Hydrocele, varicocele and epididymal cysts are common benign conditions of the scrotum that can cause heaviness, pain or visible enlargement, and in some men a varicocele reduces the quality of the semen. Small findings without symptoms are monitored; when the symptoms get in the way or fertility is affected, surgery is the lasting solution.
Dr Penev assesses whether surgery is needed with an examination and a scrotal ultrasound at his practice in Plovdiv or Karlovo, and he operates at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv – most often as day surgery. He also sees children and adolescents.
When it is recommended
- Hydrocele – when there is a lot of fluid causing heaviness or discomfort when walking, during sport or during sex; draining it with a needle is not a solution, because the fluid collects again. In boys, a congenital hydrocele often disappears on its own by the age of two.
- Varicocele – with persistent heaviness or pain, with abnormal semen analysis results in a couple having difficulty conceiving, and in adolescents whose testicle is lagging behind in growth. A small varicocele without symptoms is usually not operated on.
- Epididymal cyst (spermatocele) – only if it is large, painful or bothersome; in men who are planning to have children, removal is considered carefully, because it can affect the patency of the epididymis (whether sperm can pass through it).
Ultrasound confirms the diagnosis and rules out other causes of swelling or a lump in the testicle, including a tumour. Sudden severe pain in a testicle with swelling and nausea may be testicular torsion – an emergency: go to an emergency department or call 112 (the European emergency number) immediately, rather than booking a scheduled appointment.
How it is done
Surgery for hydrocele and epididymal cysts
Through a short incision in the scrotum the fluid is removed, and the excess sac is cut away or turned inside out and stitched, so that fluid does not collect again. In children the approach is through the groin, where the connection with the abdominal cavity is closed. An epididymal cyst is removed through the same approach and sent for histological examination.
Surgery for varicocele
The aim is to interrupt the dilated veins while preserving the artery and the lymphatic vessels. The microsurgical method is usually preferred – ligation through a small incision in the groin under magnification, with the lowest risk of recurrence and of hydrocele. Laparoscopic ligation is suitable for a varicocele on both sides and in adolescents; in certain cases embolisation is an alternative. The technique is chosen according to the individual case and the doctor’s judgement.
The operations are performed under spinal or general anaesthesia and take approximately half an hour to an hour and a half; the stitches are dissolvable.
Preparation
Blood tests, an electrocardiogram (ECG) and a consultation with an anaesthetist are needed and, for a varicocele in a man who is planning children, a semen analysis. Tell the doctor about all the medicines you take, especially blood thinners – these are stopped only on a doctor’s instructions. Do not eat or drink for six hours before the operation; you will need someone to take you home.
After the operation and results
Most often you go home the same day or the next morning. Mild pain and swelling in the first few days are managed with painkillers, ice and a scrotal support; sport and heavy lifting are possible after two to four weeks.
With a hydrocele, the fluid does not collect again in most cases. After varicocele surgery the pain usually settles and semen quality may improve – a follow-up semen analysis is done after three to six months; many men see an improvement, but not all, and it cannot be guaranteed. Complications – a haematoma, infection or recurrence – are rare; see a doctor immediately if you have a fever, rapidly increasing swelling or severe pain.
Where it is done
Consultation and ultrasound – at Dr Penev’s practice in Plovdiv, 5 Anri Barbyus St, or at Vita Med Medical Centre, Karlovo, by appointment. Operations – at the Department of Urology at Kaspela University Hospital, Plovdiv, 64 Sofia St.
Price
Initial consultation €50, follow-up consultation €30. The price of the operation is confirmed at the consultation.
If you have swelling, heaviness or pain in the scrotum, or a varicocele while you are having difficulty conceiving, book an appointment with Dr Penev – after an examination and an ultrasound you will find out whether surgery is right for you.
Frequently asked questions
Will the operation affect my sex life or my hormones?
This is not expected. The testicle is preserved and continues to produce testosterone and sperm, so erections, libido and hormonal balance do not change. You can resume sex once there is no pain – usually after about two weeks.
Can a varicocele come back after surgery?
Recurrence is possible, but it is rare with the microsurgical technique. If the heaviness or the dilated veins come back, a Doppler ultrasound shows whether a vessel with reversed blood flow has remained and what can be done.
Are both sides operated on for a varicocele?
Only when there is a varicocele on both sides and it is clinically significant. Most often a varicocele is only on the left and is operated on only there; the right side is checked during the examination and the ultrasound.
What is the difference between a spermatocele and an epididymal cyst?
Both are fluid-filled cavities in the epididymis – a spermatocele contains sperm, while an ordinary cyst contains clear fluid. Ultrasound cannot always tell them apart, but this does not change the approach: both are benign and are treated in the same way.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.