Introduction
A hydrocele (literally in ancient Greek a 'water hernia') is where fluid collects inside the scrotum, within a form of sac around the testicle called the 'tunica vaginalis'. They are relatively common in newborn males (1 in 10) and normally resolve naturally before the first birthday. They can appear later in childhood and in adulthood, but are much less common, affecting around 1% of males, where they may resolve naturally within around 6 months.
Generally, hydroceles are not serious and do not impact fertility, however they may indicate underlying conditions, such as infection or a tumour, or the presence of an inguinal hernia, which needs medical attention.
Causes
In newborn males
During development in the womb, the testicles form near the kidneys and then at or near birth 'drop' from the abdomen into the scrotum via the inguinal canal. During this process, if the tunica vaginalis sac around a testicle does not fully close, sometimes fluid from the abdomen may collect in the scrotum and create a hydrocele. This fluid is often absorbed back in to the body naturally.
In some cases, the sac remains open (referred to as a 'communicating hydrocele'), in which case fluid can flow back into the abdomen.
In childhood / adulthood
The main cause of a hydrocele in older males is injury to, or infection in, the scrotum or testicles. A testicular tumour may lead to the development of a hydrocele and therefore anyone with a hydrocele should seek medical attention.
Symptoms
Generally, the presence of a hydrocele is painless (if there is pain, it may indicate another more serious condition such as infection or testicular torsion and always required immediate medical attention). The main symptom is a swollen, heavy feeling scrotum. This can cause some discomfort and may affect one side or both sides of the scrotum. Sometimes the size of the swelling can vary during the day.
Tests / Diagnosis
Diagnosis of a hydrocele involves a review of medical history and a physical examination, where the doctor will check for any tenderness in the scrotum and check both the scrotum and abdomen for any signs of an inguinal hernia. Other tests that may be required include:
- 'Cough' test – where the person is asked to cough to detect any changes in the groin area when under pressure.
- Transillumination – shining a light through the scrotum to detect fluid presence.
- Ultrasound scan.
- Blood tests.
- Urine test.