Hydrocele

A hydrocele affects many men worldwide. This condition, often considered taboo, can occur at any cross any age group, from newborns to older adults, and often raises concerns among those affected. Understanding hydrocele helps patients make informed decisions about their health and treatment options. This article explores the essential aspects of hydrocele, including its causes, symptoms, available treatments, and when to seek medical attention.

What is a Hydrocele?

A hydrocele is a medical condition where fluid accumulates in a thin sac that holds the testicle, specifically between the layers of the tunica vaginalis. This sac naturally secretes a small amount of lubricating fluid that helps the testicle move freely, but when the balance between fluid production and absorption is disrupted, a hydrocele forms.

Doctors can classify hydroceles into two main categories:

• Primary Hydrocele
  • Congenital: Present at birth with communication to the peritoneal cavity
  • Infantile: Occurs when fluid accumulates below the inguinal ring
  • Vaginal: Forms directly around the testicle
  • Encysted: Develops along the spermatic cord
• Secondary Hydrocele 
  • Generally, secondary hydrocele develops due to underlying conditions or can result from infection or injury. Sometimes, it may indicate the presence of other medical issues.

Causes and Risk Factors of Hydrocele

The development of a hydrocele occurs through several distinct mechanisms that affect fluid balance in the testicular region. Doctors have identified four primary ways this condition develops: 

• Through connection with the peritoneal cavity
• Excessive fluid production
• Defective fluid absorption
• Interference with lymphatic drainage

In newborns, the formation of a hydrocele relates closely to testicular development. During foetal growth, the testicles descend from the abdomen into the scrotum, accompanied by a fold of tissue called the processus vaginalis. Usually, this passage closes before birth, but it can lead to fluid accumulation when it remains open.

Adults may develop hydrocele due to different causes, primarily:

• Injury or trauma to the scrotal area
• Inflammatory conditions or infections
• Testicular torsion
• Complications from varicocele surgery
• Testicular tumours
• Epididymitis

Several risk factors increase the probability of developing a hydrocele:

• Premature birth
• Low birth weight
• Age under six months
• Late testicular descent
• Maternal exposure to certain chemicals
• Connective tissue disorders

Symptoms of Hydrocele

Patients experiencing a hydrocele typically notice a gradual enlargement of their scrotum. The primary characteristic is a distinctive swelling that usually appears on one side of the scrotum, though it can sometimes affect both sides.

The affected area feels smooth to the touch and is typically located in front of the testicle. A notable feature of this condition is that the size of the swelling may fluctuate throughout the day.

Patients may experience several hydrocele symptoms:

• A sensation of heaviness in the affected area
• Occasional discomfort, particularly with larger swellings
• Size changes during different times of the day
• Physical activities such as walking may become uncomfortable, and in some cases, intimate activities might be affected. 

Complications

While many hydroceles remain harmless, untreated cases can lead to serious medical complications that require immediate attention. The most significant complications of untreated hydrocele include:

• Infection and Related Conditions:
  • Development of pyocele (accumulation of pus)
  • Formation of haematocele due to bleeding
  • Risk of Fournier's gangrene, a serious tissue-destroying condition
• Physical Complications:
  • Increased pressure on the scrotum from fluid buildup
  • Potential rupture of the hydrocele sac
  • Risk of testicular torsion in cases of injury
  • Possible development of inguinal hernia
• Reproductive Health Impact:
  • Reduced sperm quality due to increased scrotal temperature
  • Potential testicular atrophy from restricted blood flow
  • Risk of fertility issues in severe cases

Diagnosis

The primary diagnostic methods include:

• Physical Examination: During the examination, patients may need to be positioned both standing and lying down, as the fluid can shift with different postures. Doctors may perform:
  • Manual palpation of the scrotum
  • Assessment of swelling characteristics
  • Transillumination test using light
• Imaging Studies:
  • Scrotal Ultrasound with Doppler: Ultrasound remains the most reliable and commonly used diagnostic tool, providing detailed images of the scrotal contents. 
  • CT Scan: It offers detailed cross-sectional images for complex cases
  • MRI: It provides comprehensive visualisation of the scrotal area, particularly useful when complications are suspected or the diagnosis remains unclear.
• Laboratory Tests:
  • Blood tests for infection markers
  • Urinalysis when needed

Treatments for Hydrocele

Doctors typically recommend observation for small, asymptomatic hydroceles, particularly in infants where the condition often resolves naturally.
For adults requiring treatment, several options are available:

• Hydrocelectomy: The primary surgical treatment involving the removal of the hydrocele sac
• Aspiration and Sclerotherapy: A less invasive option using needle drainage
• Window Operation: Creation of a small opening to drain fluid
• Lords Plication: A technique involving folding of the sac wall

Recovery from hydrocele treatment follows these stages:

• Initial rest period of 24-48 hours
• Wearing supportive underwear for 1-2 weeks
• Gradual return to normal activities after 4-7 days
• Complete recovery within 4-6 weeks

When to See a Doctor

Emergency Situations requiring immediate medical attention include:

• Sudden, severe pain in the scrotum
• Rapid swelling following injury
• Hardening of the previously soft swelling
• Development of fever with scrotal swelling
• Redness or warmth in the affected area

Even in non-emergency situations, patients should schedule a medical consultation when they notice any persistent scrotal swelling. This is particularly important as approximately 1 in 10 cases of testicular cancer present with an associated hydrocele, making professional evaluation essential for ruling out serious underlying conditions.

Conclusion

Patients should not ignore scrotal swelling or delay seeking medical attention. Regular monitoring and prompt treatment prevent complications and lead to better outcomes. Doctors work with patients to choose the most suitable treatment approach, considering factors like severity, symptoms, and overall health status. Medical guidance and appropriate care help patients return to normal activities with minimal disruption to their daily lives.

FAQs

1. How to remove water from a hydrocele?

The removal of fluid from a hydrocele requires medical intervention. While aspiration can temporarily drain the fluid using a needle, this method often leads to rapid fluid re-accumulation. Hydrocelectomy remains the most effective long-term solution, where surgeons remove the sac and prevent fluid buildup through careful surgical techniques.

2. What happens if hydrocele is not treated?

Untreated hydrocele can lead to several complications affecting reproductive health. The condition may cause increased scrotal temperature, potentially reducing sperm quality by up to 40% for each degree rise in temperature. Large hydroceles can also lead to:

• Testicular atrophy
• Blood flow obstruction
• Risk of infection
• Potential fertility issues

3. Can hydrocele be cured naturally?

While some small hydroceles may resolve naturally, particularly in infants, most adult cases require medical intervention. Natural approaches can help manage symptoms but typically don't provide a cure. Supportive measures include wearing proper scrotal support and maintaining good hygiene.

4. What food is good for hydrocele?

A balanced diet supports overall health during hydrocele treatment. Doctors recommend:

• Foods rich in antioxidants, like berries & leafy greens
• Omega-3-rich foods, including fish and walnuts
• Fresh fruits and vegetables
• Adequate hydration through water and natural juices

5. Is hydrocele painful?

Hydroceles cause minimal pain, presenting primarily as a painless swelling. However, larger hydroceles may create discomfort through:

• Sensation of heaviness
• Pressure during physical activities
• Interference with daily movements
• Occasional tenderness

6. Is hydrocele a major surgery?

Hydrocelectomy is considered a minor surgical procedure, typically performed as day hydrocele surgery. The operation usually takes about 30 minutes under local or general anaesthesia. Most patients return home the same day and can resume routine within a week, though complete recovery may take 4-6 weeks.

7. How to remove hydrocele without surgery?

Non-surgical approaches include aspiration and sclerotherapy, though these methods often provide temporary relief. Some patients find relief through:

• Epsom salt baths
• Proper scrotal support
• Cold compresses
• Activity modification
• Wearing supportive underwear

Dr. Ritesh Satardey

MBBS, MS (General Surgery), MCh (Urology)
Ganga CARE Hospital Limited, Nagpur

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