Hydrocele – Definition, Causes, and Treatments.

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.

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55 comments

  1. I never knew something like this ever existed something that I have learned new. thank you for so much Vital Information

  2. wow.
    I’m very lucky to have this app.
    But I want every procedure in detail and including medication.
    But, I have learned a lot through this app.

  3. Very informative in an easy to understand vernacular.
    Dr. K. J. S.

  4. thanks doctor, would like to know the medicine to cure hydrocele because i had a surgery but never healed so i fear having it the second time. thank you

  5. Thank you for the in-depth information.It is beneficial.

  6. I have read both ur offline n online topics and I can say convincingly that u guys r damn good. Keep it up .

  7. thanks for your vital information, we need more conditions

  8. l have a hydrocele please help me out.
    Is there any medicine available for hydrocele treatment?

  9. is there any medicine for hydrocele?

  10. Thanks for this incisive exposè. Are there drugs to treat hydrocel, especially in adults?

  11. i my testis is swollen and sometime it goes down , ……..pls what can i use to cure this without operating it

  12. Nambuya Enterprises

    Ilove it treatment guidence type medicine

  13. Andrew Maranga Omato

    Good helpful counsel and encouragement.Thanks.Be blessed

  14. The app its self is good but the problem is it needs internet connection to get the information.how i wish u can create one which does not need internet connection. thanks….

  15. EdwardYour Name

    thanks 4 your educative post..but i would like you to post paediatrics guideline on conditions under 5years have plz..

  16. l have two diseases,FIRST,split come out from my penis ,SECONDLY,my penis mouth want block together lf are urine is come scatter,please what is solution

  17. I love this test but I’m going through it now because I just had operation twice hernia and appendix I’m in pains.

  18. I had it, it’s gradually reducing alone.
    After an Inguinale hernia, my scrotum started to swell and I was almost operated again, luckily the Dr didn’t. Now it’s reducing and going alone.
    Thanks, great app…

  19. Thanks so much doctor. It’s really an educative app. Now I can understand exactly what the condition is. My son once had a hydrocele before birth and I only discover it when he was two months old. Consulting a doctor, he explained that by a year old it will eventually goes back. But still with that fear, I opted for an OP and he’s very OK now.

  20. good site for easy understanding and consists doctors with known factors of desieses

  21. I’m worried, my doctor told me that i have hernia and gives me is hypertension tablets. I’m loosing my weight because the tablets making me to urinate frequently please help me

  22. l a friend who is not able to impregnate his wives he needs advice and treatment please

  23. Evangelist Coker Mike Osokhae.

    How do I train to be able to handle and cure hydrocele cases as a career?

  24. Ezema Chinonso Hillary

    my testis are small,is there a hope for me that can bring a solution

  25. wow,am one of the lucky ones in this app,pls I lost having fillings with girls after having this infection,pls I need a Doctor’s contact. thank you guys

  26. I have hernia for three years now and I’m afraid of operation what can help me remove it from me. and please if I make a operation how many days I can work without any pain please help me I’m waiting for reply

  27. Sir I am a patient of full phaymisis
    Please help me

  28. I have done two surgery bet still I fell the same hydrocele.pps help me

  29. I did surgery of right testicle which is suffering from hydrocele last six years . water has been removed but not decreased testicle swelling.Testicle size is observing bigger than left testicle means not comes to same size.
    My surgery was done on 16th March at 3:00pm.
    I have informed to doctor but he is saying it will take a time approximately 20days to come in same size.

    Please suggest me what I can be do next

  30. I am having hernia for about ten years now and am afraid of the surgery .what do I do?

  31. Abubakar Muhammad Y.

    Well done job and more grease to your elbow. Please can you help and tell me the type of drug (s) that may be injected into the scrotal to avoid re-accumulation of the fluid ? this is because l have been removing the from time to time through the use of syringe and needle for over o long period of time but the fluid keep on re-acumulating . So please help me out. Thanks.

  32. plz send me the name of medice which i can use in this symptoms

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