What is a hydrocele?

A hydrocele (pronounced ‘hydro-seel’) develops when fluid collects inside the sac surrounding a testicle. It is most common in newborns, but can develop in men of any age. While hydroceles in newborns typically absorb their fluid and disappear within a year, those in adult men can develop following an injury and may require treatment.

There are two main types of hydrocele. Communicating hydroceles are connected to an inguinal hernia which lets fluid flow in and out, while non-communicating hydroceles are largely independent. Most hydroceles in adults are classified as non-communicating.

Sandhurst Urology offers diagnosis, management, and medical intervention for hydroceles from our clinic in Bendigo. To book an appointment, please ask your GP for a referral.

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Symptoms of hydroceles

Hydroceles in adult men are generally painless and present with an increase in the size of the scrotum as their only symptom. This usually affects only one testicle, though both are sometimes involved. Other symptoms of a hydrocele may include:

  • One or both testicles appearing dilated or enlarged
  • Lumps in the testicles
  • The scrotum feeling heavy or ‘tight’
  • Swelling that is worse in the morning
  • Pain and/or discomfort in the scrotum

Note that hydroceles often occur alongside inguinal hernias, which carry greater health implications and present with their own set of symptoms. Remember that your own experience with a hydrocele is individual and your symptoms may not be exactly as described – for further advice and diagnosis, book an appointment at Sandhurst Urology.

How hydroceles are diagnosed

Your doctor generally begins diagnosing a hydrocele with a physical exam. After taking your medical history and asking about your symptoms, they may gently place pressure on your abdomen or scrotum to check for tenderness or abnormal shapes. Your doctor may also ask you to cough so they can see whether the bulge changes under pressure.

Doctors who suspect a hydrocele will usually ask for more tests to confirm the diagnosis. These tests may include:

  • Transillumination – this simple test involves shining a light through the scrotum. If a hydrocele is present, your doctor will be able to see clear fluid inside.
  • Ultrasound – this test uses sound waves to create images of the body’s softer structures. It may identify the hydrocele or show another case for your symptoms, such as a hernia or testicular tumour.
  • Blood and/or urine tests – used to identify infections, illness, or other causes of swelling in the scrotum, these tests involve taking a small sample of your bodily fluids which are tested in a pathology lab.

Preventing hydroceles

Hydroceles present at birth cannot be prevented, though adolescent and adult men can take steps to reduce their likelihood of developing them. In addition to any recommendations made by your care team, methods to do this may include:

  • Practicing safe sex – some sexually transmitted infections can cause scrotal swelling and hydroceles. Using barrier contraceptives which protect against STIS (such as male condoms) may therefore prevent hydroceles.
  • Using adequate protection during sports – as hydroceles can be caused by injury to the testicles and scrotum, consider wearing an athletic cup or protective underwear when playing sports.
  • Manage your infection risk – to prevent hydroceles caused by infection, notify your doctor of any changes in existing wounds or medical conditions and seek treatment as soon as possible.

Treatments for hydroceles

Most hydroceles disappear on their own within 12 months, though the right management strategies can help them heal faster and minimise discomfort as they heal. Strategies used to do this may include:

  • Observation – If they hydrocele is small and does not currently cause any problems, your doctor may recommend observing it over time to ensure it heals as expected and does not develop further.
  • Rest – although inconvenient, most hydroceles disappear on their own if given time. You may wish to avoid activities that involve straddling (such as bike riding) to minimise discomfort as they heal.
  • Fine needle aspiration – This is not recommended due to the risk of infection.
  • Antibiotics – hydroceles caused by bacteria or diseases may be managed using medications which help your body fight the infection.

Medical interventions for hydroceles

Most hydroceles disappear on their own within 12 months, though it may need to be surgically removed if it becomes very large or does not resolve itself. Surgery can also prevent the hydrocele from returning in the future.

Sandhurst Urology offers a suite of surgical treatments for hydroceles, including:

  • Hydrocelectomy – this surgery aims to remove the hydrocele by draining the fluid from it and closing the passage which allows more fluid to enter. Redirecting lymphatic fluid reabsorption can be done to help prevent recurrence. In some cases, your doctor may opt to remove the sac completely to prevent it from refilling in the future.
  • Hernia repair – If the hydrocele accompanies an inguinal hernia, especially one which lets fluid into the hydrocele, your surgeon may recommend surgery to repair it and therefore prevent the hydrocele from growing. This may be done in the same procedure as a hydrocelectomy or may require a separate procedure.

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