Hydrocele

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Overview

Hydroceles occur in males only. The testes, or testicles, are the two male reproductive glands that produce sperm and the male hormone testosterone. They are located in the scrotum, which is a pouch located behind the penis. A hydrocele is an abnormal fluid-filled sac around the testes that causes the scrotum to swell.

Hydroceles can occur on either side of the scrotum or, in rarer cases, on both sides. While hydroceles are benign (mild and not progressive) and usually painless, they should be brought to a doctor's attention because they sometimes can signify a more serious condition related to the testes.

There are two types of hydroceles: communicating and non-communicating. Communicating hydroceles have an open connection between the scrotum and abdomen. Non-communicating hydroceles are enclosed with no connection.

Incidence and Prevalence
Hydroceles most commonly affect males in two age groups, but they can develop at any age. About 10% of male infants (particularly premature babies) are born with a hydrocele. The condition also may occur in boys between the ages of 2 and 5, usually as a result of inflammation of the testis or epididymis (structure located on top of each testis). Older men (typically over the age of 40) can develop a hydrocele, often following an injury in the scrotal area.

Cause and Risk Factors

Hydroceles are caused by the accumulation of fluid in the scrotum, surrounding one, or less often both, of the testes. In most cases, the condition is congenital, or present at birth.

Before birth, the testicles develop in the abdomen. A few weeks before the baby is born, they descend connected to a tube (called the processus vaginalis) to the scrotum. When this movement is complete, the tube usually closes. When it doesn't, fluid from the abdomen can collect in the scrotum, causing a communicating hydrocele. This condition is called "communicating" because the pathway between the abdomen and scrotum is wide open. This type of hydrocele is typically bigger in the evening and smaller, or absent, in the morning as the fluid often returns to the abdomen due to hours of being recumbent.

Non-communicating hydroceles occur when fluid stays inside a closed sac and is not gradually absorbed into the body. Men (especially over the age of 40) can develop non-communicating hydroceles as a result of an infection or injury to the scrotal area, or if blood or fluid becomes blocked inside the spermatic cord. Most, however, seem to occur for no apparent reason.

In adult males, radiation therapy (e.g., used to treat prostate cancer) can increase the risk for developing hydroceles.

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