Overview

A hydrocele is a fluid-filled sac surrounding a testicle that causes swelling in the scrotum. It is a common condition, especially in newborn males, but can also develop in older males due to injury, infection, or other medical conditions. While hydroceles are usually painless and harmless, they can cause discomfort due to the size of the swelling. In most infants, hydroceles resolve on their own within the first year of life. In adults, treatment may be necessary if the hydrocele is large, symptomatic, or associated with an underlying cause.

Causes

The causes of hydrocele vary by age group and can include:

• Congenital hydrocele: In newborns, a hydrocele occurs when the processus vaginalis (a pouch of peritoneal tissue) fails to close properly after birth, allowing fluid to accumulate around the testicle.
• Acquired hydrocele: In adults, hydroceles may develop due to:
• Injury or trauma to the scrotum
• Infections, including sexually transmitted infections (STIs)
• Inflammation of the epididymis (epididymitis)
• Testicular tumors (rare)
• After surgery, particularly inguinal hernia repair
• Idiopathic, meaning no identifiable cause

Symptoms

The main symptom of a hydrocele is scrotal swelling, but other associated symptoms can include:

• Painless scrotal swelling: The most common presentation, usually soft and smooth to the touch.
• Feeling of heaviness or discomfort: Especially when the hydrocele is large.
• Fluctuating size: In some cases, the swelling may increase during the day and reduce at night.
• No redness or heat: Hydroceles typically do not cause signs of acute infection such as warmth or redness.
• In infants: Usually painless and detected by parents during diaper changes or baths.

Diagnosis

Hydroceles are usually diagnosed through a simple physical examination and may include the following steps:

• Physical exam: The doctor will examine the scrotum for swelling, tenderness, and firmness.
• Transillumination test: A flashlight is shined through the scrotum; a hydrocele will appear as a translucent area since fluid allows light to pass through.
• Scrotal ultrasound: Imaging may be used to confirm the diagnosis, rule out other causes of swelling such as hernias, tumors, or infections.
• Urine and blood tests: To check for infections if the hydrocele is associated with pain or redness.

Treatment

Treatment of hydrocele depends on the age of the patient and severity of symptoms:

• Observation: In infants, hydroceles often resolve spontaneously within 12 to 18 months and usually do not require treatment unless they persist.
• Surgical treatment (hydrocelectomy):
  • Recommended for adults or children over 1 year with persistent, large, or symptomatic hydroceles.
  • Performed under local or general anesthesia, involves draining and removing the fluid sac.
• Aspiration: Draining the fluid using a needle may provide temporary relief but is generally not preferred due to high recurrence rates and risk of infection.
• Sclerotherapy: In some cases, after aspiration, a sclerosing agent is injected to prevent fluid re-accumulation; typically reserved for patients not suitable for surgery.

Prognosis

The prognosis for hydrocele is generally excellent, particularly with appropriate management:

• Infant hydroceles: Most resolve without treatment within the first year of life.
• Adult hydroceles: Surgery is highly effective with low recurrence rates.
• Recovery: Most patients recover fully within a few weeks after surgery, with minimal risk of complications.
• Complications: Rare, but may include infection, recurrence, or injury to nearby structures during surgery.
• Long-term outlook: Hydroceles generally do not affect fertility or sexual function, and with treatment, quality of life is fully restored.

Timely consultation with a healthcare provider ensures proper diagnosis and appropriate treatment for optimal outcomes.