Hematocele - Causes, Symptoms and Treatments

Generality

Hematocele is the medical term for an abnormal collection of blood within a body cavity.

The most well-known type of hematocele that has the greatest interest is the one concerning the male genital apparatus, namely the scrotum and the vaginal tunic containing the testicles.

Almost always due to traumatic injuries or surgery, testicular hematocele is usually responsible for swelling, a sense of hardening of the scrotum, pain and hematoma.

The diagnosis of hematocele is based, as a rule, on an accurate physical examination, a careful medical history and testicular ultrasound.

The therapy of a hematocele to the testicles can be conservative or surgical, depending on which triggers were and depending on the severity of the symptoms.

Brief anatomical review of the male genital apparatus

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 genital system:

Testicles or didymas . Contained in the scrotum, they are the male gonads . Their job is to produce sperm and the important testosterone hormone.
Prostate and seminal vesicles . The prostate is the gland that produces seminal fluid . The seminal fluid, in addition to collecting the spermatozoa (becoming sperm ), also provides for their nutrition.
In number of two, 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 join the testicles to the seminal vesicles and the prostate and which inject into the latter the spermatozoa.
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 spermatozoa from man to woman.
Urethra . The urethra is a small canal that begins at the vesicular level, runs along the entire penis and is used to expel urine and sperm. The expulsion of urine and sperm 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 within a body cavity.

In common jargon, however, the term "hematocele" refers to the unusual accumulation of blood within the vaginal tunic, ie the bag in which each testicle resides.

Given the greater interest that testicular hematocele gives to other types of hematocele as well as its greater notoriety, this article - as already mentioned - will focus above all on this particular problem to which, for obvious reasons, only men are subjected.

Clarification

The vaginal tunic is a sort of lining membrane, which classically surrounds the testicle (each testicle, therefore, has one).

The vaginal tunic should not be confused with the scrotum, which is a fibro-muscular skin pouch.

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 "dilation".

Other forms of hematocele

Another important type of hematocele - which certainly deserves a quotation - is the hematocele having as its object the retroperitoneal cavity of the woman.

To be precise, the precise location 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 blood loss (hemorrhage), from a blood vessel with a scrotal site victim of an injury.

The main causes of scrotal haemorrhage (thus the main causes of hematocele) are traumatic scrotum injuries and testicular surgery.

Hematocele due to a testicular operation is a surgical complication.

Less common causes of testicular hematocele

In a very small number of clinical cases, testicular hematocele is the result of a testicular tumor, which caused the lesion of a scrotal blood vessel.

Resulting from the uncontrolled proliferation of one of the germinal or non-germinal testicular cells, testicular cancer is a serious neoplasm, fortunately not very common, which if detected and treated promptly tends to have a benign prognosis.

Risk factors of testicular hematocele

As can be easily understood, they are risk factors of the testicular hematocele:

Scrotum trauma e
The surgical interventions that have the testicles as object.

Causes of retroperitoneal hematocele

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

Symptoms and complications

The typical symptoms and signs of testicular hematocele are:

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

Hematocele is one of the main causes of the condition known as a swollen testicle.

Among the other causal factors of swollen testicle, include: hydrocele, varicocele, testicular torsion, inguinal hernia, epididymal cysts, epididymitis and orchitis.

Symptoms of retroperitoneal hematocele

In women, retroperitoneal hematocele may cause abdominal discomfort or pain and abdominal bloating.

Complications

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

When should I go to the doctor?

The presence of a hematoma at scrotal level, combined with testicular pain and swelling, is a valid reason to contact the attending physician and request a follow-up visit.

This foresight is particularly important and to be implemented very promptly, in the absence of trauma and scrotum surgery, since, in such circumstances, the hematoma and other symptoms could probably be due to a testicular tumor.

Diagnosis

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

Physical examination and medical history

Physical examination and medical history allow the doctor to know what the symptoms and signs are, how and when the various disorders have arisen and so on.

In many cases, carrying out the physical examination and medical history is sufficient to establish a correct diagnosis of hematocele.

Curiosity: how to distinguish a hematocele from a hydrocele

A condition similar to hematocele is the so-called hydrocele . Also falling among the causes of swollen testicle, the hydrocele consists of an anomalous collection of transparent liquid in the vaginal tunic of the testicles (exactly as it happens for the blood, in the case of the hematocele).

To distinguish a hematocele from a hematocele, the doctors rely on the visual examination of the scrotum, which in the first case (hematocele) appears bluish-red, while in the second case (hydrocele) it is usually colored.

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 all the various tissues and all the various structures placed around the testicles, obviously inside the scrotum.

In the presence of hematocele, testicular ultrasound allows the precise cause of the haemorrhagic phenomenon to be established. Its execution is very important, when there is a suspicion of a testicular tumor; testicular ultrasound, in fact, allows any tumoral mass located on one of the two testicles to be detected quite easily.

Curiosity

Testicular ultrasound is a very advantageous diagnostic test; it is, in fact, safe, highly effective, inexpensive and rapid.

If the testicular ultrasound detects a tumor, what are the subsequent exams?

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.

Cure and Therapy

Treatment options that can be used in the presence of testicular hematocele vary from conservative therapies to surgical therapies, depending on which are the causes 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 a testicular surgery.

It includes:

A period of rest, preferably in bed with a table or a pillow placed under the thighs, lasting 24-48 hours;
Apply 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;
The intake of anti - inflammatories, such as paracetamol or ibuprofen (an NSAID);
Manual reduction of a dislocation of the testicles . It is a specific treatment for this health condition; therefore, where there has been no testicular dislocation, it is not among the conservative treatments (unlike the previous ones, which instead 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 an operation of resection of the vaginal tunic, aimed at removing the collection of blood;
Cases of testicular hematocele due to testicular cancer. In such circumstances, surgical therapy consists of the removal of the tumor mass, combined with the elimination from the vaginal tunic of the collection of blood.
In fact, the operating doctor combines two surgical operations for the price of one.