Hydrocele Testis

Introduction

A hydrocele is basically a sac of fluid surrounding a testicle. The hydrocele is NOT a life threatening condition. It is far more common in newborns than in adults (about 10% are born with it – more often in premature babies), but it can also happen in the later years, with a few cases occurring during the middle years. Most often it occurs in boys aged 2 – 5 years, but also in men over the age of 40, particularly after an injury to the scrotal area.

A hydrocele appears as a swelling in the scrotum. It forms because fluid builds up and envelopes one testicle or (rarely) both. The fluid (called serous fluid) is sterile – it is not itself an infection. It isn’t contagious, and it has no effects on other parts of the body. So while it may be unsightly, it doesn’t pose a health threat.

There are two basic types of hydrocele. 'Communicating hydroceles' have an open connection between the scrotum and abdomen. This type appears in young men and babies. 'Non-communicating hydroceles' are totally enclosed with no connection, and are the type more typically found in older men.

Symptoms and diagnosis

Hydroceles very rarely affect testicle function, and do not physically interfere with sexual activity. Symptoms are easy to identify; the scrotum appears enlarged. There may be a feeling of slight pressure at the base of the penis, a slight pain in the groin area, or redness on or around the scrotum. Often there is nothing but the slight visible swelling.

Although not dangerous, hydroceles can occasionally enlarge with time, or in certain rare cases restrict blood flow, requiring treatment. They can also indicate another problem with the testicles (they may appear because of another problem underneath). If you suspect you have one, it should be checked by a doctor to be safe.

Diagnosis is most often made by shining a pen light through the scrotum (called transillumination). This illuminates the serous fluid around the testicle, and the testicle shows up as a dark shadow in the middle. Ultrasound can also be used if transillumination is inconclusive, or if a tumor is suspected (very rare).

Causes and risk factors

It is not known what causes hydroceles to appear. In infants it happens before birth. Normally the testicles form in the abdomen, and then descend through a tube to the scrotum shortly before birth. Most often, this tube then closes off by itself.

If not closed before birth, the tube may allow some of the serous fluid in the abdomen to drain by gravity to the scrotum, forming a communicating hydrocele. In this case the tube will most often seal itself over the next 12 months, and the fluid is absorbed without surgery.

As an interesting side note, a communicating hydrocele will typically be smaller in the morning after a long period of laying down, then larger late in the day as the fluid flows back and forth.

Non-communicating hydroceles can form in men (more frequently over the age of 40) after an injury or infection to the scrotal area, when fluid gets caught in the spermatic cord. There is some indication that radiation therapy (as for treatment of prostate cancer) may cause hydroceles. However, at this time it is unknown what causes the majority of hydroceles in older men.

Treatments

Treatment of hydroceles is fairly straightforward. If there is no pain, they are typically left untreated because they often disappear on their own, especially in older men and young boys. So the best news is for men over 65, for whom hydroceles often disappear totally without treatment. For babies the usual process is to wait and watch for the first year or so of development. Treatment is usually only suggested for young boys and adult men. Some adult men find the condition bothersome or embarrassing, and so chose to have the hydrocele removed.

The removal process is straight forward. A doctor will usually aspirate the fluid using a hollow needle while the subject is under general anesthetic. Sometimes the fluid returns, requiring further aspiration. If the body doesn’t seal off the opening and the hydrocele reoccurs, another surgery can seal off the passage between the abdomen and scrotum.

Conclusion

Removal of a hydrocele is largely based on personal choice rather than because of a health threat. Leaving it alone appears to pose no threat to health, and it may simply clear up on its own. However, removal is also low risk, so if you don’t like it - or feel that it would significantly improve your sexuality - then consider having it drained.