A hydrocele is a medical condition characterized by a collection of fluid in the scrotum, the pouch of skin that holds the testicles. This fluid accumulation causes swelling around one or both testicles. A hydrocele is generally not a hernia; it involves only fluid, whereas a hernia occurs when an organ or tissue, such as part of the intestine, pushes through a weak spot in the muscle wall. Hydroceles are relatively common, particularly in newborn infants, and often resolve without specific intervention.
Understanding Hydroceles
A hydrocele is a fluid-filled sac that surrounds a testicle, causing scrotal swelling. This fluid collects within the tunica vaginalis, a thin membrane that encases the testicle.
There are two primary types of hydroceles: communicating and non-communicating. A communicating hydrocele occurs when an open connection exists between the abdominal cavity and the scrotum through the processus vaginalis. This allows fluid to flow back and forth, which can cause the swelling’s size to fluctuate. Non-communicating hydroceles form when the processus vaginalis has closed, but fluid remains trapped around the testicle or accumulates due to an imbalance between fluid production and absorption. These typically remain a consistent size or grow slowly.
Causes and Risk Factors
Hydroceles can be congenital or acquired later in life. Congenital hydroceles develop when the processus vaginalis, a channel that forms during fetal development as the testicles descend into the scrotum, fails to close completely. This open channel allows fluid from the abdominal cavity to enter the scrotum. While approximately 80-90% of male infants have a patent processus vaginalis at birth, most close spontaneously within the first two years of life.
Acquired hydroceles result from various factors. Injury or trauma to the scrotum is a common cause, leading to fluid accumulation. Inflammation or infection of the testicle or epididymis, such as epididymitis or orchitis, can trigger a hydrocele.
Certain medical conditions that cause fluid retention, like heart failure or liver cirrhosis, may contribute to hydrocele formation. Hydroceles can also develop as a complication following surgical procedures in the groin or scrotum, including hernia repair or kidney transplants. Age is a factor, as acquired hydroceles are more common in men over 40.
Recognizing the Signs
The primary sign of a hydrocele is often painless swelling in one or both testicles. This swelling may feel soft and smooth, resembling a water balloon. It typically does not cause discomfort unless it becomes very large and heavy, which can lead to a feeling of heaviness or mild discomfort in the groin.
For communicating hydroceles, the swelling might appear larger at the end of the day or after physical activity and may seem smaller in the morning. Non-communicating hydroceles tend to maintain a consistent size. While hydroceles are generally not painful, any sudden or severe pain accompanied by scrotal swelling warrants immediate medical attention to rule out other serious conditions like testicular torsion.
Diagnosis and Treatment Approaches
Diagnosing a hydrocele begins with a physical examination by a healthcare provider. During this exam, the provider assesses the scrotal swelling and may gently press on the area to check for tenderness or to differentiate it from a hernia. A common diagnostic technique is transillumination, where a light shined through the scrotum will pass through the clear fluid, causing the scrotum to glow.
Imaging tests like an ultrasound are often used to confirm the diagnosis and rule out other conditions such as a hernia, tumor, or infection. An ultrasound provides detailed images of the scrotal contents and clearly shows the fluid collection around the testicle. Blood and urine tests may also be conducted to check for underlying infections.
Treatment for a hydrocele varies based on its type, size, and whether it causes symptoms. For small, asymptomatic hydroceles, particularly in infants, a watchful waiting approach is often adopted, as many resolve spontaneously within the first 12 to 24 months. If a hydrocele persists, grows large, causes discomfort, or is associated with a communicating channel, surgical correction, known as a hydrocelectomy, is the primary treatment. This procedure involves making a small incision in the scrotum or groin, draining the fluid, and either removing part of the hydrocele sac or everting it to prevent fluid re-accumulation.
Less common treatments include aspiration, where fluid is drained with a needle, sometimes followed by sclerotherapy, which involves injecting a solution to prevent fluid buildup. These methods carry a higher risk of recurrence and infection compared to surgery. Surgical repair is usually performed as an outpatient procedure, with recovery typically involving a few weeks of avoiding strenuous activities.