Disorders of the Scrotum

Scrotal hernias (ie, direct or indirect inguinal hernias that descend into the scrotum), especially large, neglected ones, are difficult to correct surgically. However, primary surgical repair or secondary repair using autogenous fascia or a plastic mesh may be successful in healthy elderly men without advanced chronic obstructive pulmonary disease or prostatism.

Hydroceles occasionally present de novo in the elderly. Testicular cancer should be ruled out. Large symptomatic hydroceles may be treated with aspiration, which is seldom permanently effective, or surgical excision.

Epididymo-orchitis (inflammation of the epididymis and testis) usually is a temporary sequela of a urinary tract infection, prostatectomy, cystoscopy, or indwelling catheterization. Treatment of this painful condition consists of bed rest, scrotal support, and an antibiotic effective against both gram-negative bacteria and Chlamydia sp (eg, tetracycline). These bacterial infections occasionally form abscesses that require surgical drainage.

Testicular cancer is rare in elderly men; however, painless testicular masses should be considered neoplastic until proved otherwise. At a minimum, ultrasound evaluation is indicated. Lymphoma is the most common testicular cancer in the elderly. Of the germ cell tumors, spermatocytic seminomas occur most frequently in the elderly and have a favorable prognosis. Orchiectomy is the only treatment required. Other germ cell tumors, including other seminomas, are usually aggressive and metastasize early.