Hydrocele

A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the scrotum, the loose bag of skin underneath the penis. 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.

Symptoms

Hydroceles are generally not painful or harmful and generally do not require treatment. However, if you have scrotal swelling or discomfort, see your doctor to rule out other causes such as testicular cancer or other conditions.

Causes

For baby boys, a hydrocele can develop in the womb. At about 28 weeks 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).

Treatment

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

Hydrocelectomy

Hydrocelectomy is a minor outpatient surgical procedure in which the fluid and sac are removed. The procedure 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.

Needle Aspiration

In needle aspiration, a needle is used to drain the fluid. Aspiration is not the most common treatment for hydroceles but it may be performed for patients that are considered “high risk” for surgery. In some cases, medication is injected after the procedure to close the sac and help prevent hydroceles from recurring. However, this treatment increases the risk for infection and hydroceles sometimes recur even with this procedure.

From: Mayo Clinic