HYDROCELE
A hydrocele is a painless swelling in the scrotum which occurs when fluid collects in the thin layer of skin surrounding a testicle. This is common in newborn males and usually disappears without treatment within the first year of life.
In older males, a hydrocele can have one of several different causes, ranging from injury to infection. Its diagnosis is usually straightforward, and there is often no need for treatment.
Hydroceles in newborns usually require no treatment.
A hydrocele is a collection of fluid in the membrane of the testis that causes a swelling in the scrotum.
Though it is very rare, females can also experience a hydrocele along the canal of Nuck.
About 10% of newborn males have a hydrocele, but this usually disappears before the age of 1 year.
The swelling can occur on one or both sides of the scrotum. It does not cause pain but may be uncomfortable, particularly when the swelling is significant.
TYPES OF HYDROCELE
There are two types of hydroceles:
- Congenital (meaning present at birth)
- Acquired (meaning develops after birth)
It is not possible to tell from examination or scanning what type of hydrocele a patient has. However, there is ample evidence that boys under the age of 12 will, in general, have a congenital hydrocele, whilst boys over the age of 12 are more likely to have an acquired hydrocele.
Congenital hydroceles
The most common type of hydrocele in boys is the congenital variety.
Before birth, the testicles develop inside the baby's tummy. The testicles then pass through the tummy wall - through the inguinal canal - and then down into the scrotum. To aid the testicles in its travel down to the scrotum, some tissue from the lining of the inside of the tummy goes down as well, which acts like a slide. This is known and called the 'processus vaginalis'. It is like the finger of a glove. This tissue forms a protective layer around the testicle and the connection with the tummy normally closes once the testicle is in the scrotum. This connection is open in nearly all boys at birth and closes in most boys during the first year of life. This open connection is called a 'patent processus vaginalis' (PPV).
In the vast majority of boys, although this connection is open, it does not cause any symptoms and you would not know that it is there. If fluid starts to go down this connection and surrounds the testicle, this causes a hydrocele. The fluid comes from the natural fluid that is produced on the outside of the intestines to lubricate it (peritoneal fluid). If the intestines start to go down the connection then this is called an inguinal hernia.
Girls also have a processus vaginalis, which leaves the tummy through their inguinal canal. The processus vaginalis goes on to form a structure called the round ligament in girls. If the opening inside the processus vaginalis does not close, fluid can accumulate in it. This is called a hydrocele of the canal of Nuck.
Acquired hydroceles
An acquired hydrocele is seen more commonly in older boys and in adults. In this occurrence, the fluid in the hydrocele does not come from the tummy.
There are a number of possible causes such as:
- Tumor
- Trauma
- Infection
- Torsion of the testicle or one of the other structures in the scrotum.
Sometimes too no cause is found for the build-up of fluid.
CAUSES
The cause of a hydrocele depends on a person's age.
In babies
During pregnancy when a male fetus is growing, the testicles develop near the kidneys in the abdomen. By the end of a full-term pregnancy, they would have moved down to their usual position in the scrotum.
A muscle lining opens in the scrotum (the inguinal ring), forming a canal or sac. To facilitate the testicles' descent.
The inguinal ring closes once the testicles have moved into their usual position. If the ring stays open or reopens, fluid can pass from the belly to the scrotum through this canal, and this causes a hydrocele.
Some other times, babies are born before the testicles have descended, increasing the chances of a hydrocele developing.
In adults
In older males, if the inguinal ring has not closed up or it reopens, a communicating hydrocele can form.
Hydroceles in adult males have several other possible causes, including:
- An injury
- Inflammation
- An infection
A hydrocele is unlikely to be painful, but it can cause an uncomfortable feeling of heaviness in the scrotum.
Hydroceles are not usually dangerous and will not affect fertility. In rare instances, it might link to an underlying testicular condition, such as an infection, tumor, or inguinal hernia.
People should seek out a diagnosis from a doctor to rule out any other conditions.
SYMPTOMS OF A HYDROCELE
Hydroceles usually don't cause any pain. Usually, the only symptom is a swollen scrotum.
In adult men, there may be a feeling of heaviness in the scrotum. In some cases, the swelling might be worse in the morning than in the evening. It is not usually very painful.
Parents should seek medical treatment if they or your male child has sudden or severe pain in their scrotum. This could be the sign of another condition called testicular torsion. Testicular torsion occurs when the testicles become twisted, typically due to an injury or accident. Testicular torsion isn't common, but it must be treated as a medical emergency because it can lead to blocked blood supply to the testicle and ultimately infertility if not treated. If a parent thinks he or a child has testicular torsion, they must go a hospital emergency room right away. It needs to be evaluated and treated immediately.
RISK FACTORS
Most hydroceles are present at birth. Hydrocele occurs in at least 5 percent of newborn boys. Babies who are born prematurely have an even 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)
COMPLICATIONS
A hydrocele typically is not considered dangerous and usually doesn't affect fertility. However, a hydrocele might be associated with an underlying testicular condition that can cause serious complications, including:
- Infection or tumor. Either of these might reduce sperm production or function.
- Inguinal hernia. The loop of intestine trapped in the abdominal wall can lead to life-threatening complications.
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. A hydrocele for example, 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 will disappear on its own. But if your baby's hydrocele doesn't disappear after a year or if it enlarges, ask the 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.
DIAGNOSIS
To diagnose a hydrocele, the doctor will perform a physical exam. If you have a hydrocele, your scrotum will be swollen, but you won't have any pain. Your doctor won't be able to feel your testicle well through the fluid-filled sac.
The doctor may check for tenderness in the scrotum and shine a light through the scrotum. This is called trans illumination. It allows the doctor to determine if there's fluid in the scrotum. If fluid is present, the scrotum will allow light transmission and the scrotum will appear to light up with the light passing through. However, if scrotal swelling is due to a solid mass (cancer), then the light will not shine through the scrotum. This test does not provide a definite diagnosis but can be very helpful.
Your doctor may also apply pressure to the abdomen to check for another condition called inguinal hernia; your doctor may also ask you to cough or bear down to check for this. This can occur when part of the small intestine protrudes through the groin due to a weak point in the abdominal wall. While it's usually not life-threatening, a doctor may recommend surgery to repair it.
The doctor may take a blood or urine sample to test for infections. Less commonly, a doctor may administer an ultrasound to check for hernias, tumors, or any other cause of scrotal swelling.
TREATING A HYDROCELE
If the new infant has a hydrocele, it will probably go away on its own in about a year. However, if the child's hydrocele doesn't go away on its own or becomes very large, he might need surgery by an urologist.
In adults, hydroceles typically go away within six months. A hydrocele usually only needs surgery if it causes discomfort or if it's a communicating hydrocele, which can lead to hernias.
SURGERY
Surgery to remove a hydrocele is performed under anesthesia. In most cases, you'll be able to go home within a few hours of the surgery.
Depending on the location of the hydrocele a small cut is made in the abdomen or scrotum and the hydrocele is surgically removed. Your surgeon will most likely apply a large dressing to the site of your incision. Depending again on the location and size, one may also need a drainage tube for a few days.
Risks associated with anesthesia include:
- Allergic reactions
- Breathing difficulties
- Heart rhythm disturbances
Risks associated with this procedure may include:
- Blood clots or excessive bleeding
- Scrotal injury, including nerve damage
- Infection
A patient will need ice packs, a support strap for the scrotum, and plenty of rest will ease discomfort after the surgery. The doctor will likely recommend a checkup exam because a hydrocele can sometimes reoccur.
Needle aspiration
Needle aspiration is commonly performed on men who are at high risk for complications during surgery. In this option for hydrocele treatment, the aim is to drain it with a long needle. The needle is inserted into the sac to draw out the fluid. In some cases, a drug may be injected to prevent the sac from filling again.
The most common side effects of needle aspiration are temporary pain in your scrotum and the risk of infection.
PREVENTION
The best protection against adult hydrocele is to keep the testicles and scrotum free of injury.
For example, if taking part in contact sports, use an athletic cup.
Although hydroceles are usually not a major health issue, you should tell the doctor about any abnormality or swelling in the scrotum. Another disease or condition may be causing or mimicking the abnormality.
What can be expected after treatment for adult hydrocele?
Following surgery there will likely be pain in the area of the scrotum. Over-the-counter pain relievers or prescribed pain medications can help to ease the pain.
Ice packs are applied for the first 24 hours.
Activity levels may be restricted for a number of weeks until the healing process is complete.
A jockstrap is worn for about 2-4 weeks following surgery in order to keep the scrotum elevated towards the testicles.
It might take 2-3 months for the swelling of the operated scrotum to go down completely.
It is possible that a hydrocele may return, even after surgery.
SUMMARY
Hydroceles are very common in newborn males and usually disappear within a year.
The most common cause is fluid traveling from the abdomen and collecting in the tissue surrounding one or both testicles.
In adult males, swelling in the scrotum has many possible causes, including inflammation from infection or injury.
Most hydroceles, in both infants and adults, disappear without the need for medical intervention. In rare cases, doctors might need to perform surgery or aspiration to drain the fluid.
