Hydrocele

What is a Hydrocele?

A hydrocele is defined as the excessive and abnormal accumulation of serous fluid within the tunica vaginalis—a double-layered membrane or sac that surrounds and protects the testicle inside the scrotum. Under normal conditions, there is a minimal amount of fluid between these layers to allow for testicular mobility without friction. However, when there is an imbalance between the production and natural reabsorption of this fluid, it accumulates under pressure, causing a voluminous increase in one or both sides of the scrotal sac.

A hydrocele can appear at any age and is clinically divided into two distinct realities:

  • Adult Hydrocele (Acquired): It is typically non-communicating. It results from inflammation, local testicular trauma, infections (such as orchitis or epididymitis), or arises idiopathically (without an evident cause as one ages).
  • Infantile Hydrocele (Communicating): Very common in newborns. It is due to the persistence of an open processus vaginalis, allowing fluid from inside the abdomen to descend freely into the scrotum. In most children, it closes spontaneously by the first or second year of life.
Symptoms and Warning Signs

A hydrocele is essentially characterized by being a benign and painless physical alteration. The main symptoms described by patients include:

  • Increased Scrotal Volume: A gradual, smooth, and elastic swelling on one side of the scrotum. The size can range from small dimensions to large masses the size of an orange.
  • Mechanical Discomfort and Feeling of Heaviness: As the volume increases, the patient feels a bothersome weight, creating friction when walking, discomfort when sitting, or aesthetic embarrassment in daily and intimate activities.
  • Absence of Acute Pain: A pure hydrocele does not cause severe pain. If the swelling is accompanied by sudden pain, local redness, or fever, it may indicate an active infection (orchiepididymitis) that requires urgent urological treatment.
Diagnosis of Hydrocele

Diagnosis in a urological office is simple, fast, and painless, essentially aiming to confirm the diagnosis and exclude serious pathologies hidden by the fluid:

  • Physical Examination: The urologist palpates the scrotal sac to evaluate the consistency of the mass.
  • Scrotal Ultrasound: This is the reference complementary exam. The ultrasound confirms the presence of the hydrocele and, crucially, allows the urologist to clearly visualize the structure of the testicle that is hidden by the fluid. This is fundamental to **unequivocally exclude testicular tumors** or epididymal cysts that may be causing the fluid production.
Treatment: Hydrocelectomy

Small hydroceles that do not cause physical discomfort, pain, or aesthetic impact do not require any surgical treatment and are kept under surveillance. Medications or ointments have no efficacy in eliminating or reabsorbing this fluid.

When the hydrocele reaches significant dimensions or causes mechanical symptoms, the definitive and recommended treatment is surgical:

Hydrocelectomy Surgery (Tunica Vaginalis Plication)

Performed in the operating room under general, regional (spinal anesthesia), or local anesthesia with sedation.

  • The surgeon makes a small incision in the skin of the scrotal sac or in the inguinal region.
  • The tunica vaginalis is accessed, all accumulated fluid is drained, and the membrane is opened, everted, or resected, suturing it behind the testicle to prevent the space from closing again and accumulating fluid in the future.
  • The skin is closed with fully absorbable stitches. The procedure takes about 20 to 30 minutes.

Note on Needle Aspiration: Simple drainage or aspiration of the fluid with a needle in the office **is not recommended as a definitive treatment**. It has a recurrence rate (the fluid filling the scrotum again) of practically 100% within a few weeks and carries a high risk of introducing bacteria, causing serious infections or local hemorrhages. It is reserved only for very debilitated patients who cannot undergo any form of anesthesia.

Post-Operative Recovery

Recovery is usually fast. The patient should use a scrotal support or tight underwear during the first two weeks to minimize natural post-operative swelling. Relative rest is recommended for the first 3 to 5 days, along with local ice application and abstinence from intense physical effort, sports, or sexual activity for about 3 to 4 weeks.

Have you noticed an increase in volume or painless swelling in one of the testicles? Treat the discomfort and exclude other problems.
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