Hydrocele is a fluid-filled sac that occurs around the testicle. Hydrocele is most common in newborn babies. About 10% of newborn boys are born with a hydrocele, while men can get hydroceles at any age.
Hydrocele causes
In late pregnancy, a newborn boy’s testicles descend from his abdomen into the scrotum. The scrotum is a sac made of skin that encases the testicles as they descend.
Each testicle has a surrounding sac filled with fluid. Normally, this sac seals itself off and the body reabsorbs the fluid within the first year of life. However, this does not happen for newborns with a hydrocele. Babies born prematurely (preterm birth) are more likely to develop a hydrocele.
A hydrocele can also occur later in life, most often in men over 40 years old. This usually happens when the canal the testicle descended through doesn’t completely close or reopens. This allows fluid to flow from the abdomen into the scrotal sac.
A hydrocele may also be caused by inflammation or injury to the scrotal sac or canal path. Inflammation can result from infection (epididymitis) or other illnesses.
Hydrocele types
Hydrocele has two related and communicating types:
1-Non-communicating type
Non-communicating hydrocele occurs when the sac seals off but your body doesn’t reabsorb the fluid. The remaining fluid is usually absorbed by the body within a year.
2-Communicating type
Communicating hydrocele happens when the entire scrotal sac doesn’t seal off around your testicle. This allows fluid to flow in and out.
Is hydrocele dangerous?
In general, fluid in the scrotal sac is not dangerous, but if it doesn’t get reabsorbed it can cause pain over time or prevent detection of other problems.
Hydrocele symptoms
Hydrocele is usually painless. The only symptom is usually swelling of the scrotal sac. Adult men with a hydrocele may feel heaviness in the scrotal sac. In some cases, the swelling may be worse in the morning than at night.
See your doctor if you or your child has sudden, severe pain in the scrotal sac. This could be a sign of a different problem called testicular torsion. Testicular torsion occurs when the testicle twists, usually due to injury or accident.
Though uncommon, testicular torsion is a medical emergency because it can cut off blood flow and permanently damage the testicle if not treated promptly.
If you think you or your child has testicular torsion, get emergency care right away or call 115. This condition requires immediate attention and treatment.
Hydrocele diagnosis
To diagnose a hydrocele, your doctor will perform a physical exam. If you have a hydrocele, your scrotal sac will be swollen but you likely won’t have pain. Your doctor won’t be able to feel your testicle well through the fluid-filled sac.
The doctor may check for pain reflex in your testicle or shine a light on your scrotal sac. This allows the doctor to see if fluid has accumulated in the sac.
If fluid is present, the scrotal sac will allow light to pass through it, making your scrotal sac appear illuminated. However, if your scrotal sac is swollen from a solid mass (cancer), light will not pass through the sac. This test cannot provide a definitive diagnosis but can be very helpful.
The doctor may also press on your abdomen to assess for another condition called inguinal hernia. The doctor may ask you to cough or bend over to check for this. An inguinal hernia can occur when a small part of the intestine pokes through a weakened area in the abdominal wall and out through the inguinal canal. Though not typically life-threatening, your doctor may recommend surgery to repair it.
A blood or urine sample may be taken to check for infection. Often, your doctor may request an ultrasound to look for hernia, tumor, or other possible causes of scrotal swelling.
Video of Dr. Shahriar Nategh’s hydrocele surgery
If your newborn has a hydrocele, it will likely resolve on its own after about a year. If it doesn’t go away or gets larger, your urologist may surgically repair it.
Mild hydrocele usually doesn’t require treatment unless it’s causing complications or discomfort, or if it’s communicating (a type associated with hernia). Then hydrocele is corrected surgically.
Hydrocele surgery
Hydrocele surgeryHydrocele surgery is performed on an outpatient basis under local or light general anesthesia, and the patient is discharged the evening of the surgery.
A small incision is made on your abdomen or scrotal sac (depending on hydrocele location) and the hydrocele is surgically removed. Your surgeon will likely place a large dressing over the incision site. Depending on the hydrocele’s size and location, you may need a drain tube for a few days.
Risks of the procedure include:
- Blood clots or bleeding
- Damage to the scrotal sac, like nerve injury
- Infection
Ice packs, scrotal support, and complete rest will reduce post-surgical discomfort. Your doctor will do a general exam as sometimes hydroceles can recur.
Hydrocele aspiration treatment
Another treatment option is draining the fluid with a long needle. The needle is inserted into the sac to draw out the fluid. In some cases, medication may be injected to prevent the sac from refilling. Because of the high recurrence rate with needle aspiration, it’s usually recommended for those who would be at risk with surgery. The most common side effect of needle aspiration is transient scrotal sac pain and the risk of testicular infection.
Hydrocele surgery cost
The cost of hydrocele surgery at a well-equipped clinic with full services and performed by an expert surgeon averages around 5 million Tomans (depending on circumstances), not including insurance.
What to do after hydrocele surgery?
Whether the hydrocele goes away on its own or you have it surgically repaired, the outlook is very good. If you have surgery, the pain should subside within about a week. Your doctor may prescribe pain medication if needed.
It may take 1-2 weeks to return to normal activity. This includes avoiding sitting spread legged, like riding a bike, for at least three weeks. Other strenuous activities should also be avoided during this time.
The sutures will be absorbable and dissolve on their own, but your doctor may want to check them after a few weeks. Keeping the area clean by showering can help prevent infection.
How many days after hydrocele surgery can you have intercourse?
According to Dr. Shahriar Nategh, urology specialist, you can return to normal sexual activity about ten days after hydrocele surgery.
