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 the newborn infant. They may be unilateral or bilateral and result when there is failure of the tract through which the testis descends from the abdomen into the scrotum to close. Peritoneal fluid drains through the open tract from the abdomen into the scrotum where it becomes trapped causing enlargement of the scrotum. Hydroceles may also be caused by inflammation or trauma of the testicle or epididymis or by fluid or blood obstruction within the spermatic cord. The incidence of this type of hydrocele is higher in older men. Hydroceles normally resolve after a few months (after birth), but their appearance may worry new parents. Occasionally, a hydrocele may be associated with an inguinal hernia . Hydroceles can be easily demonstrated by shining a flashlight through the enlarged portion of the scrotum. If the scrotum is full of clear fluid, as in a hydrocele, the scrotum will light up ( transillumination ).

Signs and tests

Physical examination shows a non-tender, varying and unstable mass within the scrotal sac containing the testicle. The size of the fluid collection may or may not be able to be increased and decreased by pressure to the abdomen or the scrotum. If the size of the fluid collection is variable, it is more likely to be associated with an inguinal hernia. The fluid in a hydrocele is usually clear. Subsequently a light can be shined through the scrotum outlining the testis and indicating the presence of clear fluid. An ultrasound may 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 they get so large that they present a threat to the testicular blood supply. Treatment options include needle aspiration of the fluid or surgery. Recurrence of the hydrocele is common if aspiration is performed. Hydroceles associated with an inguinal hernia should be repaired surgically as quickly as possible. Hydroceles that do not resolve spontaneously over a period of months should be evaluated for possible surgery. MEDICATIONS: Injection of sclerosing (thickening or hardening) medications (such a tetracycline, sodium tetradecyl sulfate, or urea) may be performed after needle aspiration to obliterate (close off) the opening through the scrotal sac and thus prevent re-accumulation of fluid. Possible complications after aspiration and sclerosing include infection, fibrosis, mild to moderate pain in the scrotal area, and recurrence of the hydrocele. SURGERY: Hydrocelectomy is the surgical procedure often performed to correct a hydrocele. This is a minor surgical procedure that is performed on an outpatient basis using general or spinal anesthesia. An incision may be made in the scrotum or the lower abdomen. The procedure may require a scrotal drainage tube or a large bulky dressing to the scrotal area. You will be advised to wear a scrotal support for some time after surgery. Ice packs should be kept to the area for the first 24 hours after surgery to reduce the swelling in the area. Possible complications of this procedure include hematoma ( blood clot formation), infection, or injury to the scrotal tissue or structures. ASPIRATION: Aspiration (removal of fluid with a needle) of the fluid in the scrotum is another possibility. Surgery is generally preferred over this option. Aspiration can cause infection, and the fluid frequently re-accumulates. Aspiration, however, may be the best alternative for people who are poor surgical risks.

Expectations (prognosis)

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

Complications

The presence of an inguinal hernia requires surgery. Possible complications of surgery to correct a hydrocele include but are not limited to: hematoma ( blood clot formation), infection, or injury to the scrotal tissue or structures. Possible complications after aspiration and sclerosing include, but are not limited to: infection, fibrosis, mild to moderate pain in the scrotal area, and recurrence of the hydrocele. 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.

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 ).

Prevention

There is no known prevention.