Hydrocele is a condition where fluid accumulates around a testicle, leading to swelling in the scrotum.

Although it is typically painless, it can cause discomfort and concern due to its visible enlargement of the scrotal area.

Hydrocele is generally benign and often resolves on its own, especially in newborns.

However, in adults, it may be associated with underlying health issues and may require treatment if it becomes symptomatic or leads to other complications.

Wondering what causes hydrocele? What are its effective treatment options?

In this blog, Mykare Health explores the origins of hydrocele, delving into the possible causes, types, risk factors, and preventive measures.

What is Hydrocele?

A hydrocele is an abnormal collection of fluid in the scrotum, the sac surrounding the testicles. It is most commonly seen in newborns, with about 5-10% of male infants affected by it.

However, adult men, especially those over 40, can also develop hydroceles. There are two main types of hydroceles: congenital and acquired.

• Congenital Hydrocele: Often present at birth, congenital hydrocele results from incomplete closure of the processus vaginalis, a channel that allows testicles to descend from the abdomen into the scrotum.

• Acquired Hydrocele: This type of hydrocele develops later in life and can be linked to inflammation, injury, infection, or other underlying medical conditions.

What Causes Hydrocele?

The exact cause of hydrocele can vary depending on the type.

1. Congenital Causes

In infants, hydroceles are typically due to the natural developmental process before birth. During pregnancy, the testicles move from the abdominal cavity to the scrotum through a passage called the processus vaginalis.

After the testicles descend, this passage usually closes. If it fails to close completely, fluid can move into the scrotum, leading to a hydrocele. Over time, as the body absorbs the fluid, the hydrocele may disappear.

2. Infections

Infections can lead to an acquired hydrocele, especially in adults. Bacterial or viral infections, like epididymitis or orchitis (inflammation of the testicles or epididymis), can cause inflammation, resulting in fluid accumulation.

One such infection is lymphatic filariasis, a parasitic infection common in tropical and subtropical regions, which can lead to hydrocele by blocking lymphatic drainage.

3. Injury and Trauma

Direct injury to the scrotum or testicles, whether due to physical activities, accidents, or surgeries, can lead to fluid accumulation as a protective response of the body. This fluid buildup can then cause hydrocele as the body attempts to protect the testicle from damage.

4. Inflammatory Conditions

Chronic inflammation in the scrotal area can irritate the surrounding tissues, leading to fluid accumulation. Conditions like vasculitis (inflammation of blood vessels) or other autoimmune disorders may contribute to hydrocele formation as they affect the body's fluid balance and tissue health.

5. Tumors

In rare cases, hydrocele can develop as a secondary condition to testicular tumors or other growths in the scrotal area. Tumors can obstruct normal fluid drainage, causing fluid to accumulate around the testicles.

6. Lymphatic Blockage

A blockage in the lymphatic system, responsible for draining fluids, can also lead to a hydrocele. When lymphatic drainage is compromised, it can cause fluid to back up and pool around the testicles. Such blockages may occur due to infections, trauma, or even surgical complications.

7. Aging

Aging can weaken the walls of the scrotum, which may lead to fluid buildup over time. Older men are more likely to develop hydroceles due to gradual changes in the scrotal tissues and possible deterioration of lymphatic drainage.

Types of Hydrocele

There are two main types of hydrocele based on their origin and behavior

• Communicating Hydrocele: This occurs when there is an open channel between the abdomen and the scrotum, allowing fluid to flow freely. It may vary in size throughout the day and is more common in infants.

• Non-Communicating Hydrocele: In this type, the fluid is trapped within the scrotum and does not change in size. Non-communicating hydroceles are more common in adults and often result from injury, infection, or other acquired causes.

Risk Factors

Several factors increase the likelihood of developing hydrocele

• Age: While hydrocele is common in infants, it can also affect older men, particularly those above 40.

• Infections: Those who have had infections, especially in the scrotal area, are at higher risk.

• Geographic Region: People living in tropical or subtropical regions where parasitic infections like filariasis are common may be more susceptible.

• Previous Scrotal Injury: Any past injuries to the scrotal area can increase the likelihood of developing hydrocele.

Symptoms of Hydrocele

Hydrocele is usually painless but causes visible swelling in the scrotum. The symptoms can include:

• Swelling in one or both sides of the scrotum

• A heavy or dragging sensation

• Discomfort or pain (if the hydrocele is large or caused by an infection)

It’s essential to differentiate hydrocele from other scrotal swelling conditions, such as hernias or tumors, which may have similar symptoms but require different treatments.

Diagnosis of Hydrocele

Physicians diagnose hydrocele through a combination of physical examination and imaging tests:

• Physical Examination: A doctor may use transillumination, shining a light through the scrotum to detect fluid accumulation. If the scrotum lights up, it suggests the presence of fluid.

• Ultrasound: This imaging test can help confirm the diagnosis by providing a detailed view of the scrotum’s structures, distinguishing hydrocele from other causes of scrotal swelling.

Treatment of Hydrocele

Most hydroceles in infants resolve on their own by the age of one. For adults, treatment options depend on the hydrocele's size, severity, and underlying cause.

• Watchful Waiting: Small, painless hydroceles that don’t cause discomfort or health issues are often left untreated and monitored for any changes.

• Aspiration: In cases where hydroceles cause discomfort, the fluid may be drained using a needle. However, this method is often temporary, as the fluid can reaccumulate.

• Surgery (Hydrocelectomy): For persistent or symptomatic hydroceles, surgery may be recommended. Hydrocelectomy involves making a small incision in the scrotum, removing the fluid, and preventing reformation.

Prevention of Hydrocele

While not all hydroceles can be prevented, there are some steps to lower the risk, especially for acquired hydrocele

• Practice Good Hygiene: Preventing infections is essential. Maintaining good genital hygiene reduces the risk of infections that could lead to hydrocele.

• Wear Protective Gear: Using protective equipment during physical activities helps reduce the risk of scrotal injury.

• Seek Timely Treatment for Infections: Treating scrotal infections promptly can prevent complications that might lead to hydrocele.

Hydrocele is a relatively common and usually benign condition affecting infants and adults. While most cases resolve on their own, some hydroceles require medical intervention, particularly when they cause discomfort or are linked to underlying issues.

Understanding the causes of hydrocele can aid in its prevention and early diagnosis, ensuring appropriate treatment when necessary.