Greater Boston Urology Blog

What is a Hydrocele?

Today, we're discussing hydroceles, a type of scrotal swelling that may or may not require treatment. We asked Dr. Kevin Killeen from our Hyannis Care Center to answer some common questions about hydroceles.

As with all content on our blog, the following is meant to be educational in nature, not medical advice. Always consult your physician regarding your unique healthcare needs.

What is a hydrocele—and who gets them?

DR. KILLEEN: Hydroceles are only seen in men. The simplest explanation is this: A hydrocele is an accumulation of fluid around the testicle. It usually affects just one testicle, but it can involve both.

There are actually two types of hydroceles. The first is seen in the pediatric population, and the second is seen in the adult population. 

What causes hydroceles?

DR. KILLEEN: Pediatric hydroceles are actually very early hernias. The only difference is that a hernia has something contained within it, such as bowel or fat. In contrast, a hydrocele only has contact with the fluids of the abdominal cavity (this contact allows fluid to move from the abdominal cavity to the scrotum). This is known as a "communicating" hydrocele. 

An adult hydrocele is entirely different. Fluid accumulates around the testicle because of dysfunction with the lymphatic system. The lymphatic system helps us fight infection, but it also returns fluid to the vascular system. In the case of adult hydroceles, this dysfunction allows fluid to accumulate around the testicle.

What are symptoms of a hydrocele?

DR. KILLEEN: Classically, pediatric hydroceles change in size. They are usually smaller in the morning after sleep and larger in the afternoon with activity. We recommend repairing hydroceles in children. Left untreated, the hydrocele will become a true hernia.

In adults, the person usually sees an increase in the size of the scrotal sac. The swelling doesn't cause pain. The scrotal sac can feel somewhat "squishy" instead of something solid and hard.

In young adults, it is always possible that the scrotal swelling might be testicular cancer, particularly if the swelling is rapidly changing and feels heavy and hard. You should always see a urologist with any changes to your genitals, especially if you're a young male who notices changes to the scrotal sac. Testicular cancer is very treatable when caught early.

It's also crucial for all males to perform regular self-checks of their testicles.

How are hydroceles diagnosed?

DR. KILLEEN:  With scrotal swelling, it is often difficult to tell if it is solid or fluid-filled. One can utilize a flashlight to see if the light is transmitted through the scrotum, which would be consistent with a fluid-filled collection. An ultrasound can also provide the same information.

How are hydroceles treated—and is it always necessary to treat them?

DR. KILLEEN: In children, we only have to make a small incision and interrupt the communication between the abdomen and the scrotum so that it does not enlarge over time. It is an outpatient procedure, and the children do quite well, with only a small chance of recurrence. Children with a communicating hydrocele should have this repaired.

In adults, we can either perform sclerotherapy in the office or hydrocelectomy under anesthesia.

●  Sclerotherapy involves draining the fluid and putting medicine into the space once occupied by the fluid. This causes an inflammatory response, which improves lymphatic drainage over time.

●  Surgery involves an incision over the scrotum. Normally, there is no lymphatic drainage through the scrotal skin, but making an incision through the scrotum allows for increased lymphatic drainage through the scrotal skin. 

Both sclerotherapy and surgery are outpatient procedures. Surgery is done in the hospital under general (for most patients) anesthesia, and sclerotherapy is done in the office under local anesthesia.

Hydrocele is a benign condition in adults with a relatively high recurrence rate. I usually recommend only intervening if it starts to affect your activities of daily living (ADL), such as having to "adjust things" while sitting or crossing your legs.

Is there any way to prevent hydroceles?

DR. KILLEEN:  The simple answer is no.

Is there anything else you want to ensure people understand about hydroceles?

DR. KILLEEN: Again, in children, it should be repaired, but in adults, as it is a benign condition with a relatively high recurrence rate of at least 20%, I will recommend patience and only intervening if it is affecting activities of daily life.

If you're dealing with scrotal issues like hydroceles, we can help.

Our world-class physicians, nurse practitioners, and physician assistants can help diagnose and treat scrotal conditions like hydroceles. Request an appointment and let us help.


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