A hydrocele is a painless buildup of watery fluid around one or both testicles that causes the scrotum or groin area to swell. This swelling may be unsightly and uncomfortable, but it usually is not painful and generally is not dangerous. Although hydroceles are common in newborns, they can also occur at any age in later life. See a picture of a hydrocele.
A hydrocele can develop before birth. Normally, the testicles descend from the developing baby’s abdominal cavity into the scrotum. A sac accompanies each testicle, allowing fluid to surround the testicles.
Usually, each sac closes and the fluid is absorbed. However, fluid can remain after the sac closes (noncommunicating hydrocele). The fluid is usually absorbed gradually within the first year of life.
Sometimes, however, the sac remains open (communicating hydrocele). The sac can change size or, if the scrotal sac is compressed, fluid can flow back into the abdomen. Communicating hydroceles are often associated with inguinal hernia.
A hydrocele can develop as a result of injury or inflammation within the scrotum. Inflammation might be caused by an infection in the testicle or in the small, coiled tube at the back of each testicle (epididymitis).
The pathophysiology of hydroceles requires an imbalance of scrotal fluid production and absorption. This imbalance can be divided further into exogenous fluid sources or intrinsic fluid production.
Alternatively, hydroceles can be divided into those that represent a persistent communication with the abdominal cavity and those that do not. Fluid excesses are from exogenous sources (the abdomen) in communicating hydroceles, whereas noncommunicating hydroceles develop increased scrotal fluid from abnormal intrinsic scrotal fluid shifts.
With communicating hydroceles, simple Valsalva maneuvers probably account for the classic variation in size during day-sleep cycles. Nonetheless, with the incidence of patent processus so great, why children with clinically apparent hydroceles are relatively few remains somewhat inexplicable. Chronically increased intra-abdominal pressure (eg, as in chronic lung disease) or increased abdominal fluid production (eg, children with ventriculoperitoneal shunts) probably warrants early surgical intervention.
Noncommunicating hydroceles may result from increased fluid production or impaired fluid absorption. A sudden onset of scrotal hydrocele in older children has been noted after viral illnesses. In such cases, viral-mediated serositis may account for the net increased fluid production. Posttraumatic hydroceles likely occur secondary to increased serosal fluid production due to underlying inflammation. Although rare in the United States, filarial infestations are a classic cause of the decreased lymphatic fluid absorption resulting in hydroceles.
Usually, the only indication of a hydrocele is a painless swelling of one or both testicles.
Adult men with a hydrocele might experience discomfort from the heaviness of a swollen scrotum. Pain generally increases with the size of the inflammation. Sometimes, the swollen area might be smaller in the morning and larger later in the day.
A hydrocele is usually diagnosed by an exam of the scrotum, which may appear enlarged. As part of the exam, your doctor will shine a light behind each testicle (transillumination). This is to check for solid masses that may be caused by other problems, such as cancer of the testicle. Hydroceles are filled with fluid, so light will shine through them (transillumination). Light will not pass through solid masses that may be caused by other problems, such as cancer of the testicle. An ultrasound may be used to confirm the diagnosis of a hydrocele.
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 might need to be surgically removed.
For adult males, hydroceles often go away on their own within six months. A hydrocele requires treatment only if it gets large enough to cause discomfort or disfigurement. Then it might need to be surgically removed.
The procedure can be performed on an outpatient basis during general or regional anesthesia. An incision is made in the scrotum or lower abdomen to remove the hydrocele. If a hydrocele is found during surgery to repair an inguinal hernia, the surgeon might remove the hydrocele even if it’s causing no discomfort.
After hydrocelectomy, you might need a tube to drain fluid and a bulky dressing for a few days. To ease discomfort, your doctor might recommend:
- A scrotal support strap
- Ice packs to help reduce swelling
Your doctor is likely to recommend a follow-up examination because a hydrocele might recur.