Hematocele: symptoms and treatment

Hematocele is the increase in the volume of the scrotum (the bag that contains the testicles) due to the accumulation of blood in a layer that is medically called the tunica vaginalis. It is acute. It can appear quickly, and in rare circumstances, it can be chronic. The most common causes are trauma and surgery to the groin region. Other less common causes are tumors in the testicles, torsion of the testicle, or unknown causes. It is related to underlying diseases such as diabetes mellitus and varicocele. It presents with pain or not, swelling, or an increase in volume at the level of the scrotum and testicle. At FastlyHeal, we explain in detail what are the symptoms and treatment of hematocele.

What is hematocele, and why does it occur

Hematocele is the blood collection in the testicular cavity (part of the scrotum or bag that contains the testicles). Its origin may be related to small tears or perforations of the scrotum layer itself, which is medically called the tunica vaginalis. Typically, the cause almost always tends to be traumatic. Among the most frequent injuries are:

• Sports: balls (soccer, baseball, tennis …), martial arts, cycling, etc.
• Assaults: kicks, knees.
• Traffic accidents: especially motorcycle and bicycle.
• Falls from horses.
• Accidents: hitting against table corners, “faux-pas” (false steps) during sexual intercourse.

Other causes of hematocele in order of frequency are:

1. Surgeries of the groin and scrotum region, including inguinal hernia surgeries.
2. Hydrocele: accumulation of fluid in the layer that covers the testicle.
3. Varicocele: dilation of the testicular veins.
4. The testicular torsion: testis turns on itself, twisting the spermatic cord responsible for carrying the blood bag scrotum.
5. Testicular tumors and diseases such as diabetes mellitus or bleeding disorders (people on anticoagulants).
6. In sporadic cases, hematoceles of unknown origin (idiopathic) are described. However, it is a diagnosis to take into account.

Hematocele: common symptoms

The clinical presentation of symptoms will depend on the cause of the hematocele so that patients may manifest:

1. Pain when there is ischemia (lack of oxygen supply to the testicle).
2. An increase in the scrotum volume will depend on the magnitude of the bleeding, the time of evolution of the hydrocele, and the degree of complication of the testicle. The larger the hematocele, the greater the risk of oxygen deficiency in the testicle.
3. An unusual mass or lump that the patient can touch can be soft, challenging, and even stone (stone consistency). If the hematoma calcifies, this is a severe manifestation of the hematocele.
4. Discoloration of the scrotal skin. It may initially be reddish, and then it may turn purplish. If it becomes infected, it can be accompanied by an increase in local temperature (hot scrotum) and even present purulent discharge with increased volume of the lymph nodes in the inguinal region, accompanied by fever and leukocytosis in complete hematology.

In addition, other symptoms may occur, such as:

• A sensation of weight in the scrotum.
• A partial or total limitation in walking and performing daily activities.
• Pain or inability to have intercourse.
• Nausea or vomiting.

Hematocele: treatment

It is essential to know that any mass or lump that can be touched at the testicular or scrotal level should be evaluated by a doctor. Treatment is exclusively medical, so it is vital to go to a consultation for the manifestation of the first symptoms. In general, hematocele treatment can be conservative or surgical and will be directly related to several factors:

• Cause of hematocele.
• Age of the patient.
• I associated pathologies or diseases.
• Time since the disease appeared.
• Local or generalized complications.

Conservative treatment of hematocele

It is based on the symptomatic relief of pain and inflammation through analgesics and anti-inflammatories, as well as the elevation of the testicles towards the pubis and the slight compression of the scrotal bag with the use of testicular jockstrap (male underwear that supports the genitals ), application of local ice and physical rest.

If you are taking anticoagulant treatment, it should be stopped, and any therapy that interferes with clottings, such as vitamin E and metformin.

Surgical treatment of hematocele

It is aimed at removing the accumulated blood content, and there are several techniques to do this:

• Needle puncture directly. It can be guided by an echo or not.
• Carrying out a minimal discharge incision plus the placement or not of a kind of drainage that allows the blood contained in the scrotum to be evacuated. It can be done in the office with local anesthesia or in the operating room with conductive anesthesia (in the spine) or intravenous sedation.
• Wide surgical drainage in the operating room, the hematocele is emptied with the reconstruction of the scrotum, depending on its magnitude. Likewise, it can be done under conductive or general anesthesia. A type of drainage is left—the Urology Service. The CMA (Major Ambulatory Surgery) Unit of the General University Hospital of Valencia (Spain) evaluated the surgical treatment of hydrocele with major outpatient surgery, obtaining satisfactory results in almost 95% of the patients with this pathology who underwent a CMA [1].
• In some cases, it is necessary to perform orchidectomy (remove the affected testicle) with the placement or not of a testicular prosthesis. This is done when ischemia or infarction of the testicle occurs and cannot be preserved. Even if it is minimally invasive, any surgical procedure is accompanied by antibiotic therapy.

Any injury to the genitals is of vital importance for the patient. If you notice any of the symptoms of hematocele, such as pain in the testicles and an increase in volume, go to a medical emergency. We also recommend avoiding self-medication.

This article is merely informative. At FastlyHeal .com, we do not have the power to prescribe medical treatments or make any diagnosis. We invite you to see a doctor if you present any condition or discomfort.

If you want to read more articles similar to Hematocele: symptoms and treatment, we recommend that you enter our category of Male reproductive system.

Alivia Nyhan

I am a Surgeon with a diploma in comprehensive ultrasound and surgical care residency, an area I am specializing in. During the exercise of my profession, I have realized the need for patients to know the diseases they suffer, and I can tell you that a large part of their complications is due to a lack of information. Being a health web writer allows me to transmit my experience, without borders, to all those readers eager for knowledge, educate them in the prevention of diseases and promote a healthy lifestyle.