Brief overview
- Treatment: In case of congenital hydrocele usually only observation at first. In cases of hydrocele that do not regress or are particularly large, surgery is usually performed.
- Course of disease and prognosis: Often regression of water retention by the age of two. After surgery usually few complications, symptoms disappear after the healing phase.
- Causes and risk factors: Cause of congenital hydrocele: incomplete closure of the inguinal canal, causes of acquired hydrocele: Inflammation, injury, torsion of the testis, inguinal hernia, tumors
- Symptoms: Mostly unilateral, painless, bulging swelling of the testis, depending on the cause and size, pain is also possible on rare occasions
- Diagnosis: History, physical examination, palpation of the testicle, ultrasound examinations, in special cases also magnetic resonance imaging (MRI)
What is a hydrocele?
Hydrocele: Various clinical pictures.
Usually, the fluid is located between two skins surrounding the testis (together called tunica vaginalis testis). If fluid accumulates in the spermatic cord, it is called a hydrocele funiculi spermatici. An accumulation of fluid in the epididymis is called a spermatocele.
If a fluid accumulation occurs in the groin area in girls, it is called a Nuck’s cyst. This clinical picture is rare.
How is a hydrocele treated?
If there is a congenital hydrocele testis, there is usually no treatment by surgery at first. Instead, the doctor observes the hydrocele until the child reaches the age of two. In most cases, the hydrocele recedes on its own because the connection between the abdominal cavity and the testis closes over time.
When does a hydrocele require surgery?
If the patient suffers from an acquired (secondary) hydrocele testis, the hydrocele surgery is often performed immediately. During hydrocele surgery, the doctor usually makes an incision in the scrotum, through which he removes the fluid.
Hydrocele: Outdated treatment options
In the past, doctors would puncture a hydrocele testis with a needle or syringe to release the fluid this way. Nowadays, this is no longer done because of the increased risk of infection. So-called sclerotherapy (“hardening”) with chemical substances is also no longer performed. This is because it causes more peritonitis, and there is a higher risk of the hydrocele returning (recurrence).
Hydrocele: Do home remedies help?
Hydrocele surgery: how long are you sick?
Hydrocele surgery on the testicle is usually performed in the hospital. If the procedure proceeds without complications, patients are usually allowed to go home after a few days.
Course of the disease and prognosis
The prognosis of a hydrocele is good. The causal connection between the abdominal cavity and the testicle usually closes by itself in the baby between the third and fourth month of life, i.e. it heals itself, so to speak. Even after that, around the beginning of the third year of life, closure still occurs in some cases. For this reason, treatment of a congenital hydrocele is usually not started until the child is two years old.
Surgical therapy has a high cure rate, although in some cases the hydrocele on the testicle recurs (recurrence). In addition, as with any surgical procedure, there is a certain risk of bleeding, bruising or infection during hydrocele surgery.
If the hydrocele remains untreated and regression does not occur on its own, there is a risk for complications.
These include:
- Indirect inguinal hernia: A loop of intestine passes through the inguinal canal and there is a risk that it will become incarcerated.
- Inability to conceive: if there is a large accumulation of fluid in the scrotum, there is a risk that it will cut off blood flow to the testicle.
- Testicular torsion: the risk of the testicle twisting around itself, thus interfering with its own blood supply, is increased in the presence of a hydrocele.
What are the causes of a hydrocele?
A hydrocele is either congenital or acquired. Depending on which form of hydrocele is present, there are corresponding causes and risk factors.
Hydrocele: Congenital hydrocele
If the hydrocele on the testicle is congenital, physicians speak of a primary hydrocele. Thus, this form of hydrocele usually affects babies and young children. Only rarely does a congenital hydrocele first become apparent in older children.
In the course of pregnancy, the testis descends through the inguinal canal into the scrotum, creating an outpouching of the peritoneum (processus vaginalis peritonei). Normally, this closes while still pregnant. If this does not happen, fluid from the abdominal cavity enters the scrotum and a hydrocele develops in the baby.
Hydrocele: Acquired hydrocele
An acquired hydrocele is also called a secondary hydrocele. Various causes are known for this such as:
- testicular inflammation or epididymitis (orchitis or epididymitis)
- violent impact (e.g. blows, kicks)
- Testicular torsion (testicular torsion)
- Hernia (inguinal hernia)
- Lump (tumor)
What symptoms does a hydrocele cause?
In the course of pregnancy, the testis descends through the inguinal canal into the scrotum, creating an outpouching of the peritoneum (processus vaginalis peritonei). Normally, this closes while still pregnant. If this does not happen, fluid from the abdominal cavity enters the scrotum and a hydrocele develops in the baby.
Hydrocele: Acquired hydrocele
An acquired hydrocele is also called a secondary hydrocele. Various causes are known for this such as:
- testicular inflammation or epididymitis (orchitis or epididymitis)
- violent impact (e.g. blows, kicks)
- Testicular torsion (testicular torsion)
- Hernia (inguinal hernia)
- Lump (tumor)
What symptoms does a hydrocele cause?
Furthermore, an ultrasound examination (sonography) of the testicle is usually performed. This also allows the accumulation of fluid to be visualized. This is also possible with magnetic resonance imaging (MRI). However, it is more complex than an ultrasound examination and is only used for special problems.
Hydrocele: Differentiation from other diseases
The physician must distinguish other diseases from a possible hydrocele. Similar symptoms occur, for example, in:
- Inguinal hernia
- Testicular varicose vein (varicocele)
- Lump
If the examination does not provide a definitive diagnosis, the testicle will be exposed in surgery. This ensures that potentially serious diseases of the testicle are not overlooked.
