Hydrocele

Answer 1

Definition

A hydrocele is a fluid-filled sack along the spermatic cord within the scrotum.

Alternative Names

Processus vaginalis; Patent processus vaginalis

Causes, incidence, and risk factors

Hydroceles are common in newborn infants.

During normal development, the testicles descend down a tube from the abdomen into the scrotum. Hydroceles result when this tube fails to close. Fluid drains from the abdomen through the open tube. The fluid builds up in the scrotum, where it becomes trapped. This causes the scrotum to become swollen.

Hydroceles normally go away a few months after birth, but their appearance may worry new parents. Occasionally, a hydrocele may be associated with an inguinal hernia.

Hydroceles may also be caused by inflammation or injury of the testicle or epididymis, or by fluid or blood blockage within the spermatic cord. This type of hydrocele is more common in older men.

Symptoms

The main symptom is a painless, swollen testicle , which feels like a water balloon. A hydrocele may occur on one or both sides.

Signs and tests

During a physical exam, the doctor usually finds an swollen scrotum that is not tender. Often, the testicle cannot be felt because of the surrounding fluid. The size of the fluid-filled sack can sometimes be increased and decreased by pressure to the abdomen or the scrotum.

If the size of the fluid collection varies, it is more likely to be associated with an inguinal hernia.

Hydroceles can be easily demonstrated by shining a flashlight (transillumination) through the enlarged portion of the scrotum. If the scrotum is full of clear fluid, as in a hydrocele, the scrotum will light up.

An ultrasoundmay be done to confirm the diagnosis.

Treatment

Hydroceles are usually not dangerous, and they are usually only treated when they cause discomfort or embarrassment, or if they are large enough to threaten the testicle's blood supply.

One option is to remove the fluid in the scrotum with a needle, a process called aspiration. However, surgery is generally preferred. Aspiration may be the best alternative for people who have certain surgical risks.

Sclerosing (thickening or hardening) medications may be injected after aspiration to close off the opening. This helps prevent the future build up of fluid.

Hydroceles associated with an inguinal hernia should be repaired surgically as quickly as possible. Hydroceles that do not go away on their own over a period of months should be evaluated for possible surgery. A surgical procedure, called a hydrocelectomy, is often performed to correct a hydrocele.

Expectations (prognosis)

Generally, a simple hydrocele goes away without surgery. If surgery is necessary, it is a simple procedure for a skilled surgeon, and usually has an excellent outcome.

Complications

Complications may occur from hydrocele treatment.

Risks related to hydrocele surgery may include:

• Blood clots
• Infection
• Injury to the scrotal tissue or structures

Risks related to aspiration and sclerosing may include:

• Infection
• Fibrosis
• Mild-to-moderate pain in the scrotal area
• Return of the hydrocele

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of hydrocele (to rule out other causes of a testicle lump).

Acute pain in the scrotum or testicles is a surgical emergency. If enlargement of the scrotum is associated with acute pain, seek medical attention immediately.

References

Sandlow JI, Winfield HN, Goldstein M. Surgery of the scrotum and seminal vesicles. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 34.

Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.

Answer 2

Definition

A hydrocele is a fluid-filled sack in the scrotum.

Alternative Names

Processus vaginalis; Patent processus vaginalis

Causes, incidence, and risk factors

Hydroceles are common in newborn infants.

During normal development, the testicles descend down a tube from the abdomen into the scrotum. Hydroceles occur when this tube does not close. Fluid drains from the abdomen through the open tube. The fluid builds up in the scrotum, where it becomes trapped. This causes the scrotum to swell.

Hydroceles normally go away a few months after birth, but they may worry new parents. Sometimes, a hydrocele may occur with an inguinal hernia.

Hydroceles may also be caused by:

• Fluid or a blood blockage in the spermatic cord (this type of hydrocele is more common in older men)
• Inflammation or injury of the testicle or epididymis

Symptoms

The main symptom is a painless, swollen testicle, which feels like a water balloon. A hydrocele may occur on one or both sides.

Signs and tests

During a physical exam, the health care provider usually finds a swollen scrotum that is not tender. Often, the testicle cannot be felt because of the fluid around it. The size of the fluid-filled sack can sometimes be increased and decreased by putting pressure on the abdomen or the scrotum.

If the size of the fluid collection changes, it is more likely to be due to an inguinal hernia.

Hydroceles can be easily seen by shining a flashlight (transillumination) through the swollen part of the scrotum. If the scrotum is full of clear fluid, the scrotum will light up.

An ultrasoundmay be done to confirm the diagnosis.

Hydroceles may make it more difficult to do testicular self-exams, which help detect testicular cancer early.

Treatment

Hydroceles are usually not dangerous. They are usually only treated when they cause discomfort or embarrassment.

Hydroceles from an inguinal hernia should be fixed with surgery as quickly as possible. Hydroceles that do not go away on their own after a few months may need surgery. A surgical procedure called a hydrocelectomy is often performed to correct a hydrocele.

Expectations (prognosis)

Simple hydroceles usually go away without surgery. If surgery is needed, it is an easy procedure that usually has an excellent outcome.

Complications

Complications may occur from hydrocele treatment.

Risks from hydrocele surgery may include:

• Blood clots
• Infection
• Injury to the scrotum

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of hydrocele (to rule out other causes of a testicle lump).

Pain in the scrotum or testicles is an emergency. If you have pain and your scrotum is enlarged, seek medical attention right away to prevent the loss of the testicle.

References

Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 539.

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010. 37(3):613-626.

Sandlow JI, Winfield HN, Goldstein M. Surgery of the scrotum and seminal vesicles. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 34.

Schneck FX, Bellinger MF. Abnormalities of the testes and scrotum and their surgical management. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 127.

Reviewed By

Review Date: 09/16/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.