What is a scrotal growth from an operated incision called?

Scrotal Growth from Operated Incision

A scrotal growth arising from a surgical incision site is most commonly termed an "incisional hernia" if bowel or peritoneal contents protrude through the defect, or a "scrotal hematoma" if it represents blood collection, though other post-surgical complications including granuloma, abscess, or wound dehiscence with tissue protrusion may also present as scrotal masses at incision sites.

Diagnostic Approach

Ultrasound is the definitive initial imaging modality to characterize any palpable scrotal abnormality, including post-operative masses 1. The American College of Radiology explicitly recommends:

• US scrotum or US duplex Doppler scrotum as the first-line imaging for newly diagnosed palpable scrotal abnormalities regardless of clinical context 1
• Ultrasound achieves nearly 100% sensitivity for detecting intrascrotal masses and 98-100% accuracy in differentiating intratesticular from extratesticular processes 1

Key Ultrasound Findings by Pathology

For hematoma: Sonographic appearance varies with timing—hyperacute/acute hematomas appear heterogeneous or isoechoic relative to testicular parenchyma, while chronic hematomas are smaller and hypoechoic to anechoic 1

For vascular lesions: Duplex Doppler can differentiate solid masses from avascular mass-like hematomas, though it cannot definitively distinguish malignancies from benign conditions like granuloma or focal fibrosis 1

Common Post-Surgical Scrotal Complications

Scrotal Hematoma

• Occurs in 3.6% of primary penile prosthesis cases and 9.6% of complex cases 2
• Complex cases (revision, salvage, or concurrent procedures) have 2.61 times higher risk and greater likelihood of requiring surgical evacuation 2
• Can occur without trauma and presents as an avascular mass on duplex ultrasound 1

Wound Infection

• Reported in 3-3.3% of scrotal incision procedures 3, 4
• Successfully managed with antibiotics in most cases 3, 4
• May present as inflammatory masses with heterogeneous hypoechoic echotexture on ultrasound 1

Incisional Complications from Vasectomy

The AUA guidelines describe minimally invasive vasectomy techniques that create small (≤10 mm) scrotal openings, which when complicated can lead to:

• Bleeding and hematoma formation at incision sites 1
• Infection requiring intervention 1

Critical Pitfalls to Avoid

Never assume a post-operative scrotal mass is benign without imaging confirmation. While most post-surgical masses represent hematomas or inflammatory changes, ultrasound cannot definitively differentiate benign from malignant lesions based on appearance alone 1. All clearly delineated hypoechoic or inhomogeneous lesions are considered suspicious and may require surgical exploration 1.

Do not rely on clinical examination alone. Even experienced clinicians cannot reliably distinguish between various scrotal pathologies without imaging 1. The specificity of duplex ultrasound is lower than its sensitivity because conditions like orchitis, dermoid cyst, granuloma, and focal fibrosis can mimic malignancy 1.

Management Algorithm

1. Obtain ultrasound immediately for any palpable post-operative scrotal growth 1
2. Use duplex Doppler to assess vascularity and differentiate hematoma from solid masses 1
3. If avascular and consistent with hematoma: Consider conservative management with close follow-up, though large or expanding hematomas may require surgical evacuation 2
4. If solid or vascular mass: Surgical exploration is warranted as ultrasound cannot reliably exclude malignancy 1
5. If inflammatory features present: Treat infection empirically while awaiting culture results 3, 4