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Glamorgan Urology: Hydrocele

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Hydrocele / Testicular Fluid

A hydrocele is a collection of fluid that gradually develops around the testis, causing a lump to appear. This is harmless and only needs surgical intervention if it becomes painful or becomes bigger.

Common Questions

What is a 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.

How can hydroceles form?

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

How is a hydrocele diagnosed?

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.

Can a hydrocele be releaved without surgery?

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.

Can a hydrocele be removed with surgery?

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.

What happens during the operation?

The operation is carried out under general anaesthetic. An incision (cut) is made in the scrotum allowing fluid to drain out of the hydrocele. The hydrocele sac is then either cut out, or stitched to the back of the testicle. The scrotum is then closed with dissolvable stitches. The operation usually takes 20-30 minutes.

What happens after the operation?

You will be taken from the theatre to the recovery room, where you will be closely monitored until you are awake enough to return to the ward. You may feel uncomfortable at first, but this can be controlled with painkillers such as Paracetamol. You may have a small dressing but this can be removed when you have a bath or shower. Your stitches will dissolve within two to three weeks. You should wear briefs rather than boxer shorts for two to three weeks as these will provide some support.

How will I feel when I go home?

here may be some swelling of the scrotum after the operation and this can last for three months. You should take things easy for a week after the operation to allow the wound to heal.

Will it affect my sex life?

You can resume sexual activity as soon, as is comfortable for you.

What about follow-up by the hospital?

You will be sent an appointment to see your consultant to ensure the wound has healed. This will be for approximately six weeks after your operation.

What is the risk of complications?

All operations carry the risk of complications. However, general anaesthetics are very safe these days and you will have the opportunity to discuss these risks and complications with the anaesthetist prior to your operation. Any form of surgery carries the risk of you developing a chest infection, a clot in your lung or leg, bleeding during or after surgery, or developing cardiac problems. Your doctor will discuss all risks and complications with you when you attend the pre admission clinic.

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