 Hydrocele
(Urology)
Hydrocele
(Urology)
A hydrocele is a fluid-filled sac that surrounds a testicle,
causing swelling of the scrotum. About one in 10 male infants has
a hydrocele at birth, but most hydroceles disappear without treatment
within the first year of life. Additionally, men — usually
older than 40 — can develop a hydrocele due to inflammation
or injury within the scrotum.
Hydroceles usually aren't painful. Typically not harmful,
hydroceles may require no treatment. However, if you have scrotal
swelling, see your doctor to rule out other causes, such as testicular
cancer or other conditions.
Signs & Symptoms
Usually the only indication of a hydrocele is a painless
swelling of one or both testicles.
Causes
For baby boys, a hydrocele can develop in the womb a few
weeks before birth. At about the eighth month of gestation, the
testicles descend from the developing baby's abdominal cavity into
the scrotum. A sac (processus vaginalis) accompanies each testicle,
allowing fluid to surround them.
In most cases, the sac closes and the fluid is absorbed. However,
if the fluid remains after the sac closes, the condition is known
as a noncommunicating hydrocele. Because the sac is closed, fluid
can't flow back into the abdomen. Usually the fluid gets absorbed
within a year.
In some cases, however, the sac remains open. With this condition,
known as communicating hydrocele, the sac can change size or, if
the scrotal sac is compressed, fluid can flow back into the abdomen.
In older males, a hydrocele can develop as a result of inflammation
or injury within the scrotum. Inflammation may be the result of
infection of the small coiled tube at the back of each testicle
(epididymitis) or of the testicle (orchitis).
Risk Factors
Most hydroceles are present at birth (congenital). For
a secondary hydrocele, which usually affects men 40 or older, risk
factors include:
When to seek medical advice
See your doctor if you experience scrotal swelling. It's
important to rule out other possible causes for the swelling, such
as a tumor. Often a hydrocele is associated with an inguinal hernia,
in which a weak point in the abdominal wall allows a loop of intestine
to extend into the scrotum and which may require treatment.
Screening & Diagnosis
An infant's hydrocele typically disappears on its own.
However, if your baby's hydrocele doesn't disappear after a year
or if it enlarges, you may need to have it evaluated.
Screening and diagnosis entails a physical exam, which may reveal
an enlarged scrotum that isn't tender to the touch. Pressure to
the abdomen or scrotum may enlarge or shrink the fluid-filled sac,
which may indicate an associated inguinal hernia.
Because the fluid in a hydrocele usually is clear, your doctor may
shine a light through the scrotum (transillumination). With a hydrocele,
the light will outline the testicle, indicating that clear fluid
surrounds it. However, transillumination cannot confirm the diagnosis
because it also may indicate other conditions, such as hernia.
If your doctor suspects your hydrocele is caused by inflammation,
blood and urine tests may help determine whether you have an infection
such as epididymitis.
The fluid surrounding the testicle may keep the testicle from being
felt. In that case, further study may be needed. Possible tests
include:
- Ultrasound Imaging:
This test, which uses high-frequency sound waves to create
images of structures inside your body, may be used to rule out
a testicular tumor or other cause of scrotal swelling.
- Abdominal X-Ray:
A basic X-ray uses electromagnetic radiation to make images of
your bones, teeth and internal organs. An X-ray may distinguish
a hydrocele from an inguinal hernia.
Treatment
For baby boys, hydroceles typically disappear on their
own within a year. If a hydrocele doesn't disappear after a year
or if it continues to enlarge, it may need to be surgically removed.
For adult males as well, hydroceles often go away
on their own. A hydrocele requires treatment only if it gets large
enough to cause discomfort or disfigurement. Then it may need to
be removed.
Treatment approaches include:
- Surgical Excision (Hydrocelectomy)
Removal of a hydrocele may be performed on an outpatient basis
using general or spinal anesthesia. The surgeon may make an incision
in the scrotum or lower abdomen to remove the hydrocele. If a
hydrocele is discovered during surgery to repair an inguinal hernia,
your doctor may remove it even if it's causing you no discomfort.
A hydrocelectomy may require you to have a drainage tube and wear
a bulky dressing over the site of the incision for a few days
after surgery. Also, you may be advised to wear a scrotal support
for a time after surgery. Ice packs applied to the scrotal area
during the first 24 hours after surgery may help reduce swelling.
Surgical risks include blood clots, infection or injury to the
scrotum.
- Needle Aspiration
Another option is to remove the fluid in the scrotum with a needle.
This treatment isn't widely used because it's common for the fluid
to return. The injection of a thickening or hardening (sclerosing)
drug after the aspiration may help prevent the fluid from reaccumulating.
Aspiration and injection may be an option for men who have risk
factors that make surgery more dangerous. Risks of this procedure
include infection and scrotal pain.
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