Hydrocele

A hydrocele develops when fluid collects between the layers surrounding the testicle because the balance between fluid production and absorption is disturbed. It is a harmless condition that does not impair testicular function. In adults the cause is most often unknown, but it may be linked to inflammation, injury or surgery in the scrotum or groin, and less often to other testicular diseases. A hydrocele is a common urological finding that can occur at any age, and it becomes more common with age. It is also relatively common in newborns and infants, mainly because the connection between the abdominal cavity and the scrotum has not closed completely. In most children it shrinks or disappears on its own over time, so monitoring the child during the first year of life is usually enough.

A hydrocele is usually diagnosed during a urological examination. It most often appears as a painless, gradual enlargement of one or both sides of the scrotum, which may increase in size over time. There may be a feeling of heaviness, pressure or tension in the scrotum or mild discomfort; a very large hydrocele can also limit physical activity or make dressing difficult.

During the clinical examination, the urologist assesses the size, shape and tenderness of the enlarged scrotum and checks whether the testicle can be felt normally. An ultrasound of the testicles and scrotum is an important part of the diagnosis, especially when the diagnosis is not entirely clear, the hydrocele is larger or the testicle cannot be felt well because of the fluid. Ultrasound confirms the presence of fluid and allows examination of the testicle, epididymis and other structures, ruling out a tumour, inflammation, hernia, varicocele or other causes of scrotal enlargement.

1. Observation
Treatment of a small, stable and asymptomatic hydrocele in adults is not necessary. Monitoring is appropriate if the hydrocele does not bother the patient and other conditions have been ruled out by ultrasound. In newborns and infants, a hydrocele is often linked to an open processus vaginalis and frequently shrinks or disappears on its own during the first year of life, so observation is also recommended for most children.

2. Surgical treatment – excision of the hydrocele
For a symptomatic, large, growing or bothersome hydrocele, hydrocelectomy is the standard and most durable treatment. In children, we opt for surgery when the hydrocele persists, is communicating or is accompanied by an inguinal hernia; the procedure is usually performed through the groin, closing the connection with the abdominal cavity.

3. Aspiration with or without sclerotherapy
This is a less invasive method of treating a hydrocele and can be very useful for patients with a higher surgical risk (older patients, patients with many other conditions) or those who prefer less invasive treatment. The likelihood of recurrence is significantly higher than after surgery, and it is not considered a definitive treatment.

• symptoms or pain,
• a large or progressively growing hydrocele,
• functional problems when walking or doing sport,
• significant discomfort or cosmetic concern,
• a hydrocele that recurs after previous treatment,
• diagnostic uncertainty or associated conditions that require surgical treatment.

Author: asst. Simon Hawlina, MD, FEBU, urologist specialist