A hydrocele is a common type of swelling that occurs when fluid accumulates around a testicle in the scrotum. It is generally not considered dangerous, often presenting as a painless, fluid-filled sac. While hydroceles are frequently observed in infants and can resolve without intervention, they can also develop in adults. Understanding the nature of a hydrocele helps in recognizing when medical evaluation might be necessary.
What is a Hydrocele
A hydrocele forms when there is an imbalance between the production and absorption of fluid within the tunica vaginalis, the thin sac surrounding the testicle. This fluid accumulation causes the scrotum to swell, often feeling like a water balloon.
There are two main types of hydroceles: communicating and non-communicating. A communicating hydrocele occurs when a channel, called the processus vaginalis, remains open between the abdominal cavity and the scrotum. This allows abdominal fluid to flow into the scrotum, causing the swelling size to fluctuate. Non-communicating hydroceles develop when this channel closes, but fluid remains trapped around the testicle or the body does not properly reabsorb it. This type often stays a consistent size or grows very slowly.
In infants, hydroceles commonly arise during fetal development when the testicles descend into the scrotum, and the processus vaginalis does not fully close. Most hydroceles in newborns resolve on their own as the body absorbs the fluid, often by the age of one or two. In adults, hydroceles can form due to injury, inflammation, or infection within the scrotum. Conditions such as epididymitis, an infection of the coiled tube at the back of each testicle, can also lead to hydrocele formation.
When to Seek Medical Attention
While many hydroceles are benign, certain symptoms warrant prompt medical evaluation. Seek medical attention if the scrotal swelling appears suddenly or is accompanied by pain. Though hydroceles are typically painless, discomfort can occur if the swelling increases significantly.
Additional concerning signs include redness, warmth, or fever, which could indicate an infection. A rapid increase in the size of the hydrocele should also prompt a doctor’s visit. If the swelling makes it difficult to sit, walk, or perform daily activities, seek medical attention.
Scrotal swelling might indicate a more serious underlying condition. These can include an inguinal hernia, where part of the intestine protrudes into the groin, or, less commonly, a testicular tumor. For children, a sudden, very large and hard scrotum accompanied by continuous crying could suggest an incarcerated hernia, which is a medical emergency. Any new or changing scrotal swelling should be assessed by a healthcare provider to ensure an accurate diagnosis and appropriate management.
Medical Evaluation and Treatment Options
A medical evaluation for scrotal swelling typically begins with a physical examination, during which a healthcare provider assesses the scrotum for tenderness and swelling. They may also shine a light through the scrotum, a technique called transillumination; if the swelling is a hydrocele, the light will typically pass through, illuminating the fluid. This helps differentiate a fluid-filled sac from a solid mass, which would block the light. Pressure may also be applied to the groin or the patient might be asked to cough, which can help determine if the swelling is an inguinal hernia, as hernias often change with abdominal pressure.
To confirm the diagnosis and rule out other conditions such as a hernia, testicular tumor, or infection, imaging tests like an ultrasound may be performed. An ultrasound provides detailed images of the scrotal contents, allowing the doctor to visualize the fluid collection and examine the testicle. In some cases, blood or urine tests might be conducted, particularly if an infection is suspected.
Treatment for a hydrocele depends on its type, size, and whether it causes symptoms. For infants with a non-communicating hydrocele, watchful waiting is often the initial approach, as many resolve spontaneously within the first year or two of life. If the hydrocele persists past this time, becomes very large, or causes discomfort, surgical intervention may be considered. For communicating hydroceles, surgery is generally recommended because they do not tend to close on their own and carry a risk of developing an inguinal hernia.
The surgical procedure to treat a hydrocele is called a hydrocelectomy. This involves making an incision, typically in the groin or scrotum, to drain the fluid and remove or repair the fluid-filled sac. In cases of communicating hydroceles, the open channel to the abdomen is also closed. Most individuals can return to light activities within a few days after surgery, though strenuous activities and heavy lifting are usually restricted for two to four weeks to aid full recovery. Complete healing can take several weeks, with some residual swelling gradually subsiding over time.