A hydrocele is a medical condition characterized by the accumulation of fluid in the sac around the testicle, leading to swelling in the scrotum. It is common in newborns but can also occur in older males due to injury or inflammation. Hydroceles are usually painless and harmless, though they may cause discomfort if the swelling becomes significant. Causes include congenital factors, infections, injuries, or inflammation in the scrotal area. Treatment options range from observation, as hydroceles may resolve on their own, to surgical procedures.

What is hydrocele?

A hydrocele is a condition where fluid builds up in the thin sac that surrounds a testicle, leading to swelling in the scrotum. It is typically painless and non-cancerous, making it generally harmless. Hydroceles are most common in newborns, often resolving on their own within the first year of life, but they can also develop in adult males, particularly due to injury, infection, or inflammation. While they usually don’t cause serious issues, they can be uncomfortable if the swelling becomes significant. If a hydrocele does not go away or causes discomfort, medical intervention might be necessary.

Causes of hydrocele

Hydrocele can be caused by a variety of factors, depending on the age and circumstances of the individual. The common causes include:

• Congenital hydrocele: In newborns, a hydrocele can develop before birth if the channel that allows the testicles to descend from the abdomen into the scrotum does not close properly. This is called a congenital hydrocele and usually resolves on its own within the first year of life.
• Injury or trauma: An injury or trauma to the scrotum can cause inflammation and fluid buildup, leading to a hydrocele.
• Infections: Infections, particularly in the scrotal area, such as epididymitis (inflammation of the tube that stores sperm) or orchitis (inflammation of the testicle), can cause a hydrocele to develop.
• Inflammation: General inflammation in the scrotal or abdominal area, possibly due to an underlying medical condition, can lead to fluid accumulation.
• Blockage or poor drainage: A blockage in the lymphatic system or poor fluid drainage from the scrotum can result in a hydrocele.
• Aging: In older men, hydroceles can sometimes develop due to fluid imbalance or as a part of natural aging, where the balance between fluid production and absorption is disrupted.
• Surgery or medical procedures: Sometimes, a hydrocele can form as a side effect of previous surgery or medical procedures in the groin or scrotal area.
• Testis cancer: Some patients with testis cancer may have hydrocele.

Symptoms of hydrocele

Hydrocele symptoms can vary depending on the severity of the condition, but common signs include:

• Scrotal swelling: The most noticeable symptom is a painless swelling in the scrotum, usually on one side. The swelling may be small or quite large, depending on the amount of fluid accumulated.
• Heaviness in the scrotum: Some individuals may experience a feeling of heaviness or discomfort in the scrotum, particularly with larger hydroceles.
• Discomfort or pain: Although hydroceles are usually painless, if they become large, they may cause discomfort, especially during physical activities or when sitting.
• Size fluctuation: In congenital cases, the size of the swelling may change throughout the day, often being larger in the evening or after physical activity.

Diagnosis of hydrocele

Diagnosis typically involves the following steps:

• Physical examination: A doctor will examine the scrotum, checking for swelling, tenderness, and consistency. Hydroceles usually feel smooth and fluid-filled.
• Transillumination: A common diagnostic test involves shining a light through the scrotum. If the swelling is due to a hydrocele, the light will pass through the fluid, illuminating the area. This helps differentiate a hydrocele from solid masses like tumors.
• Ultrasound: If the diagnosis is unclear or if there are concerns about other conditions, an ultrasound may be conducted. This imaging test helps visualize the fluid buildup and rule out other potential causes of scrotal swelling, such as hernias or tumors.
• Urinalysis: In cases where infection is suspected, a urine sample may be tested to check for signs of infection or inflammation that could be causing the hydrocele.

Differential diagnosis of hydrocele

Differential diagnosis of hydrocele involves distinguishing it from other conditions that cause scrotal swelling. These conditions can have similar symptoms, so a thorough evaluation is necessary to make an accurate diagnosis. Key conditions to consider in the differential diagnosis include:

• Inguinal Hernia
• Testicular Tumor
• Epididymitis/Orchitis
• Spermatocele
• Varicocele
• Testicular Torsion
• Hematocele

Complications of hydrocele

While hydroceles are generally harmless and often resolve without treatment, there can be complications, especially if the condition is severe or left untreated. Some potential complications include:

• Discomfort and pain: If a hydrocele grows significantly, it can cause discomfort or a dull ache in the scrotum. This discomfort may be worse during physical activity or prolonged standing.
• Infection (hydrocele infection): A hydrocele can become infected, leading to symptoms such as redness, warmth, increased swelling, pain, and fever. An infected hydrocele may require medical intervention, including antibiotics or drainage.
• Reduced testicular function: In rare cases, a very large hydrocele can exert pressure on the testicle, which might affect blood flow and potentially impair testicular function over time.
• Inguinal hernia: Sometimes, a hydrocele may be associated with an inguinal hernia, where a portion of the intestine protrudes into the scrotum. This condition requires surgical treatment to prevent complications like strangulation of the intestine.
• Cosmetic concerns: A noticeable swelling in the scrotum can lead to psychological or cosmetic concerns, impacting self-esteem and causing social discomfort, particularly if the hydrocele is large.
• Recurrence after treatment: In some cases, even after surgical intervention (such as hydrocelectomy), a hydrocele may recur, requiring further monitoring or additional treatment.

Treatment of hydrocele

Treatment for a hydrocele depends on the severity of symptoms and whether the condition is causing discomfort or other complications. Here are common treatment options:

Surgery (hydrocelectomy): The treatment of hydrocele is surgery. This is standart treatment for hydrocele. During surgery, the fluid between the membranes surrounding the testicle is drained and this gap is closed to prevent it from collecting again. There is no possibility of recurrence. The surgery takes approximately 30 minutes. It can be done with local, general or spinal anesthesia.

Observation (watchful waiting): In many cases, particularly for infants or if the hydrocele is small and painless, no immediate treatment is required. The condition is often monitored over time to see if it resolves on its own. Congenital hydroceles in infants often disappear within the first year of life. In adults, if the hydrocele is not causing discomfort, doctors may recommend observation.

Aspiration: Fluid is drained from the hydrocele using a needle. This is a less invasive procedure that may be done in cases where surgery is not suitable. Aspiration is usually a temporary solution, as fluid often reaccumulates. It may be combined with a sclerosing agent (injection of a chemical to prevent fluid build-up) to reduce recurrence. Aspiration should not be performed in cases where testicular cancer is suspected, because the cancer may spread to the scrotum.

Sclerotherapy: After aspirating the fluid, a sclerosing agent is injected to seal the sac and prevent fluid from reaccumulating. This option is less common and typically used when surgery is not a viable option. It can be effective but carries a risk of local irritation or complications.

Treatment of underlying causes: If a hydrocele is caused by infection, trauma, or an underlying medical condition, treating the root cause can sometimes resolve the hydrocele. Addressing infections with antibiotics or managing inflammatory conditions can reduce the likelihood of fluid accumulation.

Summary

In summary, a hydrocele is a fluid buildup in the sac around the testicle, often causing painless swelling in the scrotum. While it is usually harmless, it can cause discomfort or complications if left untreated. Causes range from congenital factors to infections or injury. Treatment options include observation, aspiration, or surgery, depending on the severity and symptoms. Consulting a urologist is essential to choose the right approach for managing this condition effectively.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul- TURKIYE