Hydrocele is an accumulation of fluid in the scrotum. A spermatocele is an abnormal accumulation of sperm in the head of the epididymis, a convoluted tubule lying on the back and top of the testes that holds spermatozoa while they mature.
Hydroceles occur in about 1% of adult men. Spermatoceles are more common appearing in about 30% of adult men. They are usually found during self examination or while men are undergoing imaging studies for other conditions.
Usually, neither condition is painful. Hydroceles tend to appear as a swelling in one or both testicles. The scrotum with hydrocele has been described as feeling like a water-filled balloon. If pain is present, it indicates inflammation of the epididymis. Spermatoceles are much smaller and appear as a pea-sized bulge or lump in the scrotum. Sometimes this lump may be tender or painful and on occasions the scrotum is enlarged.
Hydroceles are common in newborn males. During development the testicles descend from the abdomen to the scrotum down a tract known as the processus vaginalis. When this tract fails to close after their descent, the scrotum can fill with fluid from the abdomen. This situation usually resolves within a few months. In men, hydroceles can result from inflammation in their reproductive system, from injury or from an obstruction in the spermatic cord.
Spermatoceles arise from an accumulation of sperm, usually in the head of the epididymis. The reasons for this accumulation are not well known. In many instances they appear to occur spontaneously without any preceding instances of injury, infection or inflammatory conditions. Research is pursuing the origins of spermatoceles.
Hydroceles are diagnosed by a physical examination of the scrotum. The first thing the doctor will do is rule out testicular torsion as a cause. This is a serious condition that requires immediate attention and is usually painful. With hydrocele, the scrotum is enlarged but not tender. Because the fluid causing the swelling is clear, a flashlight shined through the scrotum will show the outline of the testes. This illumination suggests the problem is hydrocele but is not diagnostic. Ultrasonography is used to confirm a diagnosis and to rule out other possible problems. Ultrasound imaging uses sound waves that bounce off internal organs and structures. These echos are converted to images (sonograms) by a computer.
Spermatoceles appear as a firm, pea-sized lump. Men find them by palpating (feeling) their scrotum. Physicians find them the same way, often during routine physical check-ups or during an examination for other problems. Ultrasonography may be used to pinpoint and define the lump. Spermatoceles are filled with fluid whereas other growths are not. A sonogram helps determine if the lump is a spermatocele or a mass that may be a benign or cancerous tumor. Sonograms are nearly 100% accurate in diagnosing spermatoceles.
When the conditions are painful, laboratory tests such as complete blood counts and urinalysis may be used to determine if inflammation and infection are present.
There are no medications that treat hydrocele or spermatocele. Analgesics may be prescribed to relieve pain. Antibiotics may also be prescribed when spermatocele is suspected of arising from an infection.
Surgical procedures are not frequently employed for either hydrocele or spermatocele. One reason is that the conditions tend to recur following surgery. Surgical interventions are used in infants to close the processus vaginalis when it fails to close naturally. In adults surgical procedures may be employed when the swelling is painful, embarrassing or when it grows to a size that threatens the function of other anatomy within the scrotum.
Hydroceles are drained under local anesthetic by making an incision in the scrotum or groin close to the scrotum. This is a minor surgical procedure and patients return home soon after it has been completed. Ice packs are applied for the first 24 hours following the procedure. A second procedure in which a needle is used to draw off the fluid (aspiration) is seldom used anymore.
Spermatoceles are also removed as an outpatient procedure. The area is anesthetized, a small incision is made in the scrotum or groin and the spermatocele is removed (spermatocelectomy).
The majority of instances of hydrocele and spermatocele in men require little treatment other than analgesics. Most will resolve on their own. Surgical interventions to drain the scrotum or remove spermatoceles approach a 100% success rate.
Although these two conditions are considered benign, any abnormality in the scrotum should be investigated. Any abnormality or pain in the groin may stem from testicular torsion, an emergency condition that requires immediate medical attention at the closest medical facility.