of post-operative hydrocele of any technique [6,7]. I do not offer this surgery but would refer you on to a specialist in this area if required.
Radiological embolisation — an interventional radiologist passes a fine catheter into the vein (usually via the groin or neck) and blocks it with tiny coils or a sclerosant, with no incision. Recovery is quicker, and it avoids an anaesthetic, which many men value; the trade-offs are a slightly higher recurrence rate, occasional technical failure to catheterise the vein, and it tends to be less reliable for pain relief than surgery [8,9].
Laparoscopic (keyhole) ligation — the veins are clipped higher up through keyhole surgery. It is effective but generally offers no advantage over the microsurgical approach for a standard varicocele.
Observation — entirely appropriate for a symptom-free varicocele found incidentally, with no fertility concern.
I will talk you through which approach best fits your reason for treatment — pain, fertility, or both — and your own priorities around recovery and avoiding an anaesthetic.
Why choose Mr Ivo Dukic for penile and testicular problems
Rapid access — a private consultation typically within 7 days, with a scrotal ultrasound often arranged the same week.
Diagnosis and treatment in one place — supported by on-site imaging and full theatre facilities across my Birmingham and Worcestershire hospital sites.
Consultant-delivered care throughout — you see the same consultant from first assessment to treatment and follow-up.
A full range of options — from reassurance and conservative management to day-case surgery, chosen around your circumstances rather than a one-size-fits-all pathway.
A university-hospital standard — as Deputy Chief Clinical Information Officer at University Hospitals Birmingham, my private practice is built on the same evidence-based standards as my NHS work.
No GP referral is required to see me privately, although a referral letter is welcome if you have one. I am fee-assured with all major insurers. Enquire about an appointment today.
Frequently asked questions
Is a lump on my testicle likely to be cancer? Most scrotal lumps are benign — hydroceles, epididymal cysts and varicoceles are all far more common than cancer. However, any new testicular lump should be assessed promptly, because when testicular cancer does occur it is highly treatable, especially when caught early. An ultrasound reliably tells us whether a lump is arising from the testicle itself or from the harmless structures around it.
Do I need a referral to be seen? No. You can self-refer directly. A GP or insurer referral is welcome and helpful if you have one, but it is not required for a private appointment.
Will these operations affect my fertility or sex life? Most do not. Circumcision and hydrocele repair do not affect fertility. Surgery close to the epididymis carries a small fertility consideration that I always discuss beforehand, and varicocele treatment is often performed specifically to help fertility. I will explain any relevant risks clearly before you decide.
Are these procedures done under general anaesthetic? It depends on the procedure and your preference. Many can be performed under local anaesthetic or sedation as a day case; others are more comfortable under a general anaesthetic. This is discussed and agreed with you before treatment.
How quickly can I be seen and treated? I aim to see new patients within 7 days, often with a scan at the same week, and surgery can usually be scheduled shortly thereafter — far faster than typical NHS waiting times for these benign conditions.
Book a consultation
If you are concerned about a penile or testicular problem, a specialist assessment will give you a clear answer and, where needed, a straightforward plan. To arrange a private consultation with Mr Ivo Dukic in Birmingham, call the practice or book online. Appointments are typically available within 7 days, with fee-assured cover for all major insurers.
Related pages
References
Rioja J, Sánchez-Margallo FM, Usón J, et al. Adult hydrocele and spermatocele. BJU Int. 2011;107(11):1852–1864.
Brockman S, Roadman D, Bajic P, Levine LA. Aspiration and sclerotherapy: a minimally invasive treatment for hydroceles and spermatoceles. Urology. 2022;164:273–277.
Lundström KJ, Söderström L, Jernow H, et al. Epidemiology of hydrocele and spermatocele; incidence, treatment and complications. Scand J Urol. 2019;53(2–3):134–138.
Ku JH, Kim ME, Lee NK, Park YH. The excisional, plication and internal drainage techniques: a comparison of the results for idiopathic hydrocele. BJU Int. 2001;87(1):82–84.
Kiddoo DA, Wollin TA, Mador DR. A population-based assessment of complications following outpatient hydrocelectomy and spermatocelectomy. J Urol. 2004;171(2 Pt 1):746–748.
Minhas S, Bettocchi C, Boeri L, et al. European Association of Urology guidelines on male sexual and reproductive health. Eur Urol. 2021;80(5):603–620.
Cayan S, Shavakhabov S, Kadioğlu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl. 2009;30(1):33–40.
Bou Nasr E, Marconi L, et al. Comparison of subinguinal microsurgical varicocelectomy versus percutaneous embolization in infertile men. Basic Clin Androl (and related prospective series), Toulouse cohort. 2017.
Shlansky-Goldberg RD, VanArsdalen KN, Rutter CM, et al. Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility. J Vasc Interv Radiol. 1997;8(5):759–767.
Mr Ivo Dukic is a Consultant Urological Surgeon practising in Birmingham and the West Midlands. This page is for general information and does not replace an individual clinical consultation.
Have any questions?
If you have any questions or wish to make an appointment please get in contact.
Ivo Dukic
Contacts
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Telephone number for private patients:
0121 716 9046
(Mondays to Fridays 0800 - 18:00)
For NHS patients seen at University Hospitals Birmingham NHS Hospitals please get in contact on
0121 424 9011
(Mondays to Fridays 0900 - 17:00)
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