Congenital Hernia/ Hydrocele

A hydrocele is a scrotal collection of clear fluid in a thin walled sack that also contains the testicle. Less frequently, due to the common embryological background of male and female gonadal structures, female children or women may also experience a hydrocele. In this case, the sack and connection exist in the labia majora (the outermost and larger of the two labial structures). A hydrocele may involve either one side (unilateral) or both sides (bilateral) of the scrotum.

Causes, incidence, and risk factors

Hydroceles are common in newborn infants. During normal development, the testicles descend down a tube from the abdomen into the scrotum. Hydroceles occur when this tube does not close. Fluid drains from the abdomen through the open tube. The fluid builds up in the scrotum, where it becomes trapped. This causes the scrotum to swell. Hydroceles normally go away a few months after birth, but they may worry new parents. Sometimes, a hydrocele may occur with an inguinal hernia. Hydroceles may also be caused by:

  • Fluid or a blood blockage in the spermatic cord (this type of hydrocele is more common in older men)
  • Inflammation or injury of the testicle or epididymis

Symptoms

The main symptom is a painless, swollen testicle, which feels like a water balloon. A hydrocele may occur on one or both sides.

Signs and tests

During a physical exam, the health care provider usually finds a swollen scrotum that is not tender. Often, the testicle cannot be felt because of the fluid around it. The size of the fluid-filled sack can sometimes be increased and decreased by putting pressure on the abdomen or the scrotum. If the size of the fluid collection changes, it is more likely to be due to an inguinal hernia.

Hydroceles can be easily seen by shining a flashlight (transillumination) through the swollen part of the scrotum. If the scrotum is full of clear fluid, the scrotum will light up. An ultrasound may be done to confirm the diagnosis. Hydroceles may make it more difficult to do testicular self-exams, which help detect testicular cancer early.

Treatment

Hydroceles are usually not dangerous. They are usually only treated when they cause discomfort or embarrassment. Hydroceles from an inguinal hernia should be fixed with surgery as quickly as possible. Hydroceles that do not go away on their own after a few months may need surgery. A surgical procedure called a hydrocelectomy is often performed to correct a hydrocele.

Complications

Complications may occur from hydrocele treatment. Risks from hydrocele surgery may include:

  • Blood clots
  • Infection
  • Injury to the scrotum