Scrotal Disorders

The three most common disorders that affect the scrotum, the sac beneath the penis that holds the testicles, include:

Hydroceles are collections of fluid within a section of the scrotum called the tunica vaginalis;

Varicoceles are an enlarged group of veins above the testicles and along the vas deferens, a blood vessel-rich cord that connects the epididymis to the prostate gland.

Spermatoceles are sperm-filled cysts at the head of the epididymis, a coil of tubes behind the testicles where sperm are stored.

SYMPTOMS

Hydroceles can have symptoms that include a bulky, achy feeling in the scrotum, and swelling of the scrotal sac.

Varicoceles most commonly demonstrate a heavy, dragging, aching feeling in the scrotum, which often increases throughout the day.

Spermatoceles typically have no symptoms. In some cases, they may grow large enough to create chronic pain or cause tight fitting clothes to be uncomfortable.

DIAGNOSIS

Hydrocele. To diagnose hydroceles, the physician manipulates the scrotum and may order an ultrasound.

Varicoceles. When manipulating the scrotum during an examination, the physician will detect the varicocele because the scrotum feels as if it contains a “bag of worms.” To diagnose varicoceles, the physician may order one of the following:

  • Doppler stethoscope;
  • Doppler ultrasound;
  • Venography; and
  • Thermography.Because spermatoceles are small, they are usually discovered during a scrotal ultrasound for an unrelated condition.

TREATMENT APPROACH

Hydroceles do not always require treatment; however, if treatment is required, a surgical procedure called hydrocelectomy is the treatment of choice. During the outpatient procedure, a physician makes an incision in the groin (in infants and children) or in the scrotum (in adults), drains the fluid, then stitches or partially removes the wall of the hydrocele sac to prevent the hydrocele from returning.

For teenage boys with varicoceles, the physician usually recommends a varicocelectomy. This procedure involves tying off the affected veins. Physicians recommend this procedure for adults only when pain persists or the varicocele is causing fertility problems. Another treatment method, less commonly used by urologists, is embolization. In embolization, an embolic (blocking) agent is injected into the malfunctioning vein to block blood flow.

Spermatoceles. Treatment for a spermatocele is not necessary unless the cyst causes pain or discomfort. To treat a spermatocele, the physician may use sclerotherapy, the injection of a chemical agent that causes the veins to close and harden, or surgery to remove the sperm-filled cyst.

CAUSES AND RISK FACTORS

Hydrocele. A hydrocele is usually found in a newborn or a man older than 40 years of age. In infants, the condition is thought to occur because fluid leaks into the scrotum as the testicles move into the scrotum from the abdomen during fetal development. Some possible causes in adult men include: trauma to the scrotal area; inflammation or infection; a tumor; tuberculosis; kidney transplantation; or a twisted testicle.

During adolescence, the testes may grow dramatically with more blood flowing into them. If a vein valve malfunctions, the blood may pool on returning to the heart, causing a varicocele.

Spermatoceles do not have a known direct cause; however, it is believed that an obstruction in the epididymis causes spermatoceles.