A hydrocele

Definition

A hydrocele is a sac filled with fluid that forms around a testicle. This occurs when the fluid collects in the thin sheath surrounding a testicle. Hydroceles are most common in babies and usually disappears without treatment by age 1. Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

Hydroceles vary greatly in size. Very large hydroceles are sometimes seen in elderly men who have never shown their swelling to a doctor. It might have been getting larger over a number of years. In most cases, hydroceles are not harmful and tend to go away on their own, without treatment, but scrotal swelling should always be evaluated by a health care provider to rule out other causes.

Pathophysiology

The normal testis is surrounded by a smooth protective tissue sac. You cannot normally feel this. It makes a small amount of ‘lubricating’ fluid to allow the testis to move freely. Excess fluid normally drains away into the veins in your scrotum. If the balance is altered between the amount of fluid that is made and the amount that is drained, some fluid accumulates as a hydrocele.

Before birth, the testicles develop near the kidneys. By the time of birth, the testicles normally drop from their position inside the abdomen into the scrotum through a tunnel of muscles called the inguinal canal. If the peritoneal sac in the canal is reopened, fluid may leak from the belly into the scrotum and cause a hydrocele.

Types of Hydrocele

Communicating

Communicating hydroceles are present at birth and occur as a consequence of the failure of the “tail” end of the process vaginalis to completely close off. Peritoneal fluid (free fluid in the abdominal cavity) is thus free to pass into the scrotum in which the process vaginalis surrounds the testicle.

Non-communicating

Non-communicating hydroceles may also be present at birth or develop as a boy matures. In a non-communicating hydrocele, the tail end of the process vaginalis has closed appropriately. The fluid surrounding the testicle is created by the lining cells of the process vaginalis and is unable to either drain or be reabsorbed efficiently and thus accumulates.

Causes

Most hydroceles occur in adults and are most common in men aged over 40 years. The cause is not known in most cases.

• A small number of hydroceles are caused when something is wrong with one of the testicles (testes). For example, infection, inflammation, injury or tumors of your testicle (testis) may cause fluid to be formed which leads to a hydrocele forming.
• Sometimes hydroceles develop when there is generalized swelling of the lower half of your body due to fluid retention.
• Other causes of hydrocele include:
• Blockage in the spermatic cord.
• Inguinal hernia surgery.
• Infection of the scrotum or a testicle.

Risk factors

• Prematurity and low birth weight
• Male sex
• Infants less than 6 months of age
• Infants whose testes descend relatively late
• Increased intraperitoneal fluid or pressure
• Inflammation or injury within the scrotum
• Testicular cancer
• Connective tissue disorders
• Varicocelectomy
• Filariasis
• Maternal exposure to polybrominated biphenyl

Symptoms

• Scrotum becomes swollen like a water-filled balloon and feels heavy.
• Swelling of the scrotum may cause some discomfort during walking and sexual activities.
• Sometimes, the swollen area might be smaller in the morning and larger later in the day.

Complications

• Hematoma
• An inguinal hernia (view full topic)
• Testicular injury after surgery
• Pain in the inguinal area radiating to the abdomen
• Lower extremity edema
• Testicular atrophy
• Hydronephrosis
• Infertility

Diagnosis and Test

• Physical examination by the doctor is the usual method. The doctor may also feel the testes for tenderness. If there is hydrocele, the doctor will not be able to feel the testicles through the fluid-filled testicular sac.
• Applying pressure to the abdomen and scrotum to check for an inguinal hernia.
• Another method is by shining a light behind the testicles. If there is fluid present, there will be light transmission and the scrotum will glow with diffused light. However, if this swelling is due to cancer, then the light will not pass through. This is called transillumination.

• Blood and urine tests to help determine if you or your child has an infection, such as epididymitis
• Ultrasound to help rule out a hernia, testicular tumor or other causes of scrotal swelling

Treatment and Medications

In adults, if the hydrocele causes no symptoms, one option is simply to leave it alone. If it becomes larger or troublesome, you can always change your mind and have treatment.

Surgery

Surgery may be recommended if your hydrocele is large or uncomfortable. The operation of a hydrocele involves making a very small cut in the scrotum or lower tummy (abdominal) wall. The fluid is then drained from around the testicle (testis). The passage between the abdomen and the scrotum will also be sealed off so the fluid cannot re-form in the future.

Drainage

The fluid can be drained easily with a needle and syringe. Draining every now and then maybe suitable though, if you are not fit for surgery or if you do not want an operation.

Sclerotherapy

Sclerotherapy is the injection of a solution to stop the hydrocele recurring after having it drained. This is not commonly undertaken but may be offered to some people who are not suitable to have an operation.

Hydrocelectomy

The surgery to remove a hydrocele (hydrocelectomy) can be done under general or regional anesthesia. An incision is made in the scrotum or lower abdomen to remove the hydrocele. If a hydrocele is found during surgery to repair an inguinal hernia, the surgeon might remove the hydrocele even if it’s causing no discomfort. After hydrocelectomy, you might need a tube to drain fluid and a bulky dressing for a few days.

Prevention

• Recognize the signs and symptoms.
• Avoid trauma to the testes and STDs.
• Healthy lifestyle choices, such as exercising and eating right, and avoiding sexually transmitted infections (STDs) are also recommended to help prevent hydrocele.