Expert: Dr Ian Jackson - please note UK based - 1/28/2010

Question
My husband had both knees replaced (staged 4 days apart) in May 2008 with sciatic and femoral nerve blocks.  Tourniquet was used in both surgeries.  The right was done first and the very next morning I noticed that his scrotum was swollen to the size of a cantelope. It is still swollen now about the size of a large apple. 2 urologists including Mayo have said that until they know where the fluid is coming from there is no sense in doing a hydrocelectomy.  What in the world could have happened during the knee replacement surgery to cause this?

Answer
Hi Jayra
I don't believe this is really an anaesthetic issue. I also suspect that if 2 urologists who have seen and examined your husband cannot provide an explanation then it will be difficult for me to provide one.
If we work on the basis there was no bruising then the swelling cannot be blood. I say this because the femoral nerve blocks would have involved injecting local anaesthetic into the groin to an area that is close to the femoral artery and the femoral vein. However if they had been touched then there would have been bruising - and this is more likley to be in the groin and leg but can spread to the scrotum.
So it has to be a build up of 'fluid' in the scrotum. Where would that come from? People who have low protein levels in their blood do sometimes get swelling in the scrotum when they are given a lot of intravenous fluid. Again this is unlikley as your husband was having bilateral knee surgery - this is not something we would undertake on someone who was not in good health.
So why did it happen?
I'll end as I started I can't give you a definitive answer. I suspect this is 'just one of those things' in that your husband had a fair bit of IV fluids and has a 'weakness' in that area that allowed the fluid to build up for some reason.
Sorry can't illuminate further.
Dr Ian Jackson