Causes, Symptoms, and Treatment of Hydrocele

General Surgery Clinics ~ A Surgeon's Blog: Surgery For Hydrocele-  Jaboulay's Procedure or Eversion TV Sac

Causes, Symptoms, and Treatment of Hydrocele A hydrocele is a sac filled with fluid that forms around a testicle. Hydroceles are most common in babies.

Nearly 10 percent of males are born with a hydrocele. However, they can affect testicles of any age.

Hydroceles generally don’t pose any threat to the testicles. They’re usually painless and disappear without treatment. However, if you have scrotal swelling, see your doctor to rule out other causes that are more harmful such as testicular cancer.

What causes a hydrocele?

Hydroceles can occur at any age, yet tend to be more common in newborns. While they can occur without any underlying causes, an underlying injury or even inflammation can also contribute to their development. For most people, hydroceles are nothing more than an inconvenient — yet temporary — condition.

In infants

A child’s testicles descend from their abdomen into the scrotum towards the end of pregnancy. The scrotum is the sac of skin that holds the testicles once they descend.

During development, each testicle has a naturally occurring sac around it that contains fluid. Normally, this sac closes itself and the body absorbs the fluid inside during the baby’s first year. However, this doesn’t happen for babies with a hydrocele. Babies born prematurely are at a higher risk for developing hydrocele.

Illustration of hydrocele
Causes, Symptoms, and Treatment of Hydrocele

In adults

Hydroceles can also form later in life, mostly in men over 40. They can occur from a hernia but this is less common. Most of the time it is either from inflammation or from the sac (called the tunica vaginalis) not reabsorbing fluid properly. The epithelial cells in the sac produce and reabsorb the fluid constantly and there can be dysfunction with these cells leading to excess fluid.

Hydroceles can also be caused by inflammation or injury in the scrotum or along the channel. The inflammation may be caused by an infection (epididymitis) or another condition.

Language matters

The sources used in this article don’t differentiate between sex and gender, but we’d like to. Sex refers to a collection of biological characteristics that are determined by your chromosomes. Gender is a social construct that can vary greatly depending on time period and culture.

Both sex and gender are recognized to exist on a spectrum, both now and historically.

At the time of publication, no research could be found that discussed the presence of hydroceles in intersex individuals. If you are experiencing swelling in either the scrotal or pelvic area, your doctor will have the best information for your treatment.

Types of hydroceles

Although hydroceles tend to be fairly harmless in most patients, the condition can present differently depending on how it develops in the body. The two most common forms are known as noncommunicating and communicating hydroceles.

  • Noncommunicating hydroceles occur when the sac closes, but your body doesn’t absorb the fluid. The remaining fluid is typically absorbed into the body within a year.
  • Communicating hydroceles occur when the sac surrounding your testicle doesn’t close all the way. This allows fluid to flow in and out.
  • Nuck’s hydroceles are a rare type, found in people without testicles, that can occur in the lining of the pelvic wall and can cause painful swelling in the lymph nodes of the groin. This can be mistaken for ovarian cysts, endometriosis, and a host of other conditions, making diagnosis and treatment difficult.

What are the symptoms of a hydrocele?

Hydroceles usually don’t cause any pain. Usually, the most common symptom is a swollen scrotum. However, depending on the severity of the swelling, pain or discomfort may also occur.

In adults, there may be a feeling of heaviness in the scrotum. In some cases, the swelling might be worse in the morning than in the evening. It is not usually very painful. For noncommunicating hydroceles, the size usually stays the same or grows very slowly.

Also, with a communicating hydrocele, there’s the potential for other conditions to also develop. For example, with a communicating hydrocele, the sac doesn’t fully close. In most cases, this means that fluid can travel in and out of the sac. But depending on the size of the remaining opening, it’s possible for a hernia to also develop.

These are known as inguinal hernias and may require surgery in some cases. If this occurs, the scrotum will appear larger, swollen, and may even change size throughout the day. Inguinal hernias are very painful. So, if your baby has this condition, they won’t stop crying.

When to call a doctor

Experts usually recommend seeing a doctor if scrotal swelling occurs. Although most infant hydroceles resolve on their own, it’s important to rule out any other underlying medical conditions that can also cause swelling. Seek medical treatment if you or your child has sudden or severe pain in their scrotum.

This could also be a sign of another condition called testicular torsion. Testicular torsion occurs when the testicles become twisted, typically due to an injury or accident. Testicular torsion isn’t common, but it’s a medical emergency because it can lead to blocked blood supply to the testicle and ultimately infertility if left untreated.

If you think you or your child has testicular torsion, go to a hospital emergency room right away or call emergency services (like 911). It needs to be evaluated and treated immediately. Likewise, if you suspect that your baby might be suffering from an inguinal hernia, seek immediate medical attention.

What does a hydrocele look like?

 Causes, Symptoms, and Treatment of Hydrocele
Causes, Symptoms, and Treatment of Hydrocele
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Diagnosis of hydroceles

To diagnose a hydrocele, your doctor will perform a physical exam. If you have a hydrocele, your scrotum will be swollen, but you won’t have any pain. Your doctor won’t be able to feel your testicle well through the fluid-filled sac.

Your doctor may check for tenderness in the scrotum and shine a light through the scrotum. This is called transillumination. It allows your doctor to determine if there’s fluid in the scrotum. If fluid is present, the scrotum will allow light transmission, and the scrotum will appear to light up with the light passing through. However, if scrotal swelling is due to a solid mass (cancer), then the light will not shine through the scrotum. This test does not provide a definite diagnosis but can be very helpful.

Your doctor may also apply pressure to the abdomen to check for another condition called inguinal hernia; your doctor may also ask you to cough or bear down to check for this. This can occur when part of the small intestine protrudes through the groin due to a weak point in the abdominal wall. While it’s usually not life threatening, a doctor may recommend surgery to repair it.

If there is significant, sustained scrotal swelling, your doctor will likely order a scrotal ultrasound to help determine the cause.

They may take a blood or urine sample to test for infections. Less commonly, your doctor may administer an ultrasound to check for hernias, tumors, or any other cause of scrotal swelling.

Similar conditions

Most evidence suggests that hydroceles are usually harmless conditions that resolve themselves without the need for medical interventions. But sometimes the hydrocele symptoms can be very similar to what might happen with other testicular conditions. However, the causes behind these other conditions are slightly different from a hydrocele.

Hydrocele vs. spermatocele

Spermatocele is another usually benign condition that can cause swelling. However, these are cysts that form within the tubules that lead to the testis.

Hydrocele vs. varicocele

Both hydroceles and varicoceles are conditions that cause testicular lumps or swelling. But the location and cause of the swelling for both conditions is different.

  • Hydrocele swelling is caused by fluid around the testical.
  • Varicocele swelling is when the veins inside the testicals are dilated or enlarged.

Hydrocele vs. inguinal hernia

A hydrocele is not an inguinal hernia. But depending on the type of hydrocele that’s present, the likelihood of an inguinal hernia forming is possible. In a communicable hydrocele where the remaining opening to the sac is large enough, pressure can push the intestines into the opening, causing a bulge.

Hydrocele vs. epididymal cyst

Epididymal cysts form when fluid collects in the epididymis, a coiled tube that sits behind the testicles.

Hydrocele vs. epididymitis

Epididymitis is inflammation of the epididymis. Often this is caused by an infection — usually a sexually transmitted infection (STI). In some cases, this condition can cause a hydrocele to develop.

Hydrocele vs. hematocele

Hydroceles and hematoceles are similar conditions but with a specific difference. While hydroceles are fluid-filled sacs, hematoceles are sacs filled with blood. A hematocele is usually associated with trauma or injury.

How to treat a hydrocele

If your new infant has a hydrocele, it will probably go away on its own in about a year. If your child’s hydrocele doesn’t go away on its own or becomes very large, he might need surgery by a urologist.

In adults, they might go away, but only if it was caused by inflammation like trauma or infection that has been treated. If they’re small, and exam and ultrasound results are promising, they’re usually monitored to see if they resolve on their own.

If they are large they will be recommended for surgery; it is considered a hernia. This is then repaired by a general surgeon with a hernia repair. If the hydrocele is noncommunicating (the most common in adults), meaning that it doesn’t change in size or just steadily enlarges over time, it probably needs surgery.

Surgery

Surgery to remove a hydrocele is performed under anesthesia. In most cases, you’ll be able to go home within a few hours of the surgery.

A small cut is made in the scrotum or abdomen (depending on the location of the hydrocele) and the hydrocele is surgically removed. Your surgeon will most likely apply a large dressing to the site of your incision. Depending on the location and size, you may also need a drainage tube for a few days.

General Surgery Clinics ~ A Surgeon's Blog: Surgery For Hydrocele- Jaboulay's Procedure or Eversion TV Sac
Causes, Symptoms, and Treatment of Hydrocele

HIV transmission: What Are The FactsTips to Managing Anxiety At WorkplaceHow does sex affect your brain?Risks associated with anesthesia include:

Risks associated with this procedure include:

  • blood clots or excessive bleeding
  • scrotal injury, including nerve damage
  • infection

Needle aspiration

Another option for hydrocele treatment is to drain it with a long needle. The needle is inserted into the sac to draw out the fluid. In some cases, a drug may be injected to prevent the sac from filling again. Needle aspiration is commonly performed on those who are at high risk for complications during surgery.

The most common side effects of needle aspiration are temporary pain in your scrotum and the risk of infection.

What to expect after surgery

Whether your hydrocele goes away on its own or requires surgery, the outlook is excellent.

If you have surgery, the pain will probably go away in about a week. Your doctor may prescribe pain medication if you find it necessary. You probably won’t return to physical activities for a few weeks. This includes avoiding anything involving straddling, like riding a bike, for at least 3 weeks. Other strenuous activities should also be avoided during that time.

Stitches at the incision site usually dissolve on their own, but your doctor may want to check them after a few weeks. Keeping the area clean using showers or sponge baths will help prevent infection.

Ice packs, a support strap for your scrotum, and plenty of rest will ease discomfort after the surgery. Your healthcare professional will likely recommend a checkup exam because a hydrocele can sometimes reoccur.

Frequently asked questions about hydroceles

Can I treat a hydrocele at home?

In most cases, yes. Unless there’s an accompanying medical condition like an inguinal hernia, medical interventions typically aren’t necessary. However, if it’s been more than 6 months in adults, or 12 months for a baby and the hydrocele is still present, you should speak with a doctor.

Will a hydrocele go away by itself?

It might. For most people who develop a hydrocele, surgery or needle aspiration won’t be necessary as the condition usually resolves itself with time.

Can a hydrocele be prevented?

Unfortunately no, there are no known preventive steps a parent can take to avoid hydroceles from developing in their baby or small child. However, since injury is most often linked to hydroceles in teens and adults, taking precautions by wearing an athletic cup when in contact sports is a smart way to avoid developing a hydrocele.

Are hydroceles common?

According to research, roughly 10 percent of newborn male infants will have a hydrocele. And the likelihood of a hydrocele developing is higher in premature babies. Meanwhile, usually only one percent of adult men are likely to have a hydrocele.

Are hydroceles cancerous?

While they can be uncomfortable or embarrassing, the majority of hydroceles are harmless. Although, any time you experience abnormal swelling or discomfort, you should get it checked out as a precaution.

Can hydrocele surgery cause infertility, erectile dysfunction, or low testosterone?

Hydroceles aren’t known to cause any of these conditions and are almost always harmless. However, if you are experiencing scrotal swelling, see a doctor to rule out more serious conditions that could lead to infertility, erectile dysfunction, or low testosterone.

Conclusion

Current research says that hydroceles tend to impact infant males more than adolescent or adult males. For most patients, the scrotal swelling is fairly harmless and will resolve itself within 6 to 12 months of first appearing. Hydroceles can’t be prevented, but older people should wear protective gear for the groin when playing contact sports to avoid causing one through injury.

For patients diagnosed with a communicating hydrocele, a proactive approach to monitoring symptoms is important as the risk of developing a hernia is possible. If symptoms become painful or the swelling doesn’t go away after 6 months in adults or 12 months in babies, seek medical attention.

Author: Thavocalist

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