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.
Inguinal hernia may extend into the scrotal compartment. It must be differentiated from hydrocele and hematocele. With an inguinal hernia, the cord is not palpable above the mass, whereas with a hydrocele or hematocele, normal cord structures usually are palpable above the mass. The mass can often be reduced when the patient lies down. Surgery is recommended because of the probability of progression and possibilities of incarceration and strangulation.