Reconstructive Urology & Men's Health

Inguinal & Testicular Surgery - Hydrocele

The scrotum and the testicles can cause a variety of problems. Some of these problems need surgery; others can be watched. The specialists in the University Health Care urology and reconstructive center are not only experienced in diagnosing and treating these conditions but also provide quality care in a professional way.

Some of the problems associated with the scrotum include fluid collections or cysts, called either a spermatocele or a hydrocele. In the testis, inflammation, infection, twisting in the scrotum or a tumor could be a source of pain or discomfort.

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What causes swelling in the scrotum?

Swelling in the scrotum is usually not cancerous and often is the result of fluid collecting around the testicle (hydrocele) or a cyst that forms filled with sperm (spermatocele). A testicular tumor is a hard mass that feels like a hard rock arising from the testicle itself and is usually not painful.

Conditions leading to swollen scrotum

Hydrocele: Fluid collects around the testicle and can cause a heavy pulling feeling that is uncomfortable. The testicle floats in the fluid and usually cannot be felt. Surgery is done to remove the sac that surrounds the fluid. This is a day surgery and done through a small incision in the scrotum. Generally, removing the hydrocele is only done if the fluid causes discomfort.

Spermatocele: Fluid containing sperm forms a cyst that arises from the epididymal gland, which wraps around the back of the testicle and carries the sperm to the prostate. Spermatoceles can form after vasectomy or occur without any known cause. These are removed if they cause symptoms through a small scrotal incision.

Testicular infection: In this condition the testicle and epididymis gland becomes infected due to bacteria travelling up the ducts that carry sperm to the prostate (vas and ejaculatory ducts). This condition causes intense pain and fevers and a very reddened scrotum. Patients that have pain like this need to go to the emergency department and get antibiotics. The other reason to be seen immediately when the testicle is very painful is to make sure it hasn’t twisted shutting of the blood supply to the testicle.

Testicular torsion: This condition is most common in young men after puberty but can happen anytime during a man’s life. The testicle twists and stays twisted in the scrotum rather than unwinding as one would expect. The twisting shuts off the blood supply to the testicle, which causes intense pain. The scrotum is reddened around the testicle and the testicle is hardened and rides very high in the scrotum. Patients with this condition need to come into the emergency department immediately to be evaluated. Surgery is done to untwist the testicle as soon as possible or remove the testicle if it cannot be saved.

Testicular cancer: Testicular cancer can happen at anytime in a man’s life. There are a variety of types of tumors, and their aggressiveness depends a lot on the type of tumor. Testicular cancer is a hard and often irregular feeling mass that arises from the testicle itself. This tumor is not very tender, although some men have with pain or a coincidental, small trauma. When men suspect they have a testicular tumor they should be seen immediately by a doctor. Delay can lead to rapid spread of the cancer.

Chronic pain in the testicle or epididymis: Occasionally, men can get chronic pain in the testicle or the epididymis gland, which surrounds the back of the testicle. This pain can be debilitating and cause a huge impact on men’s quality of life. Often the pain will occur after vasectomy, an infection, trauma or hernia surgery. There are multiple treatments if medical therapy like anti-inflammatory drugs do not work to relieve the problem.

What are some of the surgeries that can fix chronic pain in the testicle or epididymis?

Orchiectomy: Removal of the testicle in some cases can resolve pain. However, this is the last resort because all of the function is lost from the testicle, like production of testosterone and sperm. If other methods do not work this can cure some men.

Denervation: In this surgery the nerves that run to the testicle are clipped leaving the blood supply intact as well as the testicular function. This can be a very effective method of resolving the problem; it is done through a small incision in the groin.

Removal of the epididymis: When pain is localized to the epididymis then removal of the gland from the back of the testis with a small surgery may cure the pain.

Vasectomy reversal: Men that develop pain from a vasectomy may respond to reconnecting the sperm tube in order to restore the flow of sperm out of the testicle. We think pain can arise in men after vasectomy because of pressure in the testicle from the continued production of sperm. This is rare but in some men can be very debilitating.

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