Hydroceles: A Low-Impact Indicator of Potential Problems

Scrotal swelling caused by an accumulation of liquid in the protective tissue sac near the testicles is called a hydrocele. Usually painless and variant in size, hydroceles are common in newborn males but can occur in adulthood as well.

Hydroceles can be communicating or noncommunicating. Communicating hydroceles have an opening that links the fluid-filled sac to the abdomen, so abdominal fluid may also enter the hydrocele. Noncommunicating hydroceles do not have an opening to the abdomen and so will remain a generally constant size.

In most infant cases, the excess fluid dissipates within a year of birth and swelling is reduced.

Causes for hydroceles

In adult males, causes for hydroceles include infection, inflammation, injury and inguinal hernia. Symptoms are rarely overt, though some discomfort—usually a dull ache or heaviness—is often associated with an enlarged scrotum. While hydroceles in infants tend to disappear over time, surgery may be required to correct the problem if swelling does not resolve on its own, or if a hydrocele forms beyond a child’s first year.

In some tropical and subtropical regions, hydroceles are caused by a parasitic infection in adults that does not manifest until much later in life. These infections cause a reduction in the absorption of lymphatic fluids, which in turn produces hydroceles.

Treatment of hydroceles

A hydrocele may indicate an underlying genital condition, such as a tumor, that requires treatment, perhaps surgery. In some cases, an abnormally large hydrocele may cause disfigurement and pain and necessitate removal to prevent other complications, such as infection or inflammation. A hydrocelectomy is performed by using either local or general anesthesia and making an incision in the scrotum or lower abdomen. In some cases, a hydrocele can be drained simply by inserting a needle into the sac or by injecting drugs to prevent the sac from refilling with fluid.

It should be noted that a hydrocelectomy sometimes causes postsurgical complications, such as hematoma, infection and chronic pain. A new minimally invasive surgical procedure involves making a 2-centimeter incision in the scrotal wall, draining the swollen sac and removing the testicular sheath through the incision.

Hydroceles & fertility

Hydroceles do not affect fertility, though more severe cases may cause discomfort and become a nuisance during intercourse. They may be the result of a more serious condition, such as a tumor that inhibits sperm production.

A study published in Urology Case Reports revealed that though hydroceles rarely cause infertility, in instances where infertility results, the condition can be treated surgically. This report followed a 34-year-old male suffering from primary infertility who had bilateral hydroceles. After removal of the hydroceles, the subject’s sperm count improved markedly, leading the authors to conclude that hydroceles should be a leading consideration when diagnosing male patients with infertility.

A sign of something more serious

A hydrocele is a largely asymptomatic genital condition that usually causes little or no pain, though large hydroceles can become uncomfortable and may require removal to prevent infection or other complications.

Hydroceles rarely threaten male fertility, though the condition should always be examined carefully as a potential symptom of a more serious problem.