Hydrocele Explained: Causes, Symptoms and Treatment Options

Hydrocele is a common condition that affects many newborns and adult males. It occurs when fluid gets collected in the scrotum, the sac that holds the testicles. In adults, hydrocele can arise due to injury or other forms of scrotal inflammation but is typically harmless and usually not painful, which resolves on its own. However, if the hydrocele persists or becomes large and uncomfortable, surgical intervention may be recommended. Understanding the cause, types, symptoms and treatment options can help you educate yourself about the condition and seek appropriate care.

Understanding hydrocele: A simple guide  

A hydrocele is a collection of fluid around the testicle, causing the scrotum to swell. This fluid buildup can occur in one or both testicles and is more common in newborns and older men. In newborns, congenital hydrocele can arise due to the failure of the processus vaginalis to close properly. Normally, the proximal portion of the processus vaginalis is eliminated, while the distal portion is retained as the tunica vaginalis, which covers the anterior, lateral and medial aspects of the testes. If the proximal portion of the processus vaginalis stays open, it allows fluid to accumulate in the tunica vaginalis, creating space for fluid buildup. This imbalance between the secretion and reabsorption of fluid can lead to hydroceles.  

Hydrocele causes

The causes of hydrocele include:  

• Congenital hydrocele: This type of hydrocele occurs in newborns due to closure failure of processus vaginalis, a thin membrane that allows the testicles to descend from the abdomen into the scrotum. It leads to flowing of the abdominal fluid into the scrotum.  
• Acquired hydrocele: In older males, hydroceles can develop due to injury, inflammation or infection within the scrotum. Sometimes, they occur without any obvious cause.  
• Injury and trauma: Physical activities, accidents and surgeries can cause fluid buildup in the scrotum as the body tries to protect the testicle, leading to hydrocele.
• Inflammatory conditions: Chronic inflammation such as vasculitis or autoimmune disorders can irritate tissues and cause fluid accumulation, resulting in hydrocele.
• Lymphatic blockage: Blockages in the lymphatic system caused by infections, trauma or surgical complications can lead to fluid pooling around the testicles, causing hydrocele.  

Hydrocele types

Types of hydroceles include:

Communicating hydrocele  

Communicating hydrocele occurs when the sac around the testicle does not close, allowing fluid to flow back into the abdomen. This type of hydroxyl may appear smaller in the morning and larger in the evening due to the child being afraid during the day. It may also look smaller when the doctor puts pressure on the scrotum, as the pressure can cause the fluid to flow back into the abdomen.

Non-communicating hydrocele  

In non-communicating hydrocele, there is no connection between the abdominal cavity and the sac that surrounds the testicle in the scrotum. This type is often found in the newborn and usually resolves on its own over time, typically within the year. If the swelling is decreasing, it can be safely monitored. In older children or adolescents, this type of hydrocele is called adult-type hydrocele, which may be caused by other issues such as infections, twisting of testicles or tumours. Therefore, any swelling in the scrotum in older children or adolescents should be examined by a physician.

Hydrocele symptoms  

The hydrocele symptom is primarily characterised by swelling. Other symptoms include:

• Swelling: The major symptom is a painless enlargement of one or both sides of the scrotum that looks like water ballon and changes in size  
• Discomfort: While typically painless, a large hydrocele can produce pain or discomfort due to increased weight and size of the swollen scrotum.  
• Heaviness: A sensation of heaviness is experienced in the scrotum region.
• Transparency: In some cases, the scrotum may appear slightly transparent.
• Size fluctuations: In some cases, the size of the fluid-filled sac may increase during the day and decrease at night.

Diagnosis  

• Hydrocele can often be diagnosed through physical examination, where the clinician checks for pain and examines the stomach area and scrotum to rule out other indications such as inguinal hernia.  
• To diagnose a hydrocele, a clinician may shine a light through the scrotum, a process known as transillumination. If a hydrocele is present, the light will show clear fluid surrounding the testicle.  
• Following this, an ultrasound scan of the testicles is usually arranged to ensure there is no underlying cause for the hydrocele, such as a hernia or tumour.  

Additional tests that may be needed include:  

• Blood and urine tests: These help determine if there is an infection.  
• Ultrasound imaging: This checks for other causes of swelling in the scrotum, such as a hernia or tumour.  
• These diagnostic steps help confirm the presence of a hydrocele and rule out other potential conditions.  

Treatment  

Hydrocele treatment options may include:

• Observation: For newborns and young children, a hydrocele often resolves on its own within the first year of life. Regular check-ups with a paediatrician can help monitor the condition.
• Aspiration: When the hydrocele causes discomfort, the fluid can be drained with a needle. However, this is usually a temporary solution as the fluid often reaccumulates.
• Surgical intervention: If the hydrocele does not go away on its own or if it causes discomfort, a surgical procedure may be recommended. Below are some of the surgical procedures:
• Hydrocelectomy: This surgical procedure involves the repair or removal of the hydrocele that surrounds the testes, which leads to swelling in the scrotum. The surgical process involves the following steps:
• Anaesthesia: You will be placed under general anaesthesia to avoid any discomfort, which will also make you asleep throughout the procedure.
• Incision: The urologist will make a small cut in your scrotum or groin.
• Closure: If there is a communicating hydrocele, they will close the opening between the processus vaginalis and scrotum.
• Removal: The hydrocele sac is removed. Sometimes, the tissue is turned inside out to prevent recurrence.
• Hernia repair: Any hernia is repaired, if necessary.
• Insertion of surgical drain: A small silicone tube is sewn into the area to allow for the draining of blood or fluid.
• Stitches: The wound is closed by suturing
• This surgery will take less than an hour. Post-operatively, you’ll be kept in a recovery room before you can go home.
• Laparoscopic surgery: When the cause of the hydrocele is due to underlying issues, laparoscopic surgery is performed to treat both the hydrocele and the root cause. This is a minimally invasive technique that helps in early recovery post-procedure.

Conclusion

Hydrocele is a common condition that can affect newborns and older men. It can be concerning, but it is usually not a serious health issue and often resolves on its own. If you have any concerns about hydroceles causing discomfort, consult your healthcare provider for guidance and appropriate care. Early intervention and proper management can ensure a smooth recovery and prevent long-term issues.