Can a doppler differentiate my hydrocele from a varicocele?

Question

Hello doctor,

I went for a Doppler scan because I feel a small, tiny seed inside my scrotum sack. The scan says everything is normal. Nothing is found, testicles are fine, but it says mid-left hydrocoele found. The doctor said, No need to worry and that it is no cause for alarm, and that I can drain it if it gets bigger. I went home.

After five days, I noticed a swelling that was not round in shape and close to the left testicle. The urologist did another scan for scrotal Doppler. The report is the same as the first one. Only a left mid hydrocoele was found. The doctor said, he is surprised that the scan has not picked up varicoceles.

Because he noticed left varicoceles when he feels it, I can feel the right varicocele is smaller than the left varicocele. He asked me to go to another hospital for a scan, and they should check for varicoceles. Surprisingly, the third Doppler scan for scrotal in another hospital showed nothing wrong, and the investigation was normal.

The urologist says that since the three reports have picked up nothing and no varicoceles have been found, he cannot operate on it. This is because the varicocele is not large enough to cause a problem for the Doppler to see.

I asked the doctor whether I should go for a semen analysis to see if the semen is normal. He says that it is a good suggestion to rule out every suspicion of varicocele, and my sperm count is normal. I asked him about the swelling close to the testicles, and he said that it was normal and that I should relax, and it would not affect my testicles.

Do you think I should be relaxed about this? Is the doctor right? I have a very loose scrotum sack. Is this normal? The scrotum sack reduces in size only when I feel like using the toilet to pass out stools. Is this normal? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I went through your detailed medical history and the reports you have mentioned here (attachment removed to protect patient identity).

To tell you the fact, a small hydrocele is usually harmless, but it has the tendency to increase in size gradually over a period of time, at which point you might need surgery to help you.

If the Doppler scans are not showing the varicocele, it might be at an initial stage. It is a good option to get your semen analysis done, which will help you to find out if there is any problem with your sperm, but it will not rule out the cause, which is a varicocele.

It is advisable to get follow-up Doppler at a three-month interval, but I would not recommend surgery just yet, especially if you have completed a family and you already have children.

Surgery is a necessity if your hydrocele increases in size and causes discomfort or a varicocele is found on the Doppler scan of the scrotum, or immediate surgery is advisable if your sperm count is low after ruling out other causes for a lower sperm count.

In the meantime, what you can do at home is to provide scrotal support. You can buy it at any pharmacy, or if it is not available, then you can wear tight underwear. These are just temporary measures until you can get all the tests done.

I hope this helps.

Kindly revert in case of further queries.

Thank you.