Hydrocele testis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 29, 2016
StartDiseasesHydrocele testis

Hydrocele testis is a build-up of fluid around the testicles. This condition occurs in 1 to 2 percent of newborn baby boys and an even lower percentage of young boys and men. It is unavoidable and typically symptom-free. It is not dangerous and highly treatable. 

Contents

Definition & Facts

A hydrocele is defined as a fluid-filled sac that surrounds one or both of the testicles and causes swelling in the scrotum and groin area. It is most common in newborns, but young boys and men can develop the condition if injury or inflammation within the scrotum occurs. For newborns, the condition can clear up within the first year of life without any treatment. For older boys and men, the fluid in the sac should be reabsorbed into the body within six months. 

Symptoms & Complaints

Symptoms aren't common with a hydrocele. Although an enlarged scrotum is the number one symptom, it isn't always noticeable or cause for concern. Although, swelling makes it appear as though it would be painful, a hydrocele usually only causes slight discomfort and heaviness in the scrotum.

More noticeable symptoms include redness of the scrotum, pain, tenderness, and pressure at the base of the penis. A hydrocele can also cause more serious symptoms and problems to occur. Serious symptoms include:

These symptoms can also be signs of more serious conditions, such as blocked blood flow due to a testicular torsion (twisted testicle). 

Causes

When a developing baby's testicles descend down from the abdominal cavity into the scrotum, they come enclosed in the tunica vaginalis. Fluid surrounds the testicle in the tunica vaginalis, and a non-communicating hydrocele occurs when that fluid continues to remain in the sac. The fluid is usually reabsorbed within the first 12 months of life.

Hydrocele can also be caused by an opening between the scrotum and the abdomen that did not close before birth or shortly after birth. Sometimes the tunica vaginalis stays open, causing a communicating hydrocele. In a communicating hydrocele, the sac can become enlarged and allow fluid to flow back into the abdomen which can compress the scrotum.

This type of hydrocele may cause or be the result of an inguinal hernia. Inguinal hernias occur when a loop of the intestine becomes trapped inside the abdominal wall. Besides causing a hydrocele, a hernia can cause life-threatening complications like intestinal obstructions.

Hydroceles can also be caused by surgery, scrotal injury, or groin injury. They can also be caused by infection or inflammation of the testicles or epididymis (epididymitis). Rarely, a hydrocele can be caused by a tumor or cancer of the left kidney or testicle.

Diagnosis & Tests

Hydroceles are diagnosed in two to three steps. The first step involves checking for fluid during a testicular examination. In this examination, the physician uses transillumination (shines a light behind the testicles) to check for solid masses. A solid mass is an indicator of another condition, such as cancer or a hernia. This light will not shine through anything solid. By contrast, the light will shine through a fluid-filled hydrocele and illuminate the fluid surrounding the testicle.

If no solid masses are present, an ultrasound is performed to confirm the hydrocele testis diagnosis. The ultrasound is the second step in diagnosis. Doing this type of test will also rule out the presence of an inguinal hernia. Besides the ultrasound, clinical urine tests and blood tests will also rule out infections, like those that cause epididymitis.

Some additional exams may be performed to confirm the diagnosis as well. For example, pressure will be applied to scrotum and abdomen to check for inguinal hernias. Additionally, during the physical examination the physician will also check for tenderness in the swollen scrotum. 

Treatment & Therapy

Hydrocele testis is only treated when it decreases blood flow to the penis or causes excessive pain and discomfort. Typically the body will reabsorb the fluid (within six months), causing the hydrocele to grow smaller and disappear on its own. However, this will not happen in men over the age of 65. For men over 65, the fluid must be removed by fine-needle aspiration.

Surgery (hydrocelectomy) may be necessary if an aspirated hydrocele returns. Normally, aspiration is only recommended if the patient has a risk of recurrence or infection from the surgical procedure. Surgery may also be recommended if the condition does not clear up within a year or if the fluid-filled sac continues to grow.

Hydroceles that cause disfigurement or extreme discomfort may qualify for surgery as well. A hydrocelectomy is outpatient surgery performed with local anesthesia or general anesthesia. The sac is removed through an incision in the lower abdomen or scrotum. However, hydroceles found during other surgical procedures may not be removed if they are not causing discomfort or disfigurement.

During surgery, a tube is inserted into the scrotum for draining excess fluid after surgery. Patients are given a scrotal strap for support and ice packs to reduce pain and swelling. A follow-up doctor's visit will be needed to ensure recurrence does not happen. 

Prevention & Prophylaxis 

There is no way to prevent hydrocele testis in newborns because it develops before birth. Hydrocele is most prevalent in premature babies, but proper prenatal care help prevent premature births. Older boys can protect themselves by avoiding certain extreme sports or strenuous activity that place strain on the groin.

Adults can prevent the condition from occurring by taking proper precautions during sports activities as well. Wearing a protective cup, stretching and avoiding overtraining can help prevent groin or scrotal injury. Men can further protect themselves by seeking treatment for any suspected infections or sexually transmitted infections (STIs).