Understanding a hydrocele in men

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Understanding a hydrocele in men

A hydrocele is a painless buildup of watery fluid that collects inside the scrotum, surrounding the testicles.  They are usually not considered dangerous or a threat to a man’s health.  Hydroceles are most common in newborn baby boys as about 10 percent will be born with a hydrocele which should resolve within a few months after birth.   Babies born prematurely are more likely to have a hydrocele. Hydroceles can also occur later in life in boys and men. 

Normally within the scrotum there is a small amount of lubricating fluid produced allowing the testicles to move freely.  A hydrocele can form when excess fluid that normally drains away into the veins of the scrotum, fail to do so.  This is when the excess fluid will accumulate forming a hydrocele.

Causes of hydroceles

Generally the cause of a hydrocele is unknown.  In newborns, the cause may be due to an opening between the abdomen and the scrotum which normally closes before birth or soon after.

When a boy or man develops a hydrocele it could be caused by an injury or surgery to the scrotum or groin area or by inflammation or infection of the epididymis or testicles.  Another uncommon cause is that a hydrocele could form due to cancer of the testicle or left kidney. 

Symptoms of hydroceles

The main symptom of a hydrocele is a painless, swollen or enlarged scrotum or testicle on one or both sides that feels like a water-filled balloon that is mainly found in front of one of the testicles. Normally the scrotum feels loose, soft, and fleshy.  Other symptoms could include pain, swelling, or redness of the scrotum or a feeling of pressure at the base of the penis.

If a hydrocele becomes large, then it may cause discomfort because of the size particularly when a man walks or has sex. 

Diagnosing a hydrocele

Any male of any age who notices a change in the size or feel of his scrotum or testicles needs to have it checked out by his physician as it could be associated with an underlying testicular condition.

The physician will exam the area and will shine a light behind each testicle known as transillumination.  This is to check for solid masses due to other problems such as cancer of the testicle.  Hydroceles are filled with fluid so light will shine through them whereas light does not pass through a solid mass. 

An ultrasound may also be used to confirm the diagnosis of a hydrocele.

Treatment for a hydrocele

Since there is little to any health danger from a hydrocele, they are treated only if they are causing pain, embarrassment or if they reduce the blood supply to the penis.  If the hydrocele stays the same in size or gets smaller on its own as the body reabsorbs the fluid, then no treatment is necessary.  A hydrocele in men younger than age 65 should go away on their own but in men over 65, they do not.  There are no medications available to treat adult hydrocele, although pain medication may help relives any discomfort.

Another option is surgery known as a hydrocelectomy which may be recommended if the hydrocele is large, causes pain or has developed an infection.  A large hydrocele can become embarrassing or threaten the normal functioning of the other structures in the scrotum. The surgery, which is typically outpatient, involves making a very small cut in the scrotum and then draining the fluid from around the testicle.  To prevent a hydrocele from forming again, the passage between the abdomen and the scrotum will be sealed off. 

A hydrocele can also be removed by draining the fluid by aspiration or with a needle.  However, hydroceles that are aspirated will often come back refilling with fluid within a few months.  If a man is not fit for surgery, then he can have them drained every now and then.

David B. Samadi, MD, Urologic Oncology Expert and Robotic Surgeon located at 485 Madison Avenue on the 21st floor, New York, NY.   Follow Dr. Samadi at www.samadimd.comwww.prostatecancer911.com, and www.roboticoncology.com