What are hydroceles?

Causes and Symptoms

Hydroceles occur in 1 percent of adult males. In patients between the ages of eighteen and thirty-five, the presence of an underlying testicular tumor must be ruled out. Accurate diagnosis can be carried out through physical examination. A hydrocele is a smooth, cystlike mass completely surrounding the testicle such that only the mass can be palpated; the testis, inside, cannot be felt. Hydroceles do not involve the spermatic cord. When a light is shined through the cyst, the light is readily transmitted. If the hydrocele is large or tense and the testis cannot be examined, ultrasound examination can eliminate the diagnosis of a testicular abnormality.

Treatment and Therapy

Removal, called hydrocelectomy, is primarily indicated for adult hydroceles
that produce discomfort, objectionable scrotal enlargement, or an uncertainty regarding underlying testicular abnormalities upon scrotal ultrasound or physical examination. The presence of a hydrocele does not necessarily require surgical intervention, drainage, or other intervention; it must be accompanied by some significant abnormality to require surgery.

Surgical excision is the most effective method for treatment and can be done on an outpatient basis. A 5.0- to 7.6-centimeter (2.0- to 3.0-inch) incision is made in the scrotum, and the wall of the hydrocele is identified and dissected free. The hydrocele sac is removed and its edges sewn or cauterized to eliminate bleeding. The testis is then returned to the scrotum, and the incision is closed. For large hydroceles, a small drainage tube is introduced into the scrotum to limit swelling.

The most frequent complication of hydrocele surgery is scrotal swelling, which may continue for eight weeks. Most patients return to full activity within seven to ten days of surgery, however, and recurrences are rare.

In addition to surgical removal, other treatment options include needle aspiration and aspiration with the injection of sclerosing agents. Needle aspiration is rarely effective and increases infection risk. Fluid usually reaccumulates within three months of aspiration. Aspiration with the injection of sclerosing agents such as tetracycline is successful in fewer than 50 percent of patients and usually requires multiple treatments.

Bibliography

Francis, John J., and Laurence A. Levine. "Aspiration and Sclerotherapy: A Nonsurgical Treatment Option for Hydroceles." Journal of Urology 189, 5 (May 2013): 1725–1729.

Graham, Sam D., Jr., et al., eds. Glenn’s Urologic Surgery. 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2010.

"Hydrocele." Mayo Clinic, November 3, 2011.

Kay, K. W., R. V. Clayman, and P. H. Lange. “Outpatient Hydrocele and Spermatocele Repair Under Local Anesthesia.” Journal of Urology 130, no. 2 (August, 1983): 269-271.

Lyons, Sonja. "Hydrocele/Varicocele." HealthLibrary, September 26, 2011.

Sherwood, Lauralee. Human Physiology: From Cells to Systems. 7th ed. Pacific Grove, Calif.: Brooks/Cole/Cengage Learning, 2010.

Wampler, Stephen M., and Mikel Lianes. "Primary Care Urology: Common Scrotal and Testicular Problems." Primary Care: Clinics in Office Practice 37, 3 (September 2010): 613–626.