Hydrocele
A hydrocele is a fluid-filled sac surrounding the testicle that results in swelling in the scrotum or groin. Common in newborns, in whom it usually disappears during the first year, it can also develop in older boys or men as a result of inflammation or injury. Between 1 and 2 percent of male infants have this problem and babies born prematurely are at increased risk. In men, hydroceles most often develop when patients are older than 40 years of age. Risk factors for hydrocele in adults include scrotal injury and infections, including sexually transmitted ones.
While hydroceles are not normally painful or dangerous and may not require any treatment, any scrotal swelling should be checked by a physician. Even in infants, if a hydrocele enlarges or fails to be reabsorbed, it may require removal.
Causes of Hydrocele
Hydroceles are most often the result of incomplete prenatal development in which either the sac around the testicle closes, but the body does not absorb the fluid (a noncommunicating hydrocele) or the sac surrounding the testicle doesn't close completely, allowing fluid to flow in and out (a communicating hydrocele). Communicating hydroceles are associated with inguinal hernias.
In older boys or adult men, hydroceles may appear due to:
- Injury to, or surgery of, the groin or scrotum
- Inflammation or infection of the testicles or epididymis
- Cancer of the testicle or of the left kidney
In some cases, the cause of a hydrocele is unknown.
Symptoms of a Hydrocele
Though in most cases, painless swelling of one or both testicles is the only sign of a hydrocele, some men may experience scrotal heaviness. The larger the swelling, the more likely the man is to experience pain. In some cases, the swelling increases as the day goes on, but in many cases, it may disappear on its own within 6 months.
Anyone who experiences scrotal swelling should be seen by a physician to rule out more serious causes for the inflammation, such as:
- Inguinal hernia
- Testicular torsion(twisted testicle)
- Malignancy
All of these conditions require medical attention.
Diagnosis of a Hydrocele
The first step in diagnosing a possible hydrocele is a physical examination during which the patient is checked for tenderness in the scrotum, the presence of an inguinal hernia, and, through transillumination, for the presence of clear fluid around the testicle. Other tests may also be taken, including blood and urine tests to diagnose a possible infection, and ultrasound to rule out a hernia or a testicular tumor
Treatment of a Hydrocele
Hydroceles in infants that do not resolve on their own, or that grow larger, may require surgical removal or aspiration to remove the accumulated fluid. In adults, hydroceles are generally removed if they cause discomfort, or if they are cosmetically offensive.
The surgery performed to remove a hydrocele is known as a hydrocelectomy. During an outpatient procedure under general or local anesthesia, an incision is made in the scrotum or lower abdomen and the hydrocele is removed.
Sometimes needle aspiration is performed to drain excess fluid from a hydrocele as an alternative to surgery. When this method of treatment is used, the needle aspiration must be followed by the injection of a sclerosing agent in order to prevent the refilling of the sac. Aspiration alone only provides temporary relief and each repeated aspiration increases the chance of infection.
Recovery from a Hydrocelectomy
After the surgery, patients may have a drainage tube and bulky dressing for a few days. Applying ice packs and wearing a scrotal support strap immediately after the procedure may be advised to decrease discomfort. Typically, the patient is fully recovered and back to normal activities a week or two after treatment, though some swelling may be visible for up to a couple of months. Since there is a possibility that a hydrocele may recur, at least one follow-up examination is necessary.
Complications of a Hydrocele
A hydrocele is not generally a serious problem and it doesn't normally affect male fertility. It is only problematic when it is associated with an infection, a tumor, or an inguinal hernia. A serious infection or tumor can possibly reduce sperm production or sexual function and an inguinal hernia can, left untreated, lead to life-threatening complications.
