Hydrocele: Symptoms, Diagnosis & Treatment

14 Oct 2019 Blog

What is a hydrocele?

A hydrocele is an accumulation of fluid within the sac that surrounds the testicle, resulting in ballooning and enlargement of the scrotum. It can vary in size from just slightly bigger than the actual testes to larger than a cantaloupe.

Each testicle is surrounded by a thin sac known as the tunica vaginalis. The tunica vaginalis has an inner layer and an outer layer. There is a small amount of fluid present between these two layers that serves as lubrication so the testes can rotate and move freely within the scrotum. The inner layer is responsible for manufacturing this fluid, and the outer layer is responsible for its reabsorption.

A hydrocele is a disorder of the production and reabsorption. For example, when the outer layer of the tunica vaginalis is unable to reabsorb all of the fluid that is produced by the inner layer, the fluid will gradually accumulate. Hydroceles may also result from trauma, infections, tumors or operations such as a hernia and varicocele repairs. The fluid content of most hydroceles is straw-colored and odorless.

How is a hydrocele diagnosed?

They are evaluated by physical examination and are often further characterized by an ultrasound of the scrotum, allowing for a detailed examination of the underlying testicle that often cannot be provided by physical examination because the size of the hydrocele.

How is a hydrocele treated?

Most small and moderate-sized hydroceles that are minimally symptomatic can be managed by periodic checkups. If a hydrocele progresses to the point where it causes discomfort, pain, tightness, deformity, or embarrassment, an option is to pass a needle into the hydrocele sac and drain the fluid, but this is most often just a temporary fix, as the root cause is unchanged and the fluid generally will re-accumulate.

The most definitive means of management is a relatively simple outpatient surgical procedure called a “hydrocele repair” or “hydrocelectomy.” The incision is typically made through the midline “seam” of the scrotum. The involved testicle and surrounding hydrocele sac are delivered through the incision, the sac is opened, the fluid is drained, and generally the sac is excised and oversewn. Alternatively, the opened sac is turned back on itself and sewn to itself.  Either method results in exposing the testes to the scrotal wall (as opposed to the outer layer of the tunica), which functions to resorb the fluid produced by the inner layer of the tunica. This procedure is highly successful.

Written by Dr. Andrew Siegel

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