Scrotal Conditions Treatments UK Specialist

Scrotal Conditions Treatment

Scrotal Conditions

The scrotum is a loose sac which contains the 2 testes. Both the testes are attached to a cord-like structure called spermatic cord which contains testicular artery, vein, nerve and also vas deferens tube which takes sperms from the testes into the penile urethra.

Hydrocele in Adults

scrotal conditions

A hydrocele is a collection of fluid in the scrotum surrounding the testes. It can be either unilateral or involve both sides.

Causes of Hydrocele

In most of the cases there is no apparent cause. However in a small number of cases the scrotal fluid collection could be as a result of underlying infection, inflammation or trauma to the testes. A testicular tumour can also sometimes lead to fluid collection in the scrotum. A hydrocele can also develop when there is generalised body swelling and oedema as a result of fluid retention. It could be related to heart problems or renal failure. If you notice any swelling of the scrotum you must get medical advice from either your GP or urology specialist to rule out any underlying pathology.

Ultrasound Scan

After clinical examination your doctor will arrange an ultrasound scan of your scrotum. During the examination sound waves are used which help to assess the internal structure of the testis, the epididymis tube and surrounding tissue. This is a helpful tool to rule out any underlying testicular growth.

Treatment

  • a hydrocele is not causing any symptoms it can be left alone and monitored by the patient.
  • If the hydrocele is causing symptoms a small scrotal operation is carried out as a day case under general anaesthesia. During surgery the sac is opened, fluid drained and the sac in the majority of cases is everted and stitched behind the testis to prevent a recurrence of the hydrocele.
  • Following surgery a small percentage of patients might get infection or swelling of the scrotum which in the majority would settle with conservative management.

Epididymal Cysts

An epididymal cyst is a benign cyst arising from epididymis which is a tubular structure attacked to the testis. These cysts could single or multiple, present either unilaterally or bilaterally.

  • You may feel a cystic lump separate from the testis.
  • The majority of these cysts do not cause any pain or discomfort.
  • Larger or multiple cysts may lead to pain or discomfort and can interfere with your day to day activity.
  • If you notice any lump in the scrotum you must see you GP to rule out any other underlying pathology.

Ultrasound Scan

After clinical examination your doctor will arrange an ultrasound scan of your scrotum. During the examination sound waves are used which help to assess the internal structure of the testis, the epididymis tube and surrounding tissue. This is a helpful tool to rule out any underlying testicular growth.

Treatment

Small epididymal cysts can either be left alone or monitored if they are not causing symptoms. However larger or multiple cysts can be removed surgically. The procedure requires small scrotal operation under general anaesthesia as a day case. These cysts can be easily shelled out during surgery. However recurrence is possible in future.

Epididymo-orchitis

Inflammation of the epididymis and testis is called epididymo-orchitis.

Symptoms

You will notice a painful, tender swelling of the scrotum with redness of the overlying skin. There could be associated burning and stinging of urine. If the infection is severe you may have fever and generally feel unwell.

Causes

Epididymo-orchitis can happen in patients with urinary infection from organisms such as
E. coli which can travel along the vas deferens to the epididymis and testis.

Treatment

If you notice a painful swelling of the testis you must contact either your GP or a urology specialist. After clinical examination of your scrotum an ultrasound will be arranged for further assessment. Urine is checked for infection. The majority of cases settle with 3 to 4 week course of antibiotics, scrotal support and rest. A small percentage however may prolong and can result in abscess which requires drainage.

Varicocele

A varicocele is a collection of enlarged dilated veins in the scrotum. It occurs either unilaterally or can be present on both sides. Varicoceles are common occurring in 1 in 7 men between the ages of 15 and 25. In most cases varicoceles are painless and cause no symptoms. However in a small percentage of patients a varicocele can be large and can give a feeling of dragging sensation and discomfort in the scrotum.

Treatment

If you notice a lump in the scrotum you must see your GP or a specialist who will carry out thorough examination of the scrotum. A scrotal ultrasound scan will be arranged.

  • No active treatment is needed in most of the cases.
  • In those cases where treatment is required dilated veins can either be blocked by embolisation carried out by an interventional radiologist under local anaesthetic.
  • Surgically the veins can be ligated either through a small incision in the groin or laparoscopically as a day case procedure under general anaesthesia.

Vasectomy

A vasectomy is a small operation to cut the vas deferens tubes which carry the sperm from the testes to the penile urethra. Vasectomy is an effective and permanent form of contraception. In the majority of cases the procedure is carried out as a day case under local anaesthetic which is injected into a small area of skin on either side of the scrotum above the testes. The vas tube is tied through a small cut over the scrotal skin.

Important points about vasectomy:-

  • Vasectomy is a permanent method of contraception. A reversal vasectomy is a complicated procedure which is not always successful and not available on the NHS.
  • Vasectomy is a reliable procedure for sterilisation but is not quite 100%.
  • About 1 in 1000 operations are not successful and semen test show sperms still present after operation.
  • You must continue to use contraception until at least 2 samples of semen have come back clear showing no sperms.
  • Even after initial successful operation 1 in 2000 men who have had a vasectomy will become fertile again at some point in the future. This is only in rare situations where the 2 ends of cut vas tube may reunite.
  • Small percentage of patients may get local swelling, bleeding or infection which in the majority of cases can be easily managed conservatively.