About hydrocele

What is hydrocele?

Hydrocele facts

  • While hydroceles may occur in either gender, they are much more common in males.
  • A hydrocele is a collection of clear fluid in a thin walled sack present in the scrotum.
  • Hydroceles may be either one sided or occupy both sides.
  • Hydroceles are painless, soft swellings and may be either present at birth (congenital) or develop later.
  • A very large majority of hydroceles present at birth resolve spontaneously by one year of age.
  • Hydroceles that are not congenital or those still present after one year of age generally warrant surgical correction.
  • There are other conditions that must be considered when evaluating a boy with chronic, non-tender scrotal swelling. These include hernia, varicocele and tumor. Physical examination is very helpful in sorting through these options. Rarely are diagnostic or invasive studies necessary.

What is a hydrocele?

A hydrocele is a scrotal collection of clear fluid ("hydro" = water) in a thin walled sack ("cele" = swelling) that also contains the testicle. Less frequently, due to the common embryological background of male and female gonadal structures, female children or women may also experience a hydrocele. In this case, the sack and connection exist in the labia majora (the outermost and larger of the two labial structures). Because of less potential concern for complications in females with hydroceles, this article will focus predominantly on the male gender. A hydrocele may involve either one side (unilateral) or both sides (bilateral) of the scrotum.

There are two types of hydroceles:

  1. communicating, and
  2. non-communicating.

Communicating hydroceles

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.

A characteristic feature of communicating hydroceles is their tendency to be relatively small in the morning (having been horizontal during sleep) and increase in size during the day (peritoneal fluid drainage assisted by gravity). Actions which increase intra-abdominal pressure (for example, crying, severe coughing, etc.) will also tend to increase the size of the hydrocele.

Non-communicating hydroceles

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. Since this fluid is walled off, the size of the hydrocele is generally stable and does not reflect intra abdominal pressure.

What are the symptoms for hydrocele?

Usually, the only indication of a hydrocele is a painless swelling of one or both testicles.

Adult men with a hydrocele might experience discomfort from the heaviness of a swollen scrotum. Pain generally increases with the size of the inflammation. Sometimes, the swollen area might be smaller in the morning and larger later in the day.

When to see a doctor

See your doctor if you or your child experiences scrotal swelling. It's important to rule out other causes of the swelling that might require treatment. For example, a hydrocele might be associated with a weak point in the abdominal wall that allows a loop of intestine to extend into the scrotum (inguinal hernia).

A baby's hydrocele typically disappears on its own. But if your baby's hydrocele doesn't disappear after a year or if it enlarges, ask your child's doctor to examine the hydrocele again.

Get immediate medical treatment if you or your child develops sudden, severe scrotal Pain or swelling, especially within several hours of an injury to the scrotum. These signs and symptoms can occur with a number of conditions, including blocked blood flow in a twisted testicle (testicular torsion). Testicular torsion must be treated within hours of the beginning of signs and symptoms to save the testicle.

What are the causes for hydrocele?

Baby boys

A hydrocele can develop before birth. Normally, the testicles descend from the developing baby's abdominal cavity into the scrotum. A sac accompanies each testicle, allowing fluid to surround the testicles. Usually, each sac closes and the fluid is absorbed.

Sometimes, the fluid remains after the sac closes (noncommunicating hydrocele). The fluid is usually absorbed gradually within the first year of life. But occasionally, the sac remains open (communicating hydrocele). The sac can change size or if the scrotal sac is compressed, fluid can flow back into the abdomen. Communicating hydroceles are often associated with inguinal hernia.

Older males

A hydrocele can develop as a result of injury or inflammation within the scrotum. Inflammation might be caused by an infection in the testicle or in the small, coiled tube at the back of each testicle (epididymitis).

What are the treatments for hydrocele?

In 95% of congenital (present at birth) hydroceles, the natural history is one of gradual and complete resolution by one year of age. For those lasting longer than one year or for those non-communicating hydroceles that manifest after the first year, surgical repair is indicated since these rarely resolve spontaneously.

What are the risk factors for hydrocele?

Most hydroceles are present at birth. At least 5 percent of newborn boys have a hydrocele. Babies who are born prematurely have a higher risk of having a hydrocele.

Risk factors for developing a hydrocele later in life include:

  • Injury or inflammation to the scrotum
  • Infection, including a sexually transmitted infection (STI)

Is there a cure/medications for hydrocele?

Pediatric hydrocele is an abnormal accumulation of fluid in the scrotal sac between the layers of tunica vaginalis. It is either congenital or acquired. Treatment Surgery is the choice of treatment for hydroceles. The options are as follows: 1. Herniotomy Congenital hydroceles which do not resolve spontaneously require herniotomy. The procedure involves the ligation and excision of patent processus vaginalis. 2. Hydrocelectomy Hydrocelectomy is an option for acquired hydrocele. It has two approaches as follows: o Plication of the sac It is also called Lord’s procedure, which involves bunching the tunica into a ruff by applying a series of multiple interrupted chromic catgut sutures for the sac to form fibrous tissue. It is suitable for medium-sized and thin-walled hydroceles. o Jaboulay procedure It is suitable for hydroceles with thick walls. The technique involves subtotal excision of the tunica vaginalis and everting the sac behind the testes, followed by placing the testes in a newly created pocket between the fascial layers of the scrotum. 3. Aspiration For patients who cannot tolerate surgeries, aspiration is an alternative. It involves the removal of collected fluid. The procedure is painful and poses the risk of infection and hematoma. However, injection of sclerosant (tetracycline or doxycycline) before surgery has proven to be effective. Fluid reaccumulates after a week from an aspiration.

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