What Is Hematocele: Causes, Symptoms and Treatments

Brief anatomical review of the male genital system

Since the article in question will focus its attention above all on testicular hematocele, it is necessary to briefly review the fundamental elements of the male reproductive system:

• Testicles or didymes . Contained in the scrotum are the  male gonads . Their job is to produce sperm cells and the important  hormone  testosterone .
• Prostate and seminal vesicles . The prostate is the gland that produces semen . The seminal fluid, in addition to collecting the spermatozoa (becoming semen ), also provides for their nutrition.
  Two in number, the seminal vesicles produce a liquid similar to seminal fluid.
• Epididymis and vas deferens of each testicle . The epididymis and the vas deferens are the channels that connect the testicles to the seminal vesicles and the prostate and which introduce sperm into the latter. 
• Penis . The penis is the male reproductive organ and the last part of the urinary tract. Thanks to its particular anatomical structure, it allows the passage of sperm from men to women.
• Urethra . The urethra is a small tube that begins at the level of the bladder, runs through the penis and is used for the expulsion of urine and semen. The expulsion of urine and semen occurs through the urinary meatus, located on the  glans penis.

What Is A Hematocele?

“ Hematocele ” is the word that, in the medical field, defines any abnormal collection of blood inside a body cavity.
In common parlance, however, the term “hematocele” refers to the unusual accumulation of blood within the tunica vaginalis , the sac in which each testicle resides.
Given the greater interest that testicular hematocele arouses compared to other types of hematocele as well as its greater notoriety, this article – as already anticipated – will focus above all on this particular problem to which, for obvious reasons, only men are subject.

Origin Of The Name

The word “hematocele” derives from the union of the Greek terms “aima” (αἶμα), which means “blood”, and “cele” (κήλη), which means “dilatation”.

Other Forms Of Hematocele

Another important type of hematocele – which certainly deserves a mention – is the hematocele involving the woman’s retroperitoneal cavity.
To be precise, the precise site of the blood collection that characterizes this typically female hematocele is the retrouterine space.

Causes

The hematocele around the testicles is the result of a loss of blood (hemorrhage) from a blood vessel located in the scrotum that has been injured.
The main causes of scrotal hemorrhages (therefore the main causes of hematoceles) are traumatic injuries to the scrotum and testicular surgery.

Less Common Causes Of Testicular Hematocele

In a very small number of clinical cases, testicular hematocele is the result of a tumor of the testicles , which has caused the lesion of a scrotal blood vessel.
Resulting from the uncontrolled proliferation of one of the testicular germinal or non-germinal cells , testicular cancer is a serious, fortunately uncommon, malignancy which, if detected and treated promptly, tends to have a good prognosis.

Risk factors for testicular hematocele

As you can easily guess, the following are risk factors for testicular hematocele:

• Trauma to the scrotum e
• Surgery involving the testicles.

Causes Of Retroperitoneal Hematocele

The most important causes of retroperitoneal hematocele are episodes of ectopic pregnancy and the so-called tubal abortion .

Symptoms And Complications

Typical symptoms and signs of testicular hematocele are:

• Sense of hardening in the scrotum;
• Discomfort or pain in the scrotum;
• Swelling in the scrotum;
• Presence of a hematoma of variable size at the scrotal level.

Symptoms Of Retroperitoneal Hematocele

In women, retroperitoneal hematocele can cause abdominal discomfort or pain and abdominal swelling .

Complications

Testicular hematocele is not, in itself, responsible for serious consequences; however, its association with various complications is still possible, when it depends on a clinically relevant cause. For example, severe trauma to the scrotum can combine the presence of a hematocele with a phenomenon known as testicular dislocation ; a testicular tumor not treated promptly, on the other hand, can combine the hematocele with the spread of tumor cells to other sites ( metastasis ).

When To See A Doctor?

The presence of a scrotal hematoma, combined with testicular pain and swelling , is a more than valid reason to contact your doctor and request a check-up.
This precaution is particularly important and to be implemented extremely promptly, in the absence of trauma and surgery to the scrotum, since, in such circumstances, the hematoma and other symptoms could most likely be due to testicular cancer.

Diagnosis

Accurate diagnosis of testicular hematocele is based on physical examination, medical history, and testicular ultrasound .

Physical Examination And History

The physical examination and history allow the doctor to know what symptoms and signs are present, how and when the various disorders arose, etc.
In many cases, a physical examination and history are sufficient to establish a correct diagnosis of hematocele.

Testicular Ultrasound

Testicular ultrasound is an instrumental diagnostic test which, through the use of an ultrasound probe (the so-called transducer), provides fairly detailed images of the testicles and of all the various tissues and all the various structures located around the testicles obviously inside the scrotum.
In the presence of hematocele, testicular ultrasound allows to establish the precise cause of the hemorrhagic phenomenon. Its execution is very important when there is a suspicion of testicular cancer; testicular ultrasound, in fact, allows you to detect quite easily any tumor mass located on one of the two testicles.

If The Testicular Ultrasound Detects A Tumor, What Are The Next Tests?

If the testicular ultrasound detects the presence of a tumor, the diagnostic investigations proceed with a testicular biopsy , which serves to establish the exact nature of the neoplasm.

Treatments And Therapy

The treatment options that can be adopted in the presence of testicular hematocele vary from conservative therapies to surgical therapies , depending on what the triggering causes are and how serious the symptoms are. In other words, the treatment adopted in the presence of testicular hematocele depends on the causal factors and the severity of the symptoms.

Conservative Therapy: When It Is Indicated And What It Consists Of

Conservative therapy is the form of treatment applied in the first instance in all those cases of hematocele due to trauma to the scrotum or testicular surgery.
It includes:

• A period of rest , preferably in bed with a board or pillow placed under the thighs, lasting 24-48 hours;
• Applying ice every 3-4 hours, for 15-20 minutes each time. The use of ice has a remarkable anti-inflammatory effect , which however many people ignore or underestimate;
• Taking anti-inflammatories , such as paracetamol or ibuprofen ( an NSAID);
• Manual reduction of a testicular dislocation . It is a specific treatment for this health condition; therefore, where there has been no testicular dislocation, it does not fall within the conservative treatments (unlike the previous ones, which are valid in every situation).

Surgical Therapy: When It Is Indicated And What It Consists Of

Surgical therapy is the solution to:

• Cases of testicular hematocele that do not respond positively to conservative therapy. In these situations, the surgical treatment consists of a resection of the tunica vaginalis, aimed at removing the collection of blood;
• Cases of testicular hematocele due to testicular cancer. In these circumstances, the surgical therapy consists in the removal of the tumor mass, combined with the elimination of the blood collection from the vaginal tunic.
  In fact, the operating doctor combines two surgical operations for the price of one.

Prognosis

As a rule, with the appropriate treatments, the most common cases of testicular hematocele enjoy an excellent prognosis.