Hydroceles, Spermatoceles & Epididymal Cysts

Background

There are several conditions that can cause swelling in the male scrotum. While cancer is understandably a concern, it is relatively rare in comparison to the common development benign swellings, including hydroceles and spermatoceles. These are too similar conditions of fluid swelling in the scrotum. A hydrocele is simply the development of serum fluid accumulation in a potential space in the scrotum called the tunica vaginalis [a vestigial structure as a remnant left from embryological development]. A spermatocele [also called an epididymal cyst] is a fluid swelling above or behind the testicle as a result of the development a cystic swelling from the rete testis.  

Causes

Usually these cystic swellings occur without obvious cause. A hydrocele can occur after scrotal trauma or inflammation. In children, a hydrocele usually occurs when the processus vaginalis fails to close off and atrophy. This is what is termed a "communicating hydrocele" and it is only relevant in that it requires a slightly different surgical approach for correction. A spermatocele is also usually of no clear cause but can perhaps occur slightly more common in men who've undergone previous vasectomy.

Diagnosis & Evaulation

The diagnosis is usually made on the basis of history and physical examination, including transillumination which is a maneuver during examination where a light source is shined through the scrotal skin to see if the swelling "lights up" i.e. transilluminates which indicates that it is a fluid swelling and not a solid mass. Usually ultrasound is ordered for confirmation.

 

Treatment

Hydroceles and spermatoceles are completely benign and nonthreatening. Smaller sized lesions or usually left alone. The only definitive option for treatment is surgical excision, and this is usually only performed if the swelling is large enough that it is causing sufficient bother because of size or discomfort. The surgical approach is performed as a daycare procedure under an anesthetic where a scrotal incision is made to access the swelling and remove it. Risks include infection, bleeding, pain and recurrence [in the order of 5-10%]. Your urologist will discuss with you treatment options including surgery.

 

On the Web

General Urology Websites

Canadian Urological Association  Extenstive library of downloadable pamphlets on a wide range of urological conditions

Cleveland Clinic

Mayo Clinic

Medline Plus Produced by the US National Institutes of Health with information on virtually every health topic and extensive list of links

UrologyHealth.org The patient information site of the American Urological Association.