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What is a hydrocele?A hydrocele is a scrotal collection of clear fluid ("hydro" = water) in a thin walled sack

("cele" = swelling) that also contains the testicle. Less frequently, due to the commonembryological background of male and female gonadal structures, female children or women

may also experience a hydrocele. In this case, the sack and connection exist in the labia majora

(the outermost and larger of the two labial structures). Because of less potential concern forcomplications in females with hydroceles, this article will focus predominantly on the malegender. A hydrocele may involve either one side (unilateral) or both sides (bilateral) of the

scrotum.

What causes hydroceles?

EmbryologyBetween the 28th and 36th week of gestation, the testes, associated blood vessels and

nerves migrate from the upper posterior abdominal wall adjacent to the kidneys to the lower

abdominal cavity and through a tunnel (inguinal canal) into the scrotum. As each gonad exits thepelvic region through the inguinal canal into the scrotum, it is preceded by a thinly lined "sack"

called the process vaginalis. Once the testes and associated structures have entered the scrotum,the trailing end of the process vaginalis generally closes off, completely isolating the contents ofthe abdominal cavity and obstructing their passage into the inguinal canal or scrotum. Should

this closure be incomplete and the communication narrow, free fluid in the abdominal cavity

(peritoneal fluid) may seep into and through the process vaginalis and collect in the scrotumforming a hydrocele. If the connection is larger and a portion of the small intestine migrates out

of the abdominal cavity into the inguinal canal and/or scrotum, a herniahas developed.

What are the physical features and types hydroceles?

A hydrocele is characterized as a non-painful, soft swelling of the scrotum (one or both

sides). The overlying skin is not tender or inflamed. There are two types of hydroceles:

1. communicating, and2. non-communicating

Communicating hydrocelesCommunicating hydroceles are present at birth and occur as a consequence of the failure

of the "tail" end of the process vaginalis to completely close off. Peritoneal fluid (free fluid in the

abdominal cavity) is thus free to pass into the scrotum in which the process vaginalis surrounds

the testicle.A characteristic feature of communicating hydroceles is their tendency to berelatively small in the morning (having been horizontal duringsleep) and increase in size during

the day (peritoneal fluid drainage assisted by gravity). Actions which increase intra-abdominalpressure (for example, crying, severe coughing, etc.) will also tend to increase the size of the

hydrocele.

Non-communicating hydroceles

Non-communicating hydroceles may also be present at birth or develop as a boy matures. In anon-communicating hydrocele the tail end of the process vaginalis has closed appropriately. The

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7/27/2019 What is a Hydrocele

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fluid surrounding the testicle is created by the lining cells of the process vaginalis and is unable

to either drain or be reabsorbed efficiently and thus accumulates. Since this fluid is walled off,

the size of the hydrocele is generally stable and does not reflect intra abdominal pressure.

How are hydroceles diagnosed?

The diagnosis of a hydrocele is generally made clinically. An apt description of ahydrocele surrounding a palpable (something that can be felt) testis would be that of a small

water balloon containing a peanut. The differences between communicating and non-

communicating hydroceles described above help to support the suspected diagnosis.

A bedside test, transillumination, provides confirmation of the condition.

Transillumination involves placing a small light source (commonly an otoscope - the medicaldevice used to examine the ear) against the swollen scrotum. The fluid filled nature of the

hydrocele side is distinctly different from the non-involved side of the scrotum. In rare cases

eitherultrasoundor X-ray study of the region may be indicated. In unusual cases where a

hydrocele may be a secondary phenomenon to pathologic cause (caused by disease), surgical

exploration may be necessary to establish the diagnosis.

What is the treatment for hydroceles?In 95% of congenital (present at birth) hydroceles, the natural history is one of gradual

and complete resolution by one year of age. For those lasting longer than one year or for those

non-communicating hydroceles that manifest after the first year, surgical repair is indicated since

these rarely resolve spontaneously

Hydroceles are not usually dangerous and are treated only when they cause pain or

embarrassment or when they decrease the blood supply to the penis (rare). Treatment is not

usually needed if a hydrocele does not change in size or gets smaller as the body reabsorbs thefluid. Hydroceles in men younger than 65 may go away by themselves. But hydroceles in older

men do not usually go away.

Fluid can also be removed from a hydrocele with a needle (aspiration). But hydrocelesthat are aspirated often return, and surgery may then be needed. Aspiration is recommended only

for men who are not physically able to have surgery because of the risk of infection and

recurrence.

If the hydrocele gets larger or causes discomfort, surgery to remove the hydrocele

(hydrocelectomy) may be needed.

Hydrocelectomyhydrocele repair is a procedure that is done to repair scrotum swelling caused by a hydrocele. A

hydrocele is a backup of fluid into one or both testicles. This can occur at birth or later in life

when a hernia is present.Hydrocelectomy may be performed if:

Hydrocele interrupts blood flow to the area

Hernia is present

Hydrocele is rather large

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