Hydrocele

A hydrocele is a fluid-filled pouch that forms around the testicle in the scrotum. It occurs in about ten per cent of all males. The incidence of congenital hydrocele is more as compared to the acquired type. They are usually unilateral (i.e., affect one testicle) but, in some cases, may be bilateral (affect both testicles).

The pair of testicles (also called testes; singular: testis) develops in the abdomen of the baby during the period of pregnancy. Each testis floats in a sac with minimal fluid. The sac is a protective covering and the fluid prevents friction of the testis against the sac. As the pregnancy progresses, under the influence of hormones the testes slowly descend from the abdomen into the scrotum via a narrow tunnel (namely inguinal tract), with each testis having its own tunnel. By the time the baby is born, the testes would have finally reached the scrotum and the tunnel and sac are sealed off. Whatever amount of fluid was present around the testes, would be absorbed by the surrounding veins. If the fluid still remains or if the tunnel does not close properly, then a hydrocele is formed. If present since birth, then it is known as congenital hydrocele.

Acquired hydrocele develops later in life due to some pathology of the testes or scrotum.

Hydroceles can be of two types. They are:

• Communicating hydrocele: the sac does not close and, hence, there is communication between the abdomen and the scrotum. This results in the fluid flowing in and out from the abdomen to the scrotum.
• Non-communicating hydrocele: the sac is closed. However, the remaining fluid is not absorbed by the veins surrounding the testis and the fluid may accumulate and increase in volume.

A hydrocele does not typically cause any adverse symptoms. It is most alarming to the patient due to its unnatural size in the scrotal area. However, the typical symptoms are:

• Abnormal distension (enlargement) of the scrotum due to the swelling
• Often painless
• The swelling is fluid-filled
• On lying down, the swelling may reduce in size
• On coughing, the swelling may increase in size

The concerning symptoms of a hydrocele include:

• The swelling becomes painful
• A rapid increase in the size of the swelling
• Fever
• Any skin changes over swelling, such as skin ulceration
• Any discharge from the swelling, such as pus or blood

It is to be noted that hydroceles not caused by testicular pathologies usually do not cause any infertility issues.

The various factors for hydrocele are:

• Premature birth: in premature babies (preemies), the tunnel does not close properly or there may be a delayed closure. This results in an increased risk of congenital hydrocele. There is also an increased risk of bilateral hydrocele.
• Pathologies related to the testes and the surrounding structures: these can involve tumours, infections or injuries.
• Weakened abdominal wall: due to weak abdominal muscles or defects in the abdominal wall, the inguinal tract may reopen. This can also lead to herniation of the abdominal contents into the scrotum.

There is no way of preventing a baby from developing a hydrocele since it is present from birth.

In adults, the best way to prevent a hydrocele from developing is by protecting the testes and scrotum from injury; for example, wearing an athletic cup/jock strap in contact sports.

A hydrocele is usually diagnosed via local examination of the swelling. The doctor checks the swelling for:

• Its size
• The consistency of the fluid present in the swelling
• Whether it is unilateral or bilateral
• If the swelling has a communication with the abdomen or not

An ultrasound of the hydrocele may help identify the nature of the fluid present in the swelling and also help rule out whether the hydrocele is due to any testicular pathologies.

Hydroceles usually do not require treatment unless causing distressing symptoms.

In babies, the hydrocele usually disappears on its own within a year after birth, as the fluid around the testis is absorbed via the surrounding veins.

For hydroceles that are caused due to testicular pathologies, the pathology is to be addressed and treated.

The medical management (non-surgical) of hydroceles involves injecting a sclerosing agent (special chemical) which dries up the fluid in the sac. This procedure is used in smaller, uncomplicated hydroceles where the patient is not willing to opt for surgery. However, there is a chance of recurrence in this method.

Another method involves drainage of the fluid present in the sac via needle aspiration (sucking the fluid through a wide-bore needle). This procedure is associated with an increased risk of infection.

Surgical management is the preferred mode of treatment. The procedure is called hydrocelectomy. It is a day-care procedure and is quite risk-free with a good outcome. The technique of the procedure varies according to whether the patient is a baby or an adult. Aftercare is important to prevent complications.

In hydroceles caused due to testicular tumours, the affected testis is removed.

If the hydrocele is associated with a hernia, a hernia repair is also done along with surgically strengthening the muscles of the abdominal wall.

Post-surgery aftercare is important to prevent any complications, mainly infection.

(Read more: Homeopathic treatment for Hernia)

Hydroceles do not generally cause any adverse health problems.

In babies, they usually disappear within a year after birth.

In adults as well, hydroceles need not be treated unless they are symptomatic or visually distressing and embarrassing. That being said, the patient is advised to get any scrotal swelling checked by the doctor to rule out any other conditions. Hydroceles not caused by testicular pathologies do not interfere with fertility.

Recurrence of a hydrocele after treatment is uncommon.

In conclusion, hydroceles are a common condition in males, especially babies. They are usually asymptomatic and disappear over time. However, in case of any swelling in the scrotal area, the patient is advised to visit the doctor to rule out other pathologies. If any issues arise, a hydrocele is required to be treated. Hydrocelectomy is the preferred mode of treatment since it has minimal risk and a good outcome. Post the procedure, aftercare is important to avoid complications. Recurrence post-treatment is rare.