A Hydrocele Could Point to Other Conditions
Chances are you've gone most of your life without ever having heard of a hydrocele. But if you're reading this, consider yourself enlightened.
About 10 percent of baby boys in the first year of life have a hydrocele, an accumulation of fluid around a testicle that also affects about 1 percent of adult men.
Hydroceles are typically harmless but can appear with another medical condition, causing complications. Some of the co-conditions frequently present with hydroceles require treatment, though nothing too invasive.
The sac of fluid that forms a hydrocele (pronounced HI-droe-seal) is associated with the natural process of the testicles descending. During a child's development, the testicles pass from the lower abdomen into the scrotum through the inguinal canal. As the baby develops, each testicle is encased inside a fluid sac within the scrotum.
Lots of guys develop a hydrocele and never know it, unless it grows large enough to become annoying.
"Typically, as fluid is made, it is reabsorbed, and you have none or a very small amount of fluid in this space," said David Barham, M.D., a fellow in reconstructive urology at the University of California at Irvine. "When a larger amount of fluid collects in this space, you get a hydrocele."
For babies born with a hydrocele, it usually takes a little longer for this fluid to be reabsorbed, and by the child's first birthday, it is gone. Sometimes the sac remains open, resulting in what's called a communicating hydrocele.
"What they'd be communicating with is the inner cavity of the belly," said Petar Bajic, M.D., whose urology practice is affiliated with the Cleveland Clinic. "With a communicating hydrocele, fluid can move back and forth from the belly cavity to the testicle. That type is pretty much only ever present in children."
As a child moves around and changes his body position, the size of the scrotum fluctuates as the fluid passes back and forth via the inguinal canal. If it doesn't resolve on its own, a communicating hydrocele will likely require surgery to prevent further complications.
A noncommunicating hydrocele is usually the type that affects men. With this kind of hydrocele, the inguinal canal has closed, but some fluid was either left in the sac around the testicle or accumulated there later in life. It may even crop up unexpectedly with no apparent cause.
However, hydroceles in older men can also appear due to specific, identifiable causes.
"That fluid can be formed from a wide variety of conditions," Bajic said. "Any infection or inflammation of the epididymis or testicle can draw fluid around the testicle, and it may get trapped there."
What causes a hydrocele?
As Bajic indicated, a number of conditions can lead to the formation of a hydrocele. Some of the more common include:
- Epididymitis: The epididymis, the tightly coiled tubule behind each testicle that carries sperm to the vas deferens, can get infected or otherwise irritated, causing inflammation that leads to the formation of a hydrocele.
- Infection: Sexually transmitted infections (STIs) or other types of infection can prompt the formation of a hydrocele.
- Trauma or injury: Trauma to the groin causes inflammation, drawing fluid to the area and potentially causing a hydrocele.
- Orchitis: Inflammation of the testicle, or orchitis, can cause a hydrocele to form.
- Testicular cancer: On rare occasions, testicular cancer causes a hydrocele.
The only truly dire complications associated with a hydrocele are an increased risk of developing an inguinal hernia (in the case of a communicating hydrocele) or complications from a concurrent infection.
"Hydroceles alone usually do not cause any severe problems," Barham said. "In fact, hydroceles are often found incidentally on scrotal ultrasounds performed for other reasons when the hydrocele is not causing any problem or is even recognized by the patient."
Lots of guys develop a hydrocele and never know it, unless it grows large enough to become annoying, according to Bajic.
"Most men have some degree of a hydrocele, just a little bit of fluid around their testicle," he said. "It's not harmful and usually not bothersome. However, sometimes it might cause pain or get very large to where it's in the way of regular activity or even sexual activity."
Most hydroceles resolve on their own, but in some circumstances, they require attention.
When an infant has a persistent communicating hydrocele, doctors usually recommend waiting at least a year to see if it resolves. Barham said they often resolve by the time a child turns 2. However, if a communicating hydrocele sticks around longer, it will probably require surgery.
"If it persists or treatment is needed, then communicating hydroceles are treated like inguinal hernias through a small incision in the groin, and the small connection from the abdomen to the scrotum is ligated [surgically closed]," he said.
Another type of complication occurs when the fluid sac in a noncommunicating hydrocele has grown too large. The common treatment is surgery to remove the fluid collection, according to Bajic, who added the procedure is relatively minor and performed through a small opening in the scrotum.
Another option is aspiration and sclerotherapy, in which the fluid is drawn out through a needle inserted into the scrotum. Afterward, a substance that causes shrinkage of the space in the formerly fluid-filled sac is injected in an effort to prevent a hydrocele from reforming.
While scrotal swelling may be alarming, a hydrocele is generally not a big concern in infants or adults. A doctor can take proactive steps if the condition is causing you discomfort or disrupting your day-to-day life.