Open surgery is occasionally indicated. Usually, it appears as a painless scrotal swelling that can be transilluminated. Some men have pain or discomfort from its mass effect. Hydrocele may be congenital. Aspiration is a temporary measure, but aspiration with injection of sclerotic drugs may produce resolution.
Aspiration poses the risk of secondary infection.
Unlike hydrocele, it is a painful swelling and does not transilluminate. Treatment is surgical if the hematocele is large and does not absorb with conservative management or is associated with laceration of the tunica albuginea. A large spermatocele may be difficult to differentiate from a hydrocele, which also is cystic and painless and transilluminates. Ultrasonography may assist diagnosis. Surgical excision is indicated if the spermatocele becomes large and bothersome to the patient.