A hydrocele, also known as hydrocele, is a change in the testicles that is benign and usually occurs without pain. Water collects in the scrotum.

What is a hydrocele?

According to abbreviationfinder, a hydrocele can only occur on the testicles and/or also on the spermatic cord. There is both a primary, i.e. a congenital hydrocele, and a secondary, i.e. acquired hydrocele. This can therefore arise in the course of life through different causes.

The primary hydrocele can be unilateral or bilateral and often resolves without treatment in the first few months of life. Such a congenital hydrocele is not uncommon.

There is also a special form of hydrocele, acute hydrocele. It can be caused by trauma, bleeding, or infection. This form differs from the other two in the form of severe pain.

Causes

The causes of hydrocele are different. In primary hydrocele, the cause is due to a developmental phase in the womb. The peritoneum protrudes into the scrotum in the form of a funnel, takes place in the body of the unborn child and later recedes. Water can then collect there, resulting in a hydrocele.

The testicles of the child only descend from the abdominal cavity into the scrotum shortly before birth or within the first year of life. They have to slide through the protuberance mentioned, which normally closes afterwards. If this is not the case, a hydrocele can form there or even an inguinal hernia ( inguinal hernia ) if the closure fails completely.

Secondary hydrocele can affect male children or adults throughout life. There are several triggers for this, such as inflammation of the testicles or epididymis (see Epididymitis ). In addition, injuries or testicular tumors can lead to a hydrocele. Hydroceles can also occur as a result of an operation to remove varicose veins on the testicles (varicoceles).

Symptoms, Ailments & Signs

A hydrocele can manifest itself through very different symptoms. A swollen testicle is typical of the disease. The extent to which the testicles are swollen depends primarily on the location and severity of the accumulation of fluid.

In the early stages, the hydrocele usually does not cause any further symptoms. Only with the enlargement of the testicles do other symptoms appear, such as throbbing pain or a feeling of pressure or heaviness. If the course is severe, an acute scrotum occurs, which is associated with severe pain. Acute hydrocele can cause severe swelling of the testicles.

There is also an increased risk of developing infertility. Many sufferers also notice a throbbing sensation in the scrotum area. Externally, a hydrocele can be recognized primarily by the swelling of the testicles. In severe cases, bleeding can also occur, which is expressed by a partial red discoloration of the scrotum.

A congenital hydrocele occasionally resolves on its own. However, a hydrocele or a hernia can also occur, which can cause serious complications. In the worst case, the affected testicle dies.

Diagnosis & History

The hydrocele is diagnosed with the help of various examinations, the first being a scan by the doctor. Here it is determined whether the scrotum is swollen and whether there are other external abnormalities. An ultrasound scan is usually performed to confirm the hydrocele.

The course of a hydrocele is generally positive because it is a benign change in the testicles. The primary hydrocele is usually self-resolving and no treatment is necessary. In the case of secondary, on the other hand, the cause should be treated. Surgery may also be necessary if the hydrocele persists. However, the prognosis is still positive.

Complications

In most cases, water breakage does not lead to any particular complications or discomfort. The change in the testicles is benign and the patient usually does not experience any pain. The testicles are relatively swollen and fill with water. Without treatment, pain in the testicles can occur as the disease progresses, although this does not occur in the first place.

Pain in the testicles is a very unpleasant symptom for men and can lead to a severe reduction in quality of life. The affected person appears defeated by the water break and no longer actively participates in social life. Furthermore, it can also lead to the development of psychological complaints and depression if the hydrocele is not treated. Rest pain can also lead to sleep disturbances at night.

In many cases no treatment is necessary. However, if the hydrocele does not go away on its own, surgery can also be performed to resolve the symptoms. There are no particular complications. The life expectancy of the patient is also not affected by the hydrocele.

When should you go to the doctor?

A hydrocele must always be examined by a doctor. Since the degeneration can also turn into a malignant tumor, early diagnosis and treatment of the disease always has a positive effect on the further course and can prevent complications. A doctor should be consulted for hydrocele whenever there is swelling in the testicles. This swelling usually occurs without any particular reason and is permanent.

Usually there is no pain. Accumulations of water can also be seen on the testicles. Only in rare cases does the testicles cause pain or other unpleasant feelings. If the hydrocele symptoms occur over a longer period of time and do not go away on their own, a visit to a urologist is definitely necessary. The treatment usually takes place at the urologist and can completely limit the hydrocele. The life expectancy of the patient is not negatively affected by this disease.

Treatment & Therapy

If the congenital hydrocele does not have an inguinal hernia, the affected child does not initially need treatment because the water retention will resolve on its own. If the hydrocele has not resolved by the end of the first year of life, an operation is necessary.

This is just a minor procedure in which an incision is made in the groin to close the connection between the peritoneum and the scrotum. In the worst case, a hydrocele forms again after a few months, but this rarely happens. In the case of secondary hydrocele, therapy is scheduled to treat the cause. As a result, the accumulation of water can often recede.

If the water break persists or there is no clearly identifiable cause, an operation is also recommended here to eliminate the symptoms. A special technique is used to prevent the hydrocele from reforming.

Outlook & Forecast

The majority of patients diagnosed with hydrocele can expect improvement. Statistically, it was determined that nine out of ten patients experienced a resolution of the typical symptoms. A life without restrictions is the rule. There are two risk groups: small children up to the age of two and everyone else. Babies’ illnesses usually heal on their own. The others require surgical therapy.

Toddlers are in constant development. This means that the origin between the testicles and the abdominal cavity closes by itself. This often happens around the fourth month of life. From the age of three, only surgical intervention remains. This usually proceeds without complications. Possible difficulties are also known from other interventions: infections, swellings and others. Only rarely does the water break return.

If no intervention takes place, complications regularly arise. For example, permanent infertility is possible. Fluid in the scrotum then restricts blood flow. Testicular torsion, in which the testicle disrupts blood flow, is also conceivable. The genital area is always very sensitive. Pain occurs more and more in everyday life.

Prevention

There is no direct way to prevent a hydrocele; one can only try to keep the risk of occurrence as low as possible. For example, anyone who suffers or has suffered from testicular or epididymitis should treat it consistently with medical advice. Anyone who practices certain types of sports that involve an increased risk of injury in the genital area should protect themselves adequately. For example, there are genital protectors for athletes that could be put on.

Aftercare

After an operation, the patient usually stays in the hospital for a day or two to ensure the necessary follow-up care. This consists of removing the wound drainage tube the day after the operation and checking the operation wound. Any wound pain that occurs can be discussed with the doctor during the visit and treated appropriately with medication.

In the first two weeks after being discharged, those affected must take it easy and avoid physical exertion. Hot baths or full baths in general are taboo during this time, the shower should be used instead. Sauna sessions or the use of hot water bottles or heating pads are also contraindicated within this time frame.

If there is no redness, swelling or pain, the wound is healing as planned. Nevertheless, the patient is required to arrange a check-up appointment with his urologist shortly after his discharge and to give him the discharge letter from the clinic. This contains all the information about the treatment that has been carried out and the medication that has been administered.

The suture threads begin to unravel after two weeks and gradually fall off on their own over a period of up to three months. If the suture material causes irritation or if there are still residues on the wound after this period, a doctor should be contacted.

You can do that yourself

A hydrocele usually needs to be treated surgically. Some home remedies and tips support the treatment.

First of all, those affected should wait and see. Sometimes the congestion on the testicles clears up over time and the fluid is allowed to drain out on its own. This process can be supported by a bath with Epsom salts. The warm water combined with the salts ensures that the liquid is drawn out of the body through the skin and the swelling subsides. Epsom salt is also rich in magnesium, which relaxes muscles and reduces tenderness. However, if the hydrocele is painful, soaking in Epsom salts can cause further inflammation. If you are in pain, it is best to seek medical help.

After the recovery period, rest and warmth are recommended. Children should spend as much time as possible in bed in the first two days after treatment. Men should not engage in sexual activity for at least a week. Finally, the scrotum and especially the area around the hydrocele should be spared. Protective underwear or a bandage will protect the irritated area from further stress and help recovery.