Table of Contents
Overview – Scrotal Accumulations
Scrotal accumulations refer to abnormal fluid or mass-like collections within the scrotum, often involving the tunica vaginalis or spermatic cord structures. Common types include hydrocoele, varicocoele, spermatocele, and haematocele. These conditions are mostly benign but may lead to complications such as testicular atrophy, discomfort, or infertility if left untreated. Recognising the underlying pathology is essential for appropriate management.
Definition
Scrotal accumulations are non-solid collections—fluid, blood, or cysts—that occur around the testicle or within the spermatic cord, affecting scrotal structure and function.
Hydrocoele
- What?
- Accumulation of clear serous fluid within the tunica vaginalis surrounding the testicle
- Why?
- Congenital: Failure to obliterate the processus vaginalis (often in neonates)
- Acquired: Secondary to trauma, infection, or tumours
- Clinical Features
- Painless scrotal swelling, transilluminates on examination
- May displace the testis
- Complications
- Chronic pressure may lead to testicular atrophy
- Management
- Often self-resolving in infants
- Surgical repair (hydrocelectomy) if persistent or symptomatic
Varicocoele
- What?
- Dilated and tortuous veins of the pampiniform plexus (spermatic cord)
- Why?
- Incompetent venous valves → pooling of blood
- More common on the left side (due to drainage into left renal vein)
- Clinical Features
- “Bag of worms” sensation
- Often asymptomatic or presents with dull scrotal ache, especially after standing
- Complications
- Can impair testicular temperature regulation → infertility or oligospermia
- Management
- Observation if asymptomatic
- Surgical ligation or embolisation if symptomatic or associated with infertility
Spermatocele
- What?
- Sperm-filled cyst arising from the head of the epididymis
- Why?
- May follow trauma or infection → ductal obstruction and cyst formation
- Clinical Features
- Soft, fluctuant, transilluminating mass separate from the testis
- Typically painless
- Complications
- Usually benign, but large lesions can cause discomfort
- Surgical removal may impair fertility due to epididymal damage
Haematocoele
- What?
- Accumulation of blood within the tunica vaginalis
- Why?
- Often post-traumatic or related to tumours/rupture of blood vessels
- Clinical Features
- Painful, swollen scrotum
- Does not transilluminate
- Complications
- Risk of compressive atrophy of the testis if untreated
- Management
- Surgical evacuation may be required
Summary – Scrotal Accumulations
Scrotal accumulations encompass a variety of conditions such as hydrocoele, varicocoele, spermatocele, and haematocoele. While often benign and asymptomatic, these may cause complications like testicular atrophy, discomfort, or infertility if untreated. For a broader understanding of male reproductive disorders, refer to the Reproductive Health Overview page.