Hydrocele

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Signs and Symptoms

The main symptom of a hydrocele is swelling in the scrotum. Generally, hydroceles do not cause pain; however, adult men may feel discomfort.

Complications
Although hydroceles are benign (mild and not progressive), they can be a sign of a more serious testicular condition (e.g., tumor, infection). If a hydrocele becomes infected, it can lead to complications requiring surgical intervention.

A hydrocele also can be a symptom of an inguinal hernia, in which part of the intestine enters into the abdominal wall. Inguinal hernias can be life-threatening and must be treated surgically.

Diagnosis

The first step in diagnosing a hydrocele is a physical examination. The doctor may shine a flashlight at the swollen area. Because the fluid in a hydrocele is usually clear, the light will show the outline of the testicle.

Ultrasound is the best way to confirm the diagnosis of hydrocele and also rule out the possibility of a tumor or other condition. If the swollen area becomes larger or smaller as the doctor examines the area, the patient may have an inguinal hernia or a communicating hydrocele. If an infection (e.g., epididymitis) is suspected, blood or urine tests may be ordered.

Treatment

Most hydroceles resolve without medical treatment. However, if the condition causes discomfort or becomes very large, treatment may be necessary. There are two methods of treatment: aspiration and hydrocelectomy (surgery).

In aspiration, a needle is used to drain the fluid. Aspiration is not the most common treatment for hydroceles, but it may be performed when surgery is too risky. In some cases, medication is injected afterward the procedure to close the sac and help prevent hydroceles from recurring. However, this treatment increases the risk for infection and hydrocele sometimes recurs even with this procedure. Fibrosis (abnormal hardening of tissue) is another possible complication with aspiration.

Hydrocelectomy is a minor surgical procedure in which the fluid and sac are removed. It is performed on an outpatient basis, takes about an hour, and the patient usually goes home the same day. After the patient is given general or spinal anesthesia, a small cut is made in the scrotum or lower abdomen. The doctor drains the fluid, removes the sac, and then uses stitches to keep the muscle wall strong as it heals and help prevent hernia or another hydrocele.

After surgery, some patients experience pain or discomfort. Pain-reducing medications may be prescribed, usually for about one week. Applying an ice pack to the affected area can also be helpful. In some cases, a scrotal drainage tube, scrotal support, and/or heavy bandages are necessary for a period of time following surgery.

In children, sponge baths rather than tub baths are recommended during the healing process. Straddle toys (e.g., rocking horses, bicycles), playing sports, and participating in gym classes should be avoided for about three weeks.

Complications of a hydrocelectomy include blood clots, infection, and injury to the scrotal area. While hydroceles are not known to cause infertility, this can rarely result from surgery.

In most cases, surgery to correct a hydrocele in infant boys is not performed until the child is 12–18 months of age.

Prognosis

Many hydroceles resolve without treatment. Surgery (hydrocelectomy) usually has excellent results, but recurrence of another hydrocele is not rare.

Prevention

Because the condition develops before birth, hydroceles cannot be prevented in newborn infants. However, proper prenatal care can help prevent premature births and reduce the risk for hydroceles in baby boys.

Adult males can take steps to protect the genital area from injury—for example, wearing a protective athletic cup and following safety rules when playing sports. Following healthy habits and avoiding infection (e.g., STDs) are also recommended.

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