Excision of Hydrocele

A hydrocele is a disease observed only in males, and is usually subclinical or asymptomatic. It is a sac containing watery fluid found along the spermatic cord, which lies within the scrotum.

This condition may develop during normal development, as the testicles descend down a tract from the abdomen into the scrotum. A hydrocele will result if this tube does not close. This allows peritoneal fluid to drain from the abdomen through the open tract and accumulate in the scrotum, where it collects causing a swelling.

Abdominal fluid may then flow through the processus vaginalis in the abdomen and the tunica vaginalis in the scrotum, which causes swelling of the scrotum, on one side or even both sides.

This passage between the abdomen and the testicles usually closes and the fluid is absorbed. But if the fluid remains after the sac closes a non-communicating hydrocele is the result. This is the case if the fluid will not flow back into the abdomen when compressing the scrotal sac. This type of hydrocele is frequently seen in newborn males and normally disappears by the end of the first year of life as the fluid is absorbed. With a communicating hydrocele, the fluid moves slowly back up into the abdomen through the processus vaginalis if the scrotal sac is compressed (or the hydrocele may changes size). A communicating hydrocele is normally smaller when the child wakes up in the morning and becomes larger in the evening as fluid passes into the scrotum after activity.

A hydrocele may also be formed if a testicle is damaged, inflamed or even if there is fluid blocking the sperm duct.

Many hydroceles are congenital and occur in children under 2 years of age. Chronic or secondary hydroceles can occur in men that are over 40 years old and may be secondary to epididymitis or orchitis. Hydrocele may also be caused by infections such as filariasis or tuberculosis.

A doctor may diagnose a hydrocele by feeling the scrotum to see if the swelling is due to a solid mass or a collection of fluid. The swelling may be shown to be a hydrocele by shining a light underneath the scrotum thereby illuminating the fluid-containing sac. The testicles will be seen in outline and the rest of the scrotum will allow the light through. If the diagnosis of hydrocele is still in doubt an ultrasound scan will confirm the diagnosis.

The fluid in the scrotum may be removed with a needle in a procedure called aspiration. Aspiration of a hydrocele is not therapeutic procedure however because the fluid usually builds up once again and there is also a possibility of infection.

After aspiration the injection of thickening or sclerosing substances (e.g. sodium tetradecyl sulfate, urea or tetracycline) may be carried out to help to close the opening through the scrotum and prevent fluid accumulating in the scrotum after the procedure.

Surgery is usually preferred, but aspiration may be the safest option for patients that may have surgical risks.

A hydrocele is easily corrected with a hydrocelectomy. This is a minor surgical procedure performed on an outpatient basis using a general anesthetic. An incision is made in the scrotum and the procedure may require a drainage tube and a large dressing to be applied the scrotum.