How common is a hydrocele?
Hydrocele is a common condition in adult males in the UK.
According to the National Health Service (NHS), it is estimated that around 1 in 10 men in the UK will develop a hydrocele at some point in their life. Hydroceles can occur at any age, but they are more common in older men due to age-related changes in the scrotum.
The British Association of Urological Surgeons (BAUS) reports hydroceles are the most common cause of painless scrotal swelling in adult men.
While hydroceles are usually benign and do not require treatment, they can cause discomfort and other symptoms affecting a man's quality of life. These are the main reason/s to treat.
Who is at risk of a hydrocele?
The risk factors for developing a hydrocele are;
- Older males: Most hydroceles occur in older males due to age-related changes in the scrotum.
- Infants: Some infants are born with hydrocele due to a congenital defect that causes fluid to accumulate in the scrotum.
- Males with a history of surgery or injury to the scrotum: Trauma (from contact sports injuries) or surgery can cause inflammation, leading to fluid accumulation.
- Males with a history of infections or inflammation in the scrotum: Infections such as epididymitis, orchitis, or sexually transmitted infections can cause hydrocele.
- Individuals with lymphatic system blockage: Lymph is a fluid that circulates in the body to help fight infections. If the lymphatic vessels in the scrotum are blocked, it can cause fluid to accumulate, leading to hydrocele.
It's important to note that while certain risk factors may increase the risk of developing hydrocele, they can occur in anyone, regardless of age or medical history.
How does a hydrocele feel?
- Most present as painless swelling in the scrotum on one or both sides
- Painful swelling. When this is so, a testicular tumor, inguinal hernia, twisted testicle or testicular torsion and infection need to be excluded.
How does a doctor diagnose a hydrocele?
Diagnosing a hydrocele typically involves a medical history, a physical exam, and diagnostic tests.
Medical exam
The doctor will ask questions about the patient's symptoms, such as how long they have been experiencing swelling in the scrotum and whether they have any pain or discomfort. They may also ask about recent injuries, surgeries, or other medical conditions contributing to the symptoms.
Physical Exam
The doctor will examine the scrotum during the physical exam to check for swelling or lumps (to exclude inguinal hernia, testicular tumour, epididymal cyst, and other medical conditions leading to scrotal swelling)
Traditionally, the doctor may also shine a light behind the scrotum to see if the fluid inside the sac transmits light, a common characteristic of a hydrocele.
What imaging is ordered?
Ultrasound: This test uses high-frequency sound waves to create images of the scrotum, visualizing the collection of fluid, its location and measuring its size. It is helpful to identify the underlying cause of swelling in the scrotum, like inguinal hernias and is the best test to arrive at a definite diagnosis.
How many types of hydroceles are there?
- non-communicating hydroceles
- communicating hydrocele
Non-communication hydrocele
Non-communicating hydrocele occurs when there is a fluid-filled sac that develops around the testicle, which is usually due to a blockage in the tube that carries fluid away from the testicles. Non-communicating hydroceles are more common in older men. This blockage can occur from birth or later in life due to inflammation, injury, or infection. As a result, the fluid cannot drain properly, leading to excess fluid buildup in the scrotum.
Communicating hydroceles
When the inguinal canal between the scrotum and the abdomen is open, fluid can flow freely between the two areas. This is called a communicating hydrocele. This connection can result from an opening in the abdominal wall that fails to close properly during fetal development (patent processus vaginalis). This means the fluid in the abdomen can pass through the opening into the scrotum, leading to fluid in the scrotum. Communicating hydroceles are more common in newborn male infants and young boys.
How is a hydrocele treated? What medicines may help?
Hydrocele repair surgery is a standard procedure. The success rate is high; most patients report satisfactory outcomes.
The surgery is usually performed as a day case using general combined with local anaesthesia, and patients can expect a prompt recovery.
In children or newborn males, the surgery involves making an incision just above the groin, repairing the open communication between the abdominal cavity and scrotum, draining the fluid from the scrotum, and closing the incision.
In adult men, the procedure involves making an incision in the scrotum, draining the fluid from the hydrocele sac, and either everting the sac (Jaboulay's procedure) or sewing it up to prevent it from re-accumulating.
While scrotal drainage tubes or bulky dressings are rarely needed, in some cases, they are necessary.
Pain relief medication may be prescribed to manage any discomfort, and patients are advised to rest for a few days after the surgery to aid in their recovery.
I have a hydrocele on both testicles; can I have them repaired simultaneously?
Even though one can repair the right and left hydrocele simultaneously, some urologists prefer to operate one at a time.
Is needle aspiration a good treatment?
No
Needle aspiration of a hydrocele is a procedure in which a needle is inserted into the fluid-filled sac (hydrocele) in the scrotum to withdraw the fluid. This can be done temporarily to relieve discomfort caused by the swelling. However, needle aspiration is generally not considered a definitive treatment for a hydrocele because the fluid is likely to accumulate again, and the swelling will return.
Additionally, there is a higher risk of complications associated with needle aspiration, such as infection, bleeding, and damage to the testicles. Therefore, this procedure is usually reserved for cases where surgery is impossible or a patient is not fit for surgery due to other medical reasons.
In conclusion, while needle aspiration can temporarily relieve the pain associated with a hydrocele, surgery may be necessary for a long-term solution.
What is the recovery period?
Most people can generally return to normal activities two weeks after surgery.
During the first few days after surgery, the affected area is expected to experience pain, swelling, and bruising.
It is recommended to
- Wear a supportive garment, such as a jockstrap or compression shorts to help reduce swelling and discomfort.
- To alleviate swelling, it is recommended to place ice packs (avoid direct contact of ice with the skin) on the affected area during the initial day following the surgical procedure.
- Avoid strenuous physical activity in the first two weeks; thereafter, start building it gradually.
- You can drive once you feel comfortable pressing the emergency break without thinking. Typically most patients take 10 to 14 days to go behind the wheel.
- Keep the surgical site clean and dry.
What are the complications of the surgery?
- Bleeding that you may be taken back to the theatre
- Infection: You may be asked to take antibiotics or need emergency surgery to drain a fluid collection.
- Chronic groin pain
- Bruising and swelling in the scrotum
- Recurrence
- Injury to the testicle that may result in testicular loss
- Wound healing issues
- General risk factors (clots in the deep veins or lungs, chest infection, heart attack, stroke, COVID, anaesthetic risks)
Can hydrocele surgery cause infertility, erectile dysfunction, or low testosterone?
Hydrocele surgery is generally safe and does not usually cause infertility, erectile dysfunction, or low testosterone levels. The surgery involves draining the fluid from the hydrocele and removing the sac surrounding the testicle.
However, as with any surgical procedure, there are potential risks and complications. These may include infection, bleeding, damage to the blood vessels or nerves in the scrotum, or a recurrence of the hydrocele. In rare cases, surgery may also damage the testicle, affecting its function.
Can a hydrocele be prevented?
It is important to note that while certain measures have been mentioned that can help reduce the risk of developing a hydrocele, there is no guaranteed way to prevent its development entirely.
Are hydroceles a sign of cancer?
Testicular cancer, in rare instances, can also cause fluid to accumulate around the testicle, resulting in hydrocele formation.
In testicular cancer, a tumour usually develops within the testicle itself (as a solid mass) and causes an enlargement or change in the texture of the testicle.
It is important to note that a hydrocele is usually benign and not a sign of testicular cancer.
To rule out any underlying medical conditions, such as testicular cancer, a doctor should assess any changes in the size, shape, or texture of the testicles.
What questions should I ask my healthcare provider about hydroceles?
- What exactly is a hydrocele, and what causes it?
- How common are hydroceles, and who is most at risk of developing them?
- What are the signs and symptoms of a hydrocele?
- How do you diagnose a hydrocele?
- What treatment options are available for hydroceles?
- Are there any potential complications if a hydrocele is left untreated?
- How long does it typically take to recover from hydrocele surgery?
- Are there any lifestyle changes that could help prevent a recurrence of the hydrocele?
- How likely is it that the hydrocele will come back after treatment?
- What should I do if I experience any changes or complications after the procedure?
