Definition

A hydrocele is a swelling in the scrotum caused by fluid accumulation in the thin sac surrounding the testicles (testis). Hydroceles typically occur in newborns and can resolve on their own by the time the child is 6 months to 1 year old. However, hydroceles can also occur in adult males.

A hydrocele can develop in one or both testicles. This condition is not dangerous and does not affect fertility. However, if you experience persistent pain in the testicles, it is advisable to see a doctor.

There are generally two types of hydroceles:

• Communicating Hydrocele. This type occurs when the sac around the testicles does not close properly, allowing fluid from the abdominal cavity to easily flow in and out of the scrotum.
• Non-communicating Hydrocele. This type occurs when the sac around the testicles is closed but the body cannot absorb the fluid inside it.

Hydroceles are relatively rare. For example, in the United States, only about 1% of the adult male population experiences this condition. Even if a child has a hydrocele at birth, most cases are undetected, and the hydrocele resolves on its own.

Causes

In general, a hydrocele occurs due to an imbalance between fluid production and absorption in the scrotum. A hydrocele can occur in males of any age, from newborns to adult men.

Newborn Boys

A hydrocele can occur even before birth. Normally, when a fetus is in the womb, its testicles descend from the abdomen into the scrotum through a channel towards the end of pregnancy. The baby's body will absorb the fluid in the sac during the first year. In cases of hydrocele, this channel does not close, leading to fluid accumulation in the scrotum and causing swelling.

Adult Men

A hydrocele can occur in men over the age of 40. It usually results from inflammation or injury to the testicles. Inflammation can occur due to an infection in the epididymis (epididymitis) or elephantiasis infection (filariasis) in tropical countries. Some types of hernias can also cause hydroceles, although this is rare.

Risk Factor

Factors that can increase the risk of hydrocele in children or adults include:

• Premature birth and low birth weight
• Infants under 6 months of age
• History of sexually transmitted infections
• Living in a hot climate
• History of injury

Symptoms

Most hydrocele cases do not cause symptoms. The most common complaint is scrotal swelling. When palpated, the scrotum may feel like a water-filled balloon.

In some cases, the swelling may be accompanied by redness or bluish discoloration of the scrotum. This can cause discomfort in the testicles, and pain might happen when the testicular swelling reaches a significant size.

Diagnosis

Medical Interview

During the interview, if parents report swollen testicles in their baby or child, the doctor will ask about:

• The main complaint and accompanying symptoms
• Child's birth history
• Child's birth weight history
• Current and past medical history
• Family history of hydrocele

For adult patients, in addition to the above questions, the doctor may also inquire about:

• Sexual behavior and history of sexually transmitted infections
• Travel history
• History of injury
• History of certain medication use

Physical Examination

During the physical examination, the doctor will first check the patient's vital signs, such as temperature, blood pressure, respiratory rate, pulse, and pain level if present. The doctor will also examine the scrotum to determine:

• Whether the lump is painful
• Any changes in the scrotum's texture
• The size of the swelling
• The color of the scrotum

This examination is also useful for detecting possible hernia symptoms. If the appropriate equipment is available, a transillumination test can be performed by shining a light on the scrotum to determine whether the swelling is due to fluid or a solid mass. If fluid is present, the transillumination test will show a bright, slightly transparent light.

Additional Tests

Doctors may conduct additional tests to support the diagnosis, such as radiological or laboratory tests. An ultrasound (USG) is often recommended. Urine and blood tests may also be performed if an infection is suspected.

Management

Hydroceles usually resolve on their own before the child turns one year old. If the hydrocele persists, the doctor will refer the patient to a pediatric surgeon or urologist for further treatment.

The doctor may prescribe pain relievers such as paracetamol or ibuprofen to reduce discomfort. Surgical procedures may be considered if the hydrocele enlarges and does not improve with pain relievers. There are two surgical options:

• Hydrocelectomy Procedure

In this procedure, the doctor will remove or repair the hydrocele. A pediatric or urologic surgeon will make an incision in the scrotum to access the lump. This common procedure can be performed with local or general anesthesia and is an option for children.

• Laparoscopic Procedure

This procedure involves removing the hydrocele using advanced technology, resulting in smaller scars, less pain, and quicker recovery. However, not all hospitals have this technology.

This minor surgical procedure usually allows patients to go home the same day without hospitalization. Additionally, fluid drainage using a syringe is an option, but it is rarely performed and not recommended due to the risk of hydrocele recurrence.

Complications

Most hydrocele cases are not dangerous and do not affect male fertility. However, untreated hydroceles can cause serious problems if complications occur. Medical conditions that may arise as hydrocele complications include:

• Infection
• Tumor
• Testicular torsion
• Trauma
• Testicular deformation due to calcification or hardening of hydrocele fluid
• Fertility problems
• Chronic long-term pain
• Blood clots
• Inguinal hernia (protrusion of internal organs in the groin area)

Prevention

There is no specific way to prevent hydroceles, especially in babies. For adults, the best thing to do is to protect the testicles and scrotum from injury. Maintain safe sexual behavior to avoid sexually transmitted infections, which can be a risk factor for hydrocele.

When to See a Doctor?

Consult a doctor immediately if you or your child experiences sudden testicular and scrotal pain accompanied by swelling and skin color changes. This may indicate testicular torsion, a medical emergency requiring special treatment. Children with testicular torsion may also experience nausea, vomiting, and loss of appetite. Immediate medical attention is also necessary if there are accompanying symptoms like fever or severe bleeding.

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