HYDROCELES

Hydroceles are benign cysts of the scrotum (from "hydro", for water, and "cele", for cavity). They are very common, and more often than not need no treatment. Hydroceles are not cancerous nor will they become cancerous. They are often confused with spermatoceles, another benign cystic disease of the scrotum.

Anatomy

Normally every male has two testicles within the scrotum. Their main functions are to produce the male hormone testosterone and to produce sperm. Normally the testicle is situated in a special sac that bathes the testicles with body fluids. This sac is called the "processus vaginalis". The sac and its fluid have nothing to do with testes performance, and are merely a result of the development of the testicle.

Causes

Normally the testicle exudes or sweats a small amount of fluid (not sperm) from its outside covering, and sac re-absorbs this fluid.

Under certain circumstances, such as previous trauma or infection (but usually for no reason at all), this sac has difficulty re-absorbing the fluid. This results in a build-up of the fluid in the sac, resulting in a hydrocele. Very rarely, the hydrocele is caused by a cancer or serious infection of the testicle. While these occurrences are rare, it is important that the cause of the hydrocele be investigated. Usually the investigation requires only a physical examination, or occasionally an ultrasound of the scrotum, if the hydrocele so large that the testicle within it cannot be examined properly.

In many instances hydroceles remain small, the fluid build-up is not significant and remains relatively soft. In other instances the hydroceles continue to enlarge, and can become five to six inches or larger in size.

Most of the time hydroceles are painless. However, they can enlarge enough to make clothing uncomfortable, or at least tight fitting in the wrong places.

Treatment

Hydroceles do not go away without treatment. Fortunately, most hydroceles require no treatment. If the hydrocele is not causing pain or is not so large that clothing is uncomfortable or unsightly, it can be left alone.

If the hydrocele does require treatment, surgical removal is recommended. Surgery is usually done as an outpatient, and requires less than half an hour to perform. A general, spinal, or even local anaesthetic can be used for the procedure. Most patients will need to stay off their feet for three to five days, and to reduce activity for a week.

Risks of the surgery include the bleeding, pain, and infection that is associated with any surgical procedure. Unique risks include recurrence of the hydrocele. The recurrence rate is about one to two per hundred patients.

Hydrocelectomy should not affect either the sperm or hormone production of the testicle.

Other treatments

Other treatments for hydrocele include aspiration, and aspiration with injection of sclerotic agents. Aspiration entails sticking a needle through the skin into the fluid sac and withdrawing the fluid with a syringe. I personally do recommend this technique because the hydrocele will almost always return, and the chance of infection is not insignificant. Some physicians have had success injecting sclerotic or scarring agents into the hydrocele cavity. This scarring prevents recurrence of the hydrocele in some cases. This technique has not achieved much acceptance in the United States because of the discomfort, sometimes permanent, and the chance of infection.