What is Hydrocele and How Does it Occur?

What is Hydrocele?

Hydrocele is a medical condition characterized by the accumulation of fluid in the sac surrounding the testicles, leading to swelling in the scrotum. A hydrocele, pronounced hydro-seal, involves the accumulation of clear or yellow fluid around the testicle within the scrotum. While many male newborns may have small hydroceles at birth, which often resolve within the first year without surgery, hydroceles can also develop in babies, toddlers, and older children.

The testes are located in the scrotum, which is behind the penis. Bilateral hydroceles is the term used to describe the condition around both testicles. Hydroceles can affect either one or both sides of the scrotum. Even though they are more prevalent in newborns, hydroceles can also develop on their own in adults. Because of the abrupt swelling in a sensitive place, larger hydroceles may experience discomfort from the condition, which can be concerning. But many people don't find a hydrocele to be uncomfortable, bothersome, or severe.

In infants, hydroceles are often congenital, resolving within the first year. In adults, causes may include minor trauma, infection, testicular issues, or previous surgeries. The primary symptom is painless scrotal swelling resembling a water-filled balloon. The decision to treat a hydrocele depends on the patient's age and the degree of discomfort. Surgery is typically reserved for cases causing problems or showing underlying pathology.

What Causes Hydrocele?

Understanding the internal structure of the male reproductive system—specifically, the scrotum and testicles—is crucial for knowing the causes of hydrocele.

• During fetal development, testicles begin in the peritoneal cavity and descend into the scrotum via the inguinal canal. This canal, a passage in the abdominal wall, is prone to hernias. When hydrocele is suspected, tests are done to rule out hernias.
• In infants, after testicular descent, the tunica vaginalis forms, creating a covering. Abnormal development may leave an opening, allowing abdominal fluid to pass into the scrotum. The cause of this opening is often unknown, and premature babies have a greater risk of hydrocele.
• The tunica vaginalis surrounds the testicles, producing minimal fluid for mobility. Any imbalance between fluid production and drainage can lead to a hydrocele. Causes of hydrocele in adults may include spermatic cord blockage, scrotal injury, inguinal hernia surgery, or infections.

One of the main risk factors for newborns is premature delivery. Risk factors for later life include scrotal trauma, STDs, and inflammation of the scrotum.

Different Types of Hydrocele

It is essential to recognise the two main types of hydrocele—communicating and noncommunicating—while also exploring the available treatment options.

Communicating Hydrocele:

It involves a connection or communication with the fluids in the abdominal cavity. This connection is established during fetal development when a thin membrane called the processus vaginalis forms between the fetus's stomach lining and the scrotum. Ideally, the testicles should descend through this membrane into the scrotum, and tissue forms to seal the opening.

On the other hand, a communicative hydrocele can occur if the seal fails to develop properly and fluids from the abdominal cavity seep into the scrotum. The scrotum enlarges or swells, and its size changes over the day, making this condition visible.

Noncommunicating Hydrocele:

In contrast, a noncommunicating hydrocele occurs when the processus vaginalis closes, but there is still an accumulation of extra abdominal fluid around the testicle in the scrotum. Noncommunicating hydroceles can be present at birth or develop later in life without an apparent reason. Unlike communicating hydroceles, noncommunicating ones usually remain the same size or grow very slowly.

Additionally, a rare type known as Nuck's hydroceles, found in the lining of the pelvic wall, may occur in individuals without testicles. This type can cause painful swelling in the lymph nodes of the groin, potentially leading to misdiagnosis due to similarities with other conditions, such as ovarian cysts and endometriosis.

Treatments for Hydrocele

In many cases, if a hydrocele is present in a newborn, it tends to resolve on its own within a year. However, if it persists or becomes significantly large, surgical intervention by a urologist may be necessary. In adults, especially if the hydrocele is small and results from inflammation due to trauma or infection that has been treated, it might resolve on its own. Regular monitoring through exams and ultrasounds is typically recommended.

Surgical Intervention:

For larger hydroceles or those that do not resolve spontaneously, surgery becomes a common and effective hydrocele treatment. The surgical procedure involves removing the hydrocele, and the choice of incision location depends on the hydrocele's location—either in the scrotum or abdomen.

Risks:

• Allergic reactions, breathing difficulties, and heart rhythm disturbances due to anaesthesia.
• Surgical risks include blood clots, excessive bleeding, scrotal injury, and infection.

Needle Aspiration:

An alternative to surgery is draining the hydrocele using a long needle. This procedure, known as needle aspiration, may include injecting a drug to prevent fluid reaccumulation. It is often preferred for individuals at high risk of complications during surgery.

Risks:

• Temporary pain in the scrotum.
• Risk of infection.

Minimally Invasive Surgery: Recent studies have explored minimally invasive surgical methods for hydrocele treatment involving smaller incisions and shorter surgery times. These methods have shown effectiveness without serious complications during follow-up periods, such as chronic scrotal pain, recurrent hydrocele, or testicular atrophy. Hydrocele repair may also be conducted using microsurgical techniques to minimize damage to surrounding tissues, including the sperm transport tube (vas deferens).

The prediction for hydrocele treatment is generally favorable, and the condition is not usually dangerous unless it becomes very large or infected. After surgery, wearing a jockstrap for a few weeks helps elevate the scrotum, reducing swelling. However, complete subsiding of swelling may take several months, and there is a possibility of recurrence even after surgery.

Conclusion

Knowing the types of hydrocele and the available treatments is crucial for effective management. Understanding hydrocele involves finding its root cause in fetal development and the intricate workings of the male reproductive system. From congenital occurrences in infants to potential triggers in adulthood, a comprehensive understanding allows for better management and treatment decisions.

Whether through observation, conservative measures, or surgical intervention, the goal is to alleviate symptoms and ensure the well-being of individuals affected by this condition. Always consult with healthcare professionals for personalised advice based on individual circumstances.

References:

• https://www.verywellhealth.com/hydrocele-5077242#toc-types-of-hydroceles
• https://www.webmd.com/parenting/baby/hydrocele-baby-boys
• https://www.mayoclinic.org/diseases-conditions/hydrocele/symptoms-causes/syc-20363969
• https://my.clevelandclinic.org/health/diseases/16294-hydrocele#symptoms-and-causes
• https://www.healthline.com/health/hydrocele#treatment