“Another painless, extra testicular mass is a spermatocele. Unlike a hydrocele that engulfs the entire testicle, a spermatocele is a lesion that sits above the testicle or sometimes below it, but as part of the epididymis, until these are large, they are typically very much painless. They feel a bit like a marble, perhaps larger. Sometimes they become twice the size of the testicle. Generally speaking, we observe these, we don’t urgently operate upon these. Hydrocele treatment is typically observational until the fluid filled sac becomes inconveniently enlarged so that it becomes difficult to cross one’s legs or shows through the clothing. In that case, the most definitive management of a hydrocele is an incision and drainage of that fluid with a reconfiguration of the sac that formed the fluid in the first place. So this surgery is typically done by a urologist. It’s a simple outpatient procedure and hydroceles have a low incidence of recurrence.
Some wonder if we can just put a needle in and drain this fluid. And that’s been frowned upon. Typically because of the risk of instilling bacteria or causing an infection in that process. Some take it a step further and instill scleral therapy agents, agents that cause the tissues within to stop secreting fluid. Again, this is a reasonable sort of last resort. Someone who’s too sick to go to surgery or maybe in a third world country where surgery is not so easily available, but in general, we try not to put needles into hydroceles because we’re concerned about introducing bacteria.”