Hydrocele: Causes, Symptoms And Treatments

Diagram depicting normal testicle compared to a hydrocele.

What Is A Hydrocele?

A hydrocele is a condition that causes swelling of the scrotum due to the accumulation of fluid around one or both testicles. Hydroceles are more common among male infants, but can occur in older boys and men because of injury or inflammation of the scrotum.

Hydroceles are usually not painful or dangerous and may not require treatment. However, if you do experience swelling of the scrotum, talk to your doctor to make certain it’s not something more serious.

Hydrocele Signs and Symptoms

There is typically only one symptom to indicate the presence of a hydrocele, which is a non-painful swelling involving one or both of the testicles.

Men who have a hydrocele might feel a certain level of discomfort due to the increased weight of the scrotum. Additionally, their may appear to be less swelling at night and more during the day.

Does A Hydrocele Pose Any Health Risks?

A Hydrocele is generally not considered dangerous or to pose a risk to health, and does not interfere with fertility. However, a hydrocele could be linked to underlying health issues that can potentially lead to serious complications, such as:

  • An infection or tumor – Having either of these could adversely affect the production and function of sperm.
  • Inguinal Hernia – A condition where portion of the small intestine or abdominal fat pushes through the abdominal wall, which can potentially cause serious complications.

Hydrocele Causes

In Infants

Hydroceles can form in babies even before birth. The majority of hydroceles are present at the time of birth, and affect not less than 5% of all newborn boys. Infants who were born prematurely are at a greater risk for developing a hydrocele.

While developing in the mother’s womb, the baby’s testicles are surrounded by fluid-filled sacs. Normally, these sacs close off and the fluid gets absorbed by the body.

However, this fluid can sometimes remain after the sac is closed, a condition known as non-communicating hydrocele. In most cases, the fluid is slowly absorbed during the first year after the baby is born.

On the other hand, in certain circumstances the sac may stay open, a condition known as communicating hydrocele. This sac may become enlarged or leak back into the abdomen if the sac becomes compressed. Communicating hydroceles are frequently accompanied by inguinal hernias.

Diagram depicting the appearance of a communicating hydrocele

Boys And Adult Men

Besides cases involving newly born infants, hydroceles can occur due to trauma or injury to the scrotum at any age. They can also form as a result of inflammation.

One source of inflammation of the scrotum can be due to epididymitis, an infection of the tube that transports sperm from the testes). Other causes include STI’s (sexually transmitted infections), or by an infection of the testicle itself.

When To See a Doctor

It’s important that you schedule an appointment to see a doctor if either you or your child experiences swelling of the scrotum. This is because there are other health conditions that can cause swelling in this area that are potentially more serious, such as an inguinal hernia or infection.

When a baby has a hydrocele it will usually resolve by itself. However, if your infant’s hydrocele doesn’t go away within a year, or if it gets bigger, you should see a doctor for an additional evaluation.

If you or your child experiences an abrupt, intense pain involving the scrotum, seek medical attention immediately. This is particularly important if it occurs in the hours following a scrotal injury.

Conditions other than hydrocele could be responsible for these symptoms, including testicular torsion. Testicular torsion occurs when a testicle becomes twisted and its blood flow gets cut off. If this condition is not treated within a few hours of first having symptoms, the testicle may have to be removed.

Your doctor might refer you to a specialist trained in conditions affecting the urinary tract, called a urologist.

Questions Your Doctor May Ask

Your doctor will likely start off by asking you several pertinent questions. Here are a few examples of the type of information that he or she will likely need to help with the diagnosis.

If it is your child or infant who is experiencing symptoms, you may be asked:

  • When was the swelling noticed initially? Has it been gradually increasing?
  • Does your child seem to be experiencing pain or discomfort?
  • Have you noticed any other symptoms that your child may be having?

If you are the one experiencing signs and symptoms, your doctor may want to know:

  • When did you initially notice the swelling?
  • Are you experiencing pain or tenderness in your scrotum?
  • Are you having a frequent urge to urinate, or any discomfort during urination?
  • Have you previously had a UTI or any condition affecting your prostate?
  • Are you experiencing pain when during sexual intercourse or ejaculation?
  • Have you noticed any penile discharge or blood in your semen?
  • Do you engage in any type of heavy lifting?
  • Have either you and your partner been tested for STIs?
  • Have you ever had any surgery or radiation treatments in the groin area?

Examination and Diagnosis

The doctor will next proceed with a physical examination. Usually, this will involve:

  • Checking if there is any soreness in the scrotum.
  • Checking for an inguinal hernia by applying pressure to the abdominal area and the scrotum.
  • Performing a transillumination test, where a strong light is applied to the scrotum. A clear fluid that surrounds the testicle will be visible in infants with hydroceles.

Following the exam, your doctor may recommend a blood test and urinalysis in order to determine if there is an infection present. He or she may also perform an ultrasound to eliminate the possibility of a hernia, tumor, or other reasons for swelling in the scrotum.

Hydrocele Treatment

A hydrocele often goes away by itself in male infants. However, because it may be connected to a more serious condition, it is important to have a doctor’s evaluation regardless of age.

If a hydrocele does not resolve itself on its own it may require surgical removal, a procedure called a hydrocelectomy. This is a fairly routine operation that is usually performed on an outpatient basis using either a local or general anesthetic.

To perform the procedure, an incision is made through which the hydrocele is removed, either through the scrotum or the lower abdomen. Additionally, if a patient who is undergoing an operation to repair an inguinal hernia is found to have a hydrocele, the surgeon may go ahead and remove it at that time.

Recovery

For the first few days following a hydrocelectomy procedure, you may require a tube for draining fluid and have thick bandaging applied to the area. Since there is a possibility that the hydrocele might return, your doctor will likely schedule you for a follow-up examination.

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