Hydroceles occur in males only. The testes, or testicles, are the two male reproductive glands that produce sperm and the male hormone testosterone. They are located in the scrotum, which is a pouch located behind the penis. A hydrocele is an abnormal fluid-filled sac around the testes that causes the scrotum to swell.

Hydroceles can occur on either side of the scrotum or, in rare cases, on both sides. While hydroceles are benign (mild and not progressive) and usually painless, they should be brought to a doctor's attention because they sometimes can signify a more serious condition related to the testes.

There are two types of hydroceles: communicating and non-communicating. Communicating hydroceles have an open connection between the scrotum and abdomen. Non-communicating hydroceles are enclosed with no connection.

Hydroceles most commonly affect males in two age groups-but they can develop at any age. About 10 percent of male infants (particularly premature babies) are born with a hydrocele. The condition also may occur in boys between the ages of 2 and 5, usually as a result of inflammation of the testes. Older men (typically over the age of 40) can develop a hydrocele, often following an injury in the scrotal area.

Signs and symptoms of Hydroceles

The main symptom of a hydrocele is swelling in the scrotum. Generally, hydroceles do not cause pain however, adult men may feel discomfort.

Causes and Risk Factors for Hydroceles

Hydroceles are caused by the accumulation of fluid in the scrotum, surrounding one, or less often both, of the testes. In most cases, the condition is congenital-or present at birth.

Before birth, the testicles develop in the abdomen. A few weeks before the baby boy is born, they descend connected to a tube to the scrotum. When this movement is complete, the tube usually closes.

When the tube does not close, fluid from the abdomen can collect in the scrotum, causing a communicating hydrocele. This condition is called "communicating" because the pathway between the abdomen and scrotum is wide open. This type of hydrocele is typically bigger in the evening and smaller, or absent, in the morning as the fluid often returns to the abdomen after lying down.

Non-communicating hydroceles occur when fluid stays inside a closed sac and is not gradually absorbed into the body. Men (especially over the age of 40) can develop non-communicating hydroceles as a result of an infection or injury to the scrotal area, or if blood or fluid becomes blocked inside the spermatic cord. Most non-communicating hydroceles, however, seem to occur for no apparent reason.

Diagnosis of Hydroceles

The first step in diagnosing a hydrocele is a physical examination. During the exam, the physician may shine a flashlight at the swollen area of the scrotum. Because the fluid in a hydrocele is usually clear, the light will show the outline of the testicle and detect excess fluid.

Ultrasound is often used to confirm the diagnosis of hydrocele and rule out a tumour or other condition. If the area of swelling becomes larger or smaller as the doctor examines the scrotum, the patient may have an inguinal hernia or a communicating hydrocele. If an infection is suspected, blood or urine tests may be performed.

Treatment options for Hydroceles

For baby boys, hydroceles typically disappear on their own within a year. If a hydrocele doesn't disappear after a year or if it continues to enlarge, it might need to be surgically removed.

For adult males, hydroceles often go away on their own within six months. A hydrocele requires treatment only if it gets large enough to cause discomfort or disfigurement. Then it might need to be surgically removed.

The surgical procedure (hydrocelectomy) can be performed on an outpatient basis during general or regional anaesthesia. An incision is made in the scrotum or lower abdomen to remove the hydrocele. If a hydrocele is found during surgery to repair an inguinal hernia, the surgeon might remove the hydrocele even if it's causing no discomfort.

After hydrocelectomy, you might need a tube to drain fluid and a bulky dressing for a few days. To ease discomfort, your doctor might recommend a scrotal support strap or ice packs to help reduce swelling.