Hydrocele

A hydrocele – or, more precisely, a testicular hydrocele – is an excessive accumulation of fluid in the scrotal sac (scrotum). Hydroceles can also develop in the epididymis (the tube at the back of the testicle) or in the spermatic cord. They are usually painless.

Hydroceles often develop over the course of a person’s life – in this case, they are known as “acquired” hydroceles. They can also be congenital (present at birth) in some cases.

Congenital hydroceles often resolve within a certain period of time after the birth, as the amount of fluid usually reduces naturally.

Acquired hydroceles very often develop without an identifiable cause (idiopathic) and do not normally require treatment. However, these hydroceles can be treated if they are causing symptoms.

In rare cases, hydroceles develop following injuries to the testicles, inflammation or a hernia. Treatment is normally required in these cases.

In most cases, a hydrocele is detected due to a swelling in the scrotum. The swelling feels taut and elastic but is generally painless. However, depending on its size, the hydrocele may cause discomfort when moving.

With a congenital hydrocele, the swelling enlarges when the infant is held upright or cries. It reduces somewhat when the baby is lying down.

A congenital hydrocele occurs during pregnancy as the fetus develops. The testicles initially form in the abdomen, close to the kidneys. It is only later that they move down into the scrotal sack through a passage called the inguinal canal. As they do, they take part of the peritoneum (the internal abdominal lining) with them. This tissue from the peritoneum will ultimately form a sealed envelope around the testicles.

If this process is incomplete, a hole in the peritoneum may allow fluid to enter the scrotum. The likelihood of this increases if neither of the testicles or only one of them descends into the scrotum (undescended testicle), if the bladder does not develop as normal (bladder exstrophy), if a congenital connective tissue disorder is present, or if the baby is born prematurely.

Hydroceles can also be acquired, which means that they can develop over the course of a person’s life. Hydroceles are described as “idiopathic” if doctors are unable to find a cause for them. Idiopathic hydroceles are very common and usually harmless.

Acquired hydroceles with a known cause are rarer. Causes include an inguinal hernia or injuries as a result of an accident or operation. Other possible causes include inflammation of the sex organs, torsion (twisting) of the testicles and tumors.

Around 90 percent of boys are born with a hole in the peritoneum. In 20 percent of these children, the hole remains during the first 5 months of life, increasing the risk of a hydrocele developing. However, not all of these children will end up with a hydrocele. Most of those who do will have a right-sided hydrocele (in the right half of the scrotum).

It is impossible to say with certainty how many boys develop a hydrocele during puberty. Around 1 percent of adult men have a hydrocele.

To detect a hydrocele, the doctor will initially examine the scrotum by touch. They will assess the size of the swelling and determine whether it feels taut and elastic. They will also ask the patient if they have had any accidents or have any pre-existing illnesses. An ultrasound scan is normally used for an accurate diagnosis.

The physical examination and an ultrasound allow doctors to rule out other diseases such as varicose veins in the scrotum (varicoceles), twisting of the testicles or testicular cancer. Specific laboratory tests can also be used to exclude cancer as a diagnosis.

A hydrocele may or may not require treatment, depending on the form it takes and what has caused it.

Congenital hydroceles often disappear themselves without treatment in the first two years of life as the hole in the lining of the abdomen closes. If this doesn’t happen – for example, because the hydrocele is large or the patient also has a hernia – the hole can be sealed by means of a small surgical procedure involving an incision in the groin.

Some acquired hydroceles also resolve on their own. If this doesn’t happen, surgery may be considered. This procedure involves removing the fluid from the sheath around the testes by means of a small incision in the scrotum. The surgeon will then stitch the sheath back together to prevent fluid from building up there again.

Aspiration – a procedure that involves draining the fluid with a hollow needle – is rarely used because the results are often temporary and there is an increased risk of infection. Sclerotherapy is another treatment option that is very rarely used.

Some boys and men can have the procedure as outpatients.

Older men, premature babies and men with very large hydroceles usually remain in hospital for a few days after surgery.

To avoid swelling, the scrotum is kept elevated for a further 2 to 3 days if possible and kept cool with a damp cloth.

Special supports for the scrotum are available from pharmacies – small cushions or an elasticated bandage that fits around the thigh. These allow the testicles to lie flat, which increases blood flow to the area and promotes healing.

It is also advisable – if possible – to wear a suspensory support to protect the scrotum when walking for 2 to 4 weeks after surgery. This is a protective padded pouch or cup that fits over the scrotum. It also helps with recovery. Physical exertion and sports should be avoided.

It is also recommended that men wait some time after surgery before being sexually active again. This is best discussed with a doctor.