Sensation of scrotal heaviness

Specialty: Nephrology and urology.

• testicular heaviness
• heaviness in the scrotum
• gravitative scrotal discomfort

Why it occurs

• Varicocele (varicose dilation of the pampiniform venous plexus of the spermatic cord, more common on the left side due to the right-angled opening of the spermatic vein into the left renal vein, causing "heaviness" type discomfort that worsens standing)
• Hydrocele (accumulation of serous peritoneal fluid between the parietal and visceral layers of the tunica vaginalis, which painlessly increases scrotal weight)
• Spermatocele (benign cyst in the head of the epididymis that accumulates fluid rich in sperm and generates heaviness when it reaches large dimensions)
• Inguinoscrotal hernia (descent of abdominal contents, such as a loop of intestine or omentum, through the inguinal canal into the scrotum)
• Voluminous testicular tumor (neoplasia that increases the weight and size of the organ without causing acute pain)

Initial workup

Detailed physical examination with the patient standing and lying down, performing palpation of the spermatic cord to classify the varicocele with the Valsalva maneuver, and careful testicular palpation; high-resolution scrotal ultrasound with color Doppler to confirm venous dilation with retrograde reflux, evaluate the presence of hydrocele or solid intratesticular masses; inguinal ultrasound if hernia is suspected.

Standard management

• Ibuprofen — 400-600 mg every 8 hours orally on a scheduled basis for 5-7 days to relieve persistent aggravating pain associated with mild symptomatic varicocele or residual inflammation
• Use of a scrotal jockstrap or tight slip-type underwear — first-line mechanical measure that significantly reduces gravitational traction on the spermatic cord, reducing pain due to venous congestion
• Programming for inguinal or subinguinal microsurgical varicocelectomy, or percutaneous retrograde embolization, if there is chronic intractable pain, associated ipsilateral testicular atrophy, or alteration of the quality parameters of the spermogram.