Hydrocele: What are the symptoms of hydrocele in the scrotum and is it dangerous?

Hydrocele of the testicle is also popularly called water hernia.

This is a buildup of serous fluid in the scrotum, causing it to swell and enlarge.

Normally, the between the lining of the testicle only a small amount of fluid.

If blood accumulates in the testicles, this condition is called hematochezia.

Hydrocele often occurs in children and young boys. In adulthood, it is usually caused by an accident or infection around the genitals.

In hydrocele, varying amounts of fluid may accumulate in the lining of the testicles and its resorption may be reduced. This leads to subsequent fluid accumulation and testicular enlargement.

Hydrocele does not affect male fertility and poses no danger to the testicles.

Male genital organs

The testis is an egg-shaped paired gland located in the scrotum and covered by a whitish membrane.

The function of the testes is to produce sperm.

For proper function and because of the need to maintain a lower temperature, the testicles are stored outside the body in the scrotum. This achieves a lower temperature than in the abdominal cavity.

The epididymis is a long formation located at the back of the testicle, wider at the top, overlapping the testicle.

The fallopian tube (ductus deferens) passes from the epididymis upward, through the inguinal canal, and connects to the urethra.

Blood vessels pass through the scrotum and inguinal canal along with the seminiferous ducts. The blood vessels of the testes and the vas deferens are surrounded by a muscular sheath that forms the so-called seminal cord.

The seminal vesicles (vesiculae seminales) are small sac-like organs located on the sides of the bladder. They produce a sticky mass that inhibits the movement of sperm.

The prostate gland (prostate) is located below the bladder. It produces a thin, cloudy secretion that mixes with semen and mucus from the epididymis to form ejaculate.

The scrotum is the skin sac in which the testicles are located. The scrotum is divided into two halves by a septum. The skin of the scrotum is soft and has hairs on its surface.

The terminal part of the male sex organ is the glans penis, inside which is the urethra.

The course of descent of the testicles of the fetus

Already during intrauterine development of the fetus, the testicles, which separate the abdominal cavity from the scrotum, descend.

Descending downwards, the testes pass through the inguinal canal until they reach the scrotum. Along with the seminiferous tubules, the processus vaginalis, the connection between the peritoneum and the scrotum, also descends.

At birth, the testicles are already descended and the processus vaginalis is closed. Two sheets remain on the front of the testicles. If it fails to close, fluid is deposited in this space and a hydrocele forms.

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Hydrocele in children

The processus vaginalis allows communication between the scrotum and the peritoneum. It is a protrusion of the peritoneum protruding into the inguinal canal already during the development of the male fetus in the uterus before the descent of the testes. It disappears after the descent of the testes.

If there has been no separation of the abdominal cavity from the scrotum, the fluid in the abdominal cavity enters the inguinal canal and descends into the testes.

In newborns, the occurrence of hydrocele is not uncommon, but in most cases, this deficiency is corrected by 1 year of age. If it continues to persist, it must be corrected surgically.

Distribution of hydrocele

Hydrocele is divided into primary and secondary.

Primary hydrocele

Primary hydrocele is also called as communicating or congenital hydrocele. It arises after incomplete closure of the amniotic sacs during fetal development with a persistent opening through which fluid from the abdominal cavity flows into the scrotum.

The hydrocele communicates. That is, it's in contact with the fluid in the abdominal cavity.

This type of hydrocele is characterised by the size of the scrotum, which changes during the day as fluid moves from the scrotum into the abdominal cavity.

Hydrocele of the spermatic cord occurs after the closure of the sac and leaves fluid in the spermatic cord. In children, it is referred to as processus vaginalis of the spermatic cord. This changes during intrauterine development before birth or after birth during 1-2 years and closes the communication between the abdomen and scrotum.

Primary hydrocele can occur at puberty, even if it has not manifested by then, but also in men in middle and later age.

Hydrocele of the canal of Nuck occurs in women. It is a fluid accumulation at the site of the vaginal entrance and the labia majora. It is manifested by swelling of the labia majora or swelling in the groin.

Secondary hydrocele

Secondary hydrocele is also known as non-communicating, reactive or acquired hydrocele. It is caused by another condition, such as fluid left in the seminal vesicle after the closure of the anus. It can also result from inflammation, infection, trauma, as well as a tumour or testicular torsion.

Non-communicating hydrocele occurs when the inguinal canal is closed but there is excess fluid in the scrotum. It occurs because fluid has remained in the scrotum after the canal is closed and there is no connection to the abdominal cavity through which the fluid can return to the abdomen.

It can also occur in newborns, but also in men at an older age without any cause.

This type of hydrocele is usually small, grows slowly or remains unchanged for years. The exception is filariasis (a tropical infection caused by parasitic worms), where the hydrocele can grow to large proportions.

Fluid accumulation in the testes may also result from an imbalance in the rate of fluid production and reabsorption.

It occurs most commonly in adolescent and adult males.

Reactive hydrocele occurs as a result of inflammation, infection, scrotal trauma, or testicular curl in the scrotum. It is one of the non-communicating hydroceles.

Read: Varicocele: How do scrotal varices manifest?

Primary hydrocele

The cause of primary hydrocele is an incomplete closure of the processus vaginalis and its patency allowing the flow of fluid.

One of the testicular sheaths remains open, leaving a connection with the peritoneal cavity.

It often occurs in young children.

Secondary hydrocele

The cause of its occurrence is not exactly known, but it can occur in a variety of conditions:

• Inflammatory process in the genital area
• May be related to a tumor
• As a result of an injury to the scrotum, by a blow, trauma, in the scrotal area, which produces a larger amount of fluid
• From excessive fluid production by the testicular sheaths
• Imbalance between fluid production and absorption
• As a result of irradiation
• More common in men after the age of 40 because their vascular supply to the testicles decreases
• It can also form in a band in the inguinal area

Risk factors

• Premature babies are at higher risk of developing
• Trauma to the scrotum
• Infectious diseases
• Sexually transmitted diseases

For information on STD transmission, see our article, What are the risks of changing sexual partners? Sexually transmitted diseases

Symptoms of hydrocele depend on its cause.

With incomplete closure of the membranes, the scrotum may change during the day by moving fluid from the scrotum to the abdomen.

In most cases, hydrocele occurs only on one side and can grow to larger sizes.

Symptoms of hydrocele

• Swelling of one or both testicles in the scrotum that is not painful
• The testicles cannot be palpated despite the swelling
• Feeling of a heavy scrotum
• Feeling of tension in the scrotum
• Typically less swelling in the morning when it is softer, getting bigger and tighter in the evening
• In case of ongoing inflammation in the scrotum, pain is also associated
• Pain may also occur with impaired blood flow through the testicles
• The testicle with hydrocele moves downwards through the duct with gentle traction

The fluid-filled contents of the scrotum can be passed through during hydrocele.

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Sudden pain or swelling within a few hours that occurs after an injury requires immediate medical attention.

These symptoms also occur when the testicle is twisted, thereby blocking the blood flow. This condition needs to be addressed within a few hours to save the testicle.

Hydrocele of the spermatic cord occurs in the inguinal region as a lump that cannot be repaired and brought to its original position. This is a rare condition. It manifests as a smooth swelling that is palpable and does not dislocate when coughing as in a hernia.

Read: What is an abdominal hernia, hernia? What are its causes, symptoms?

Primary hydrocele does not hurt. Therefore, patients come to the doctor only when the scrotum becomes large.

During the examination, the doctor will get information about how long the swelling lasts, whether you have suffered an injury or have not undergone inflammation.

Examination by palpation

The hydrocele is soft and may be translucent.

Examination by palpation may show fluid shifting, spilling and, with a larger fluid content, rippling.

Fluid-filled testicles limit the ability to examine palpation.

In children, in the infantile form of hydrocele, it is not possible to determine the exact limit of the fluid passage because it extends into the inguinal entrance. In adult males, on the other hand, the upper limit of hydrocele can be accurately determined.

Another investigative method is the ultrasound examination of the scrotum. It is used to make an accurate diagnosis and to exclude other diseases that could affect the testicles, such as varicocele, testicular inflammation or cancer.

If cancer is suspected, tumour markers are taken.

Duplex ultrasound is an examination that detects blood flow in the testicles. In the case of hydrocele, blood flow is reduced or absent.

Abdominal X-ray.

In the case of young children, parents must regularly monitor the condition of hydrocele, which should spontaneously correct by the age of 1-2 years.

In adults, self-monitoring at home is recommended, and in case of worsening of the condition or intensification of pain, immediately contact a doctor.

The course can be different. Hydrocele can increase slowly, but also rapidly.

Secondary (non-communicating) hydrocele usually remains unchanged or enlarges very slowly. It can develop even at an older age.

Primary (communicating) hydrocele, when the pouch is open, may change size and when the abdomen is pressed and squeezed, there is a backflow of fluid into the abdomen. This symptom is often associated with an inguinal hernia.