Hydrocele (of the Testes)

Hydrocele

A hydrocele is a fluid-filled sack that surrounds a testicle and causes swelling in the scrotum1. A hydrocele can develop on one side of the scrotum (unilateral), or on both sides of the scrotum (bilateral). Women can also develop a hydrocele, although it is very uncommon. This is possible because of the common embryological background of male and female gonadal structures2. In this case, the sack and connection exist in the labia majora (the outermost and larger of the two labial structures).

Causes

Normally, a thin sac of fluid surrounds the testicle. When this sac fills with fluid, a hydrocele forms.

 

There are two types of hydroceles, communicating and non-communicating. Communicating hydroceles are present at birth and occur when the opening between the abdominal cavity and the scrotum hasn’t closed completely, allowing abdominal fluid to pass into the sac and around the testes4. It is estimated that 50% of all newborns develop this problem, but it typically disappears within the first year without treatment4. Non-communicating hydroceles may also be present at birth, or develop as the boy matures. In a non-communicating hydrocele, the tail end of the process vaginalis (creation of the abdominal cavity and descent of the testes) has closed atypically, creating an accumulation of fluid. Since this fluid is completely enclosed with no fluid drainage or addition, the size of the hydrocele is generally stable, with less intraabdominal pressure2.

 

            In older males, a hydrocele can develop as a result of an injury or inflammation within the scrotum. Epididymitis is an example of an infection in the testes that can lead to a hydrocele.

Symptoms

The most common symptom associated with a hydrocele is a painless swelling of one or both testes. Adult men may experience discomfort as a result of the added weight of their swollen scrotum. Swelling is often at its lowest in the morning because lying down removes the extra tension of gravity and worsens as the day goes on.

Complications if Not Treated

A hydrocele is typically not dangerous and does not influence fertility, however doctors can mistake a more serious medical (infection, tumor, cancer etc.) for a hydrocele. These two serious conditions have the adverse side-effects of sperm reduction and a decrease in sperm efficiency (difficulty fertilizing the female gamete)1. Inguinal hernias may also be mistaken for a hydrocele because the condition has similar symptoms, such as swelling of the scrotum. Inguinal hernias are caused when intestinal tissue pushes through the inguinal canal at the base of the abdomen5. Inguinal hernias can either spontaneously resolve themselves or require immediate medical attention depending on the severity.

Tests and Diagnosis

A doctor can access a patient’s medical situation in various ways.

·      Accessing whether there is tenderness and an enlarged scrotum with a manual examination

·      Applying pressure to the abdomen and scrotum to rule out an inguinal hernia

·      Shining a light through the scrotum in a process called transillumination (a light spot will indicate the presence of fluid1)

·      Ordering blood and urine tests to ensure epididymitis is not the underlying problem

·      Conducting an ultrasound to determine the other possible causes of swelling (testicular tumor, infection, cancer etc.)

 

Treatments

Most hydroceles are present at birth, and 95% of those cases resolve spontaneously after one year of age 2. Those that are not genetically transferred or are still present after one year of age generally require surgical intervention (hydrocelectomy). This procedure can be done on an outpatient basis and it involves a small incision in the scrotum or lower abdomen to remove the hydrocele 1. After the procedure, a patient may wear a scrotal support wrap and use ice to relieve any scrotal discomfort.

 

 

1.     “Diseases and Conditions: Hydrocele." Mayo Clinic. Mayo Foundation for Medical Education and Research, 9 Oct. 2014. Web. 19 Nov. 2014.

2.     Mersch, John. "Pediatric Hydrocele." MedicineNet. N.p., 12 Dec. 2013. Web. 19 Nov. 2014.

3.     "Testicle/Scrotal Disorders." The Urology Group. Specialty Urologic Medical Facilities, 2013. Web. 19 Nov. 2014.

4.     "Communicating Hydrocele." HealthyChildren.org. American Academy of Pediatrics, 11 May 2013. Web. 19 Nov. 2014.

5.     Moore, Kristeen. "Inguinal Hernia.": Causes, Symptoms & Diagnosis. N.p., 27 July 2012. Web. 19 Nov. 2014.

Last Updated: 03 12 2014