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     I have received a number of questions about scrotal edema over the last few months. These questions have asked about using compression for treating edema of the scrotum. In short, I do not think this is a good general practice, let me explain why. Scrotal edema is generally divided into acute or chronic causes. Acute cases are generally a surgical issue and require evaluation by ultrasound. Torsion or twisting of the spermatic cord is the most common etiology of acute scrotum in children. Children with torsion usually present with acute scrotal pain, nausea and vomiting. Surgical treatment, within 6 hours of the onset of symptoms, may ensure the preservation of the testis. For that reason any acute scrotal pain with edema requires urgent and specialized evaluation.

     Chronic edema of the scrotum can be caused by a number of conditions such as heart failure, liver failure, venous obstruction, lymphatic obstruction or prior surgery or trauma. For example, patients who have kidney failure and as a result have peritoneal dialysis catheters put in place can develop edema of the scrotum due to drainage from the peritoneal cavity through the inguinal canal and into the scrotum. The proper treatment in this case is surgical evaluation and treatment.

     In the case of congestive heart failure or liver failure, the problem is that blood flow to the heart or through the liver is impaired. This results in back flow and accumulation of edema in the legs and often in the scrotum. The proper treatment in these cases is the management of the congestive heart failure or the liver failure. For example, in the case of congestive heart failure, scrotal edema will often improve when some of the stress on the heart is removed by medications. These medications reduce the work of the heart in pumping blood. Other medications cause excess fluid to be eliminated by urination. In liver failure, diuretics are used to remove excess fluid and help reduce the edema.

     Edema of the scrotum can also occur due to compression of the veins in the pelvis or abdomen. For example, cancers such as prostate cancer or lymphoma can grow and put pressure on the veins or lymphatics and cause edema. In this case, the proper treatment is control of the cancer so that the pressure exerted on the veins and lymphatics is relieved. I have had many cases of severe edema of the scrotum that have resolved after effective treatment of the cancer that was putting pressure on the veins or lymphatics.

     In some cases prostate cancer or non-cancerous enlargement of the prostate can make urination difficult, resulting in the retention of urine in the bladder. If the bladder gets large enough, it can cause compression of the pelvic veins resulting in bilateral lower extremity and scrotal edema. These patients improve dramatically when the excess urine in the bladder is removed and the enlarged prostate is treated by surgical reduction.

     Since edema of the scrotum often occurs due to a blockage at the level of either the heart or the liver or the draining lymphatics or veins, application of compression of the scrotum will not fix the underlying problem and may result in worse edema. The scrotum has a limited blood supply and compression of the scrotum could further diminish that blood supply. This could potentially worsen the condition or even result in serious tissue breakdown. There are support devices to help support and cushion an enlarged scrotum. However, I do not know of any approved devices for compression of the scrotum to treat scrotal edema. I am including a figure of the anatomy of the blood flow to the testicles to make my point. The figure shows the arteries in red and the veins in blue. Please note the limited blood supply to the scrotum. Compression of an edematous scrotum may further diminish venous outflow potentially worsening the condition. In addition, the skin of the scrotum is very thin and compression could lead to skin breakdown. This could lead to further serious complications including infection and tissue necrosis.

     As I have pointed out, scrotal edema can be due to any number of causes including heart or liver failure, cancer compressing the pelvic veins or lymphatics or even enlargement of the prostate resulting in bladder distention. The proper treatment will require a full evaluation by your doctor and management of the underlying cause of the edema. Support by soft foam pads can be helpful and provide comfort to the patient while the underlying problems are being treated.