Hydrocele Causes & Treatments | Adult & Pediatric Urology

Hydrocele Causes & Treatments

What is a hydrocele?

A hydrocele is an accumulation of fluid within the sac that surrounds the testicle, resulting in ballooning and enlargement of the scrotum. It can vary in size from just slightly bigger than the actual testes to larger than a cantaloupe.

Hydrocele Causes & Treatments

A hydrocele is a disorder of the production and reabsorption. For example, when the outer layer of the tunica vaginalis is unable to reabsorb all of the fluid that is produced by the inner layer, the fluid will gradually accumulate. Hydroceles may also result from trauma, infections, tumors or operations such as a hernia and varicocele repairs. The fluid content of most hydroceles is straw-colored and odorless.

Hydrocele in Baby Boys

A hydrocele can start before your son is born. His testicles grow inside his belly and then move down into his scrotum through a short tunnel. A sac of fluid goes with each testicle. Normally, the tunnel and the sac seal off before birth, and the baby’s body absorbs the fluid inside. When this process doesn’t go as it should, he can get a hydrocele.

There are two types:

  • Noncommunicating hydrocele happens when the sac closes like normal, but the boy’s body doesn’t absorb the fluid inside it.
  • Communicating hydrocele happens when the sac doesn’t seal. With this type, his scrotum may swell more over time.
Babies born prematurely are more likely to have a hydrocele.

Symptoms

A hydrocele doesn’t hurt. The only symptom you’ll notice is that one or both of your son’s testicles look swollen. Even if he’s not in pain, you should see the pediatrician to make sure he doesn’t have other health problems that are causing the swelling, such as an infection, a tumor, or a hernia.

The swelling from a noncommunicating hydrocele doesn’t change in size. A communicating hydrocele can get bigger during the day, and if you gently squeeze it, the fluid will move out of the scrotum and into his belly.

Hydrocele in Adults

Although the condition is much more common in baby boys, it may also occur in adult men. Hydroceles occur in only about 1% of adult men, and will often disappear on their own within the first 6 months.

What causes adult hydrocele?

Before birth, the testicles develop near the kidneys. By the time of birth, the testicles normally drop from their position inside the abdomen into the scrotum through a tunnel of muscles called the inguinal canal. If the peritoneal sac in the canal is reopened, fluid may leak from the belly into the scrotum and cause a hydrocele. If there is some inflammation in the cell linings of the sac surrounding the testicles, a hydrocele can result. Other causes of hydrocele include:

  • Blockage in the spermatic cord.
  • Inguinal hernia surgery.
  • Infection of the scrotum or a testicle.

Hydrocele Treatments

Most small and moderate-sized hydroceles that are minimally symptomatic can be managed by periodic checkups. If a hydrocele progresses to the point where it causes discomfort, pain, tightness, deformity, or embarrassment, an option is to pass a needle into the hydrocele sac and drain the fluid, but this is most often just a temporary fix, as the root cause is unchanged and the fluid generally will re-accumulate.

Hydrocelectomy

The most definitive means of management is a relatively simple outpatient surgical procedure called a “hydrocele repair” or “hydrocelectomy.” The incision is typically made through the midline “seam” of the scrotum.

The involved testicle and surrounding hydrocele sac are delivered through the incision, the sac is opened, the fluid is drained, and generally the sac is excised and oversewn. Alternatively, the opened sac is turned back on itself and sewn to itself.

Either method results in exposing the testes to the scrotal wall (as opposed to the outer layer of the tunica), which functions to resorb the fluid produced by the inner layer of the tunica. This procedure is highly successful.

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