Hydrocele

What is a hydrocele?

Hydrocele occurs when fluid is accumulated in the scrotum.  The scrotum is a thin sac that surrounds the testicles. It is more common in babies or premature newborn males. Almost 10% of newborn boys are born with hydroceles. Hydrocele can also occur in older boys and adults.

Hydroceles are usually painless and do not need treatment. In infants, the swelling goes away by the time he reaches one year. Large hydroceles in adult men can cause discomforts especially while walking or during sexual activities.

Types of hydroceles

Hydroceles are of two types:

Communicating hydrocele

In communicating hydrocele, the sac is open. It is in contact with the abdominal fluids. The fluids in the abdominal cavity can flow in or out of the scrotum.

Non-communicating hydrocele

In non-communicating hydrocele, there is no communication with the abdominal cavity. The sac closes and the fluid gradually absorbs into the body. This is very common in newborns.

Hydrocele causes

In the 7^th month of pregnancy, the testicles descend from the abdomen into the scrotum. It carries the sac that covered it in the abdominal cavity. This sac is filled with fluids that are absorbed by the body in the first year. In babies born with hydroceles, natural absorption of the fluid does not occur.

In adult-type hydroceles, the channels that connect the abdomen and the testicles are still open allowing fluids from the abdomen to enter the scrotum. Hydroceles can occur in teenagers during puberty.

Hydroceles in older males can be due to:

• Injury
• Infection
• Inflammation
• Tumor in the testicle
• Hernia
• Swelling due to fluid retention in the lower half of the body

Hydrocele symptoms

The main symptom of a hydrocele is scrotum swelling. There is usually no pain.

If a child is having sudden pain in the scrotum, this may be due to testicular torsion. This happens when the testicles get twisted due to some injury. This blocks the blood supply to the testicles and needs emergency care.

Large hydroceles in adult men can cause a feeling of heaviness or discomfort. The swelling is more in the mornings.

Hydrocele diagnosis

To diagnose hydrocele in a child or an adult, the doctor will perform the following tests:

Physical examination

In hydrocele, the scrotum is filled with fluid. It is difficult for the doctor to feel the tenderness of the scrotum. The doctor uses a technique called transillumination. Light is transmitted through the scrotum to view the fluid in the scrotum. The doctor can view the presence of fluid if the light passes through the scrotum. Light will not pass if the inflammation is due to a solid mass. This may indicate cancer. Though this is not a definitive diagnosis, it helps the doctor to understand the condition.

Blood and urine tests

Blood and urine samples are ordered to check infections and to see whether the swelling is due to other diseases.

Ultrasound

An ultrasound test confirms the diagnosis and rules out diseases like tumors, hernia, and other possible causes for swelling.

Treatment options

Hydroceles are generally not painful. Unfortunately, there are no medications for hydrocele treatment.

In infants, the hydrocele goes away within the first year of their birth. In adults, they generally disappear within 6 months.

If a patient has communicating hydrocele, doctors may perform surgery or else it might lead to a hernia.

There are four procedures to remove hydroceles:

• Hydrocelectomy
• Laparoscopic surgery
• Needle aspiration
• Sclerotherapy

Hydrocelectomy is a surgical procedure. Needle aspiration and sclerotherapy are non-surgical procedures.

Preparation

Preparing the patient involves certain laboratory tests, diagnoses, and precautions before the procedure.

• Routine urine and blood tests.
• Ultrasound and x-rays to evaluate the condition.
• Consultation with an anesthesiologist regarding the side effects of anesthesia.
• The doctor will ask you to discontinue certain medications like blood thinners, herbal, or dietary supplements.
• Avoid drinking or eating any foods six hours prior to the surgery or after midnight.
• The patient must sign the consent form before the surgery.
• The genital area and the abdomen are shaved before the operation.
• The patient must wash and clean the genital area to avoid infections.
• The nurse may give an enema to clear the bowels before surgery. Some patients prefer laxatives.

Procedures

Hydrocelectomy

Hydrocelectomy in infants aims to close the processus vaginalis. The closure normally occurs a few weeks before or after the birth of the male baby. Large hydroceles in adults require surgery because they are painful, embarrassing, and disrupt normal genital functions.

Steps to perform the surgery:

• The surgeon administers general anesthesia.
• He/she then makes a small incision near the scrotum.
• The surgeon removes the fluid through suction.
• The surgeon closes the communication between the scrotum and the abdominal cavity.
• Then the surgeon removes the hydrocele sac and closes the incision.
• If there is a hernia, the surgeon will repair it.
• After surgery, the surgeon applies surgical dressings to the incision site.

Laparoscopic surgery

Sometimes, surgeons use a laparoscope to perform the surgery. The surgeon inserts a laparoscope with a tiny camera through the incision. The laparoscope camera projects the image on the video screen. The surgeon inserts other instruments and repairs the hydrocele.

Needle aspiration

Needle aspiration is a less invasive procedure compared to hydrocelectomy. The doctor uses a needle or a syringe to drain (aspirate) the fluid out of the sac. Some local anesthetic is applied.

The procedure is not so popular because there is a chance of recurrence. Within some weeks, the fluid may accumulate into the sac.

Doctors recommend needle aspiration on patients who may develop complications during hydrocelectomy surgery. There are risks of developing pain or infection after a needle aspiration procedure.

Sclerotherapy

Sometimes, doctors inject certain medications into the scrotum to prevent the recurrence of hydroceles. This procedure is known as sclerotherapy.

When should you go for hydrocele surgery?

A surgeon may recommend surgery if:

• The hydrocele is too large.
• It is painful.
• There is an infection.
• Discomfort.
• Blocks the blood flow.
• The patient has a hernia.

What is the age limit for hydrocele surgery in infants?

In newborns, hydroceles generally improve within one year of birth. Small infants are observed during the first six to twelve months. If the hydrocele does not resolve, surgery is recommended.

What is the recovery time for surgery?

The average recovery time is two weeks. Some patients may take a longer time to recover depending on their condition and response to medications.

Surgery options

Typically, hydrocele is an outpatient procedure. The surgeon can do the operation in an outpatient surgical center or a hospital depending on the condition of the patient. Some patients may need additional surgeries and post-operative care that requires a hospital stay. Many patients prefer to have surgeries in private hospitals to avoid risks and complications post-surgery. There are others who like small facilities because they are more accessible and convenient.

Big Hospitals

Pros

• State-of-the-art healthcare facilities.
• High success rates.
• Qualified doctors.

Cons

• High cost.
• Delay in consultations.

Small clinics

Pros

• Lower costs.
• Easy access to facilities.
• Quicker appointments.

Cons

• Limited accessibility to upscale amenities.
• Limited beds.

Cost of surgery

The average cost of hydrocele surgery can start from INR 20,000 and may go up to 1.2 lakhs. The cost depends on factors like:

• The type of surgery.
• Whether the surgery is done in an outpatient facility or a private hospital.
• Need for a hospital stay.
• Hospital charges.
• Surgeon fees.
• Post-operative care.
• Condition of the patient.

Post-op care and things to keep in mind

Hydrocelectomy is a minor surgery. Patients go home the same day.

Aftercare tips:

• Apply ice packs for 24 hours on the incision site to reduce swelling and pain.
• Continue using cold packs for a few days. Apply the cold pack for 10-15 minutes.
• Take pain relievers like ibuprofen.
• Wait for a few weeks to return to normal work.
• Avoid riding a bike or straddling for a few weeks.
• Take sponge baths or showers to keep the incision site clean.
• Some patients have a small drain attached to the incision site. It helps to drain out the excess fluid. The doctor generally removes the drain after one to two days post-surgery.
• Adult men must abstain from sexual activities for the first few weeks.
• Avoid taking hot baths.

Mild swelling, bruising, and bleeding are normal. Use jockstraps for a few days for comfort. If there is increased pain, swelling, and high fever, consult the doctor immediately. Doctors usually use dissolvable stitches. The doctor will check the incision site and the stitches after a few weeks.

Complications from hydrocele surgery

Hydrocelectomy surgery is a safe procedure. However, like any other surgery, there may be certain complications.

• Redness and swelling in the incision site.
• Constant pain.
• Foul-smelling secretion from the surgical wounds.
• Blood clots.
• Fever.
• Infection.
• Nerve damage.
• Allergic reactions.
• Scrotum injury.
• Excessive bleeding.
• Testicular damage.
• Infertility.
• Anesthesia complications.
• Breathing problems.

Best option

Hydroceles are generally harmless and painless. Patients with enlarged hydroceles remove them because of the discomfort and embarrassment. Hydroceles are also removed if there are infections, pain, or chances of getting a hernia in the future.

Hydrocele surgery is normally done in an outpatient setting. Hydrocelectomy is the most common surgery for hydroceles. Some doctors perform laser surgery for removing hydroceles. Recovery is faster and there are fewer risks in laser surgery. Goficure is a healthcare service provider in elective surgeries. Their team of experts assists patients from booking an appointment, consultation, hospital stay, and homecare facilities after the surgery.

Why choose goficure?

• Top hospitals.
• Experienced surgeons.
• Minimal risks.
• Insurance coverage.
• Low costs.
• Hassle-free experience.
• Personalized care.

References