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What is Hydrocele ?

A hydrocele is a collection of fluid in a sac in the scrotum next to the testicle. The normal testis is surrounded by a smooth protective tissue sac. It makes a small amount of “lubricating fluid” to allow the testes to move freely. Excess fluid normally drains away into the veins in the scrotum. If the balance is altered between the amount of fluid made, and the amount that is drained, some fluid accumulates as a hydrocele. Surgical repair or removal of the fluid filled sac is performed through an incision in the scrotum under a general anaesthetic.

A hydrocele (from gr. hydor: “water” + kele: “break” or “cavity”) is a collection of fluid around the testicle. The condition is not uncommon in newborns, but rare in adults. Most often, a hydrocele appears only on one side. Hydroceles on both sides occur in only about 10% of the cases.

Two causes of swelling of the scrotum include hydrocele and varicocele. A hydrocele is fluid build-up around the testicle(s), while a varicocele occurs when blood backs up in the main veins that drain the scrotum. Hydroceles occur in two forms, communicating and noncommunicating. Communicating hydroceles are associated with hernias and are usually seen in baby boys. Noncommunicating hydroceles are collections of fluid around the testicle and may occur at any age. Varicoceles are most common among teenagers and adult men.

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Both conditions are usually painless. In infants, noncommunicating hydroceles often resolve in the first year of life and require no treatment. Communicating hydroceles do not tend to resolve and need correction. Varicoceles increase the risk of infertility and are generally treated if they occur in adolescents or infertile men. In any event, it is important to see your doctor for a diagnosis if you or your baby boy develops a swelling in the scrotum.

In most cases, a hydrocele is congenital, i.e. a baby boy is born with it. The cause is this: When the testicles descend into the scrotum before birth, a sac and some fluid from inside the abdomen move down along with it. The sac usually closes, and the fluid is absorbed. However, if it cannot flow back upward and remains inside the closed sac, it produces a so-called non-communicating hydrocele. This condition usually corrects itself within the first 18 months of life.

In some cases, the sac itself remains open, and the fluid can travel up and down between scrotum and abdomen. In this case, one speaks of a communicating hydrocele. It is smaller after a night’s rest and larger after a day of activity.

Causes

A communicating hydrocele occurs when the channel that connects the scrotum to the abdomen (which allows the testicles to descend in baby boys) does not close up properly. This allows fluid to “leak” into the scrotum. Noncommunicating hydroceles occur when fluid builds up within the tissues that surround the testicle. Hydroceles may also be caused by injury or infection in the scrotal area, or by a testicular tumor.

A varicocele occurs when the valve in the main vein of the scrotum doesn’t work properly, allowing blood to back up. Varicoceles are rarely caused by kidney tumors , or other tumors in the location of the kidney (retroperitoneum).

Symptoms

If you experience any of these symptoms, do not assume it is due to hydrocele or varicocele. These symptoms may be caused by other, sometimes serious, health conditions. If you experience any one of them, see your physician:

Painless swelling— The primary symptom of an adult hydrocele is a painless swelling in one or both sides of the scrotum, which feels like a water-filled balloon. This may be accompanied by a persistent ache or feeling of heaviness in the scrotum.

Conditions

Call a doctor if you notice an unusual growth or swelling in the testicles. While a hydrocele is not a health risk, an examination by a doctor is warranted to rule out more serious disorders.

Treatment

Treatment options include the following:

Hydrocele

Surgical repair is recommended if the condition:
- Persists beyond the first year of life
- Becomes large enough to threaten a testicle's blood supply
- Is associated with a hernia , also known as a communicating hydrocele
Sclerotherapy can also be used for adult (noncommunicating) hydroceles, in which the fluid is removed through a needle and replaced with a substance that causes scarring. This is generally less effective than surgery.

Varicocele

Treatment is not required for all varicoceles; however, it is generally recommended if a varicocele is felt to be the cause of infertility . Treatment options include:
- Open surgery— The vein is surgically cut and tied off.
- Catheter ablation— Heat is applied through a catheter to destroy the vein.
- Catheter embolization— A substance is placed in the vein to block it.
- Laparoscopy — This involves the use of a thin, lighted tube inserted into the abdomen to view the vessels in the body as they lead to the testicle.

Surgical Procedure

Two techniques are effective treatments for hydroceles.

The first technique, plication of the sac (Lord’s procedure) is used for small to medium hydroceles. The benefits of this technique are reduced risk of hematoma (localized collection of blood). Some articles suggest a slight incidence of recurrence of the hydrocele following this procedure.

The second technique, where the sac is everted and sutured behind the testis (Jaboulay procedure), is associated with a reduced risk of recurrence, but patients may have an increased risk of hematoma.

During surgery, the bulk of the hydrocele sac is cut away, and what remains of the sac is turned inside out. As a result, the fluid-secreting surface is now in contact with the inner skin of the scrotum rather than that of the testicle with which it made previous contact. The scrotal tissue blots up any fluid that is secreted, unlike the testicular tissue that cannot absorb fluid.

Surgical approaches are governed by 1) the size of the hydrocele and 2) the experience and preference of the surgeon.

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Figure : Hydrocele in Adults

Diagnosis

The doctor will gently palpate the testicles to determine the size and consistency of any lumps.

The doctor may shine a bright light on the scrotum to determine the nature of the swelling. Because hydroceles are composed of watery fluid, they are relatively transparent and allow the light to shine through. (A tumor or other mass would appear opaque.)

An ultrasound examination may confirm the diagnosis.

Risks

Recurrence of fluid collection can occur.

Blood collection around testes, which resolves slowly or requires surgical removal.

Possible infection of incision or testis requiring further treatment.

Benefits of surgery

Cosmetic

Reduction of scrotal size

Pain relief.

Complications

Pain
- Bleeding
- Infection in the surgical wound
- Unsightly scarring
- Developing a lump under the wound
- Injury to nerves that supply the skin around the groin
- Damage to the blood supply of the testicle or the tube that carries sperm

The common treatments for General Surgery are as follows :

Abdomino-Perineal Resection	\|	Spleen-Removal-Splenectomy
Abscess-Intra Abdominal	\|	Thyroidectomy
Abscess -Pelvic	\|	Aortic Aneurysm
Abscess -Subphrenic	\|	Femoral Embolectomy
Amputation -Above Knee	\|	Femoro-Femoral Bypass
Amputation -Below Knee	\|	Femoro-Popliteal Bypass
Amputation -Toe	\|	Varicose Ulcer Treatment
Breast Biopsy	\|	Varicose Vein Removal
Mastectomy	\|	Reflux Surgery
Epididymal Cyst Removal	\|	Gallbladder Surgery
Hernia Repair -Epigastric	\|	Adrenal Surgery
Hernia Repair -Femoral	\|	Appendix Surgery
Hernia Repair -Inguinal	\|	Colorectal Surgery
Hydrocele Operation -Adult	\|	Hernia Surgery
Pilonidal Sinus	\|	Kidney Surgery
Breast -Wide Excision And Axillary Sample	\|	Cholecystectomy -Gall Bladder Removal
Mastectomy-Male Subcutaneous	\|