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But it does not mean that the body just eliminates cotinine as well

These causes include: Epididymitis (When the coiled tube at the back of the testicle becomes inflamed.) Hydrocele (Fluid buildup that causes swelling of the skin pouch that holds the testicles, called the scrotum.) Orchitis (A condition in which one or both testicles become inflamed.) Scrotal masses (Lumps in the scrotum that can be due to cancer or other conditions that are not cancer.) Spermatocele (A fluid-filled sac that can form near the top of a testicle.) Testicle injury or hard hit to the testicles