Hydrocele

Collection of fluid in the tunica vaginalis of the testis is called hydrocele. The fluid may also get collected within the spermatic cord. The word hydrocele means "a sac of water". It is a most common condition seen in 1% of the male adult population. It is a benign swelling that is usually painless. Hydrocele may be acute or chronic.

Acute hydrocele may occur in association with acute infection of the epididymis or as a result of local injury or due to any systemic infectious disease like mumps. The cause of chronic hydrocele is still unknown. Hydrocele can be present both in children as well as in older men. In children, it is usually due to patent processus vaginalis and in adults it may be because of any tumor, inflammation or trauma. Tumor, inflammation or trauma may increase the production of serous fluid which results in hydrocele. Hydrocele can occur due to decreased reabsorption of serous fluid by the lymphatics or the venous system which may be associated with conditions like inguinal hernia.

The affected person is initially asymptomatic, but later may present with complaints like scrotal swelling or mass that is large, increasing in size, uncomfortable and embarrassing. The symptoms vary and are directly related to the causes mentioned above. That is, if the person comes with hydrocele giving a history of recent trauma, he may have symptoms like pain and swelling. If the hydrocele is caused due to an infection, he may present with the symptoms like urge to urinate, pain or discomfort during urination and increased frequency in urination.

Diagnosis is made by considering the history and giving a physical examination of the patient. Hydrocele may sometimes be misunderstood for hernia which can be differentiated by a procedure called transillumination. Hydrocele transmits light when transilluminated while hernia does not. Treatment is not necessary unless the hydrocele becomes very painful or affects circulation. There are various treatments available for hydrocele. They are fine needle aspiration, needle aspiration with injection of sclerosing agent and surgical removal.

Fine needle aspiration is a simple surgical procedure that is relatively painless. A fine needle is inserted and the fluid is withdrawn. The problem with this procedure is that there are high chances for the fluid to reaccumulate. Aspiration with injection of sclerosing agent and surgical removal has good results. In the surgical removal of the hydrocele, an incision is made in the wall of the scrotum down to the enlarged tunica vaginalis. The sac is opened and the content is removed followed by suturing the them together to collapse the wall.

After the surgery the person is instructed to wear tight underwear or an athletic supporter for support and comfort. Pain killers are administered for a week after the surgery. Daily change of dressings as an out patient may be necessary to avoid infections. The major complication after this surgery is formation of hematoma in the loose scrotal tissues.

Thus hydrocele is just collection of fluids and it is not something to be embarrassed about. If you have any of the symptoms mentioned above, get in touch with your doctor and get treated at the early stage.