How to treat Hydrocele?

What is hydrocele in men and mechanism of its development

Hydrocele is congenital or acquired pathology when serous fluid collection between the layers of the tunica vaginalis surrounding a testis. Depending on the severity, the amount of fluid may reach several liters but usually it is not more than half a liter.



Hydrocele in men is a congenital pathology in many cases. The mechanism of its development starts in a prenatal period when a testicle descends to the scrotum. In the abdominal wall a short tunnel is formed which connects the abdominal cavity and the scrotum and it must be sealed off before the baby being born. If it does not happen, the fluid from the abdominal cavity is trapped around the testicles. Usually hydrocele is a transitory condition and disappears with time but unfortunately this does not happen all the time.

In case with congenital hydrocele, impaired lymphatic drainage of the testis plays an important role. There are a lot of causes for unilateral or bilateral hydrocele in men and typically the symptoms of the disease disappear when the cause is eliminated.

Causes of hydrocele in men

Causes of hydrocele can be divided into two groups: for congenital and acquired pathology.

The following factors may trigger congenital development of the disease:

  • Genetic predisposition (congenital pathology in a medical history of a father or other male relative);
  • Threats of miscarriage;
  • Premature delivery (prematurity);
  • Traumas during childbirth;
  • Chronic diseases in a mother;
  • Infection during pregnancy;
  • Peritoneal dialysis;
  • Increased intra-abdominal pressure.


The causes of acquired hydrocele are:

  • Inflammation around the testicles and in the organ itself;
  • Tumor formation in testicular tissues and its epididymis;
  • Epididymitis (any etiology);
  • Advanced heart failure (stagnant processes);
  • Testicular traumas;
  • Inverted testis (occurs as a result of anatomic anomalies);
  • Abdominal wall defects;
  • Post-operative complications;
  • Impaired lymphatic drainage.

Mothers of baby boys should be aware that wearing diapers does not have any adverse effect on the development or treatment of hydrocele . It is a myth. Besides, babies are usually born with the pathology.

Types

Hydrocele in boys and in men may be both unilateral and bilateral depending on the cause. Two types of pathology are developed depending on the communication with the abdominal cavity:

  1. Primary hydrocele (communicating hydrocele). It develops when the tunnel communicating between the abdomen and the scrotum is not sealed off. This is considered to be the most dangerous pathology as it may have complications.
  2. Isolated (non-communicating) hydrocele. The communication with the abdominal cavity is absent and due to it accumulated fluid may be removed only if it will absorbed by the lymphatic system.

There are also two forms of hydrocele depending on the pressure around the testicles:

  • Tense hydrocele (utmost degree of tension);
  • Non-tense hydrocele (accumulated fluid does not put pressure on the abdominal walls).

Clearly, tense hydrocele is more unfavorable as pressure contributes to the development of hernias.

Symptoms

Congenital form of pathology does not bring any discomfort to a baby and usually is considered to be a norm and disappears without any additional measures. Usually these are the parents who notice hydrocele in a baby when they see:

  • Enlarged scrotum (symmetrical or nonsymmetrical);
  • Swelling in the groin area.

At older age if hydrocele does not disappear, a boy may have the following complaints:

  • Moderate and tolerable pain in the groin area;
  • Sensation of heaviness in the affected area;
  • Discomfort or unpleasant sensations at the base of the penis.

Sometimes hydrocele may be complicated and lead to the infection. In such cases, the symptoms are more pronounced:




  1. Intensive pain;
  2. Fever;
  3. Local temperature rise and redness;
  4. Fatigue;
  5. Nausea and vomiting (if there is intoxication).

If you noticed these symptoms, immediately consult a doctor to avoid unpleasant consequences of hydrocele in men.

Diagnosis

There are several standard procedures which are performed routinely (in babies having this pathology) and urgently in men with the signs of hydrocele.

  • Examination. A doctor examines enlargement of the scrotum and increased thickness (if there is an increased fluid pressure). The presence of the communication between hydrocele and the abdominal cavity is detected by applying pressure to the abdomen. If there is a communication, the scrotum will be enlarged.
  • Ultrasound diagnostics. This method helps to confirm or to exclude the fluid around the testicles and to detect its amount.
  • Diaphanoscopy. The scrotum is examined using a light through its tissues to define the nature of a fluid and exclude hernias and other formations. Hydrocele will transmit light.

Additionally, a man may be referred to duplex ultrasonography scanning to detect inverted testis which contributes to the development of hydrocele and death of the testicle.

The optimal treatment of hydrocele in men is chosen according to the results of diagnostics and a doctor decides about the reasonability of therapy as often the pathology disappears itself.

Complications

While hydrocele is not considered a dangerous pathology, it may lead to some unpleasant conditions.

  • Inguinal hernia. This complication occurs quite often, especially in communicating hydrocele. The hernia itself does not pose any danger for health only if it will not be accompanied by a knuckle and then the condition of a patient becomes urgent.
  • Infection. Fluid congestion in testicular tissue is a favorable environment for infections. The worst situation when a testicle becomes a target of the infection and it can lead to infertility. Besides, testicular tissue is the structure which tends to autoimmune affection.

Infertility as a complication of the disease is developed only after infection. Hydrocele never develops infertility.

How to treat hydrocele in men?

Natural treatment of hydrocele will not be effective as only surgery can help to get rid of the pathology. Not all the patients need a therapy but all the efforts to treat hydrocele without a consultation with a doctor will only aggravate your condition. So we strongly advise you against self-treatment.

Some patients do not need a surgical treatment of hydrocele, a doctor monitors a patient and controls his condition.

Conditions that do not require operation are:

  • Babies from birth to two years old (without infections or hernia);
  • Men and boys with unclear dynamics (these patients are observed for several months to evaluate the tendency for absorption).

Natural treatment of hydrocele includes careful control and if any changes are observed, urgent measures should be immediately taken. Parents must be aware of any new symptom or sensations of a baby. It is especially important for children of older age as they are often too embarrassed to share such problems with their parents.

Indications for hydrocele surgery in men are:

  • Inguinal hernia;
  • Unclear dynamics (enlargement and reduction succeed one another);
  • Clinical presentation (pain and discomfort);
  • Infection.

There are several types of hydrocele surgeries :

  • The Ross procedure. It is performed in communicating hydrocele. The procedure involves intra-abdominal ligation and then the swelling in the groin area is removed.
  • Von Bergmann’s technique. It is used when there is no communication with the abdominal cavity. The edge of the hydrocele sac is oversewn for haemostasis and in most cases drainage is required.
  • Puncturing. It is less traumatic surgical interference which is indicated for favorable pathologies. Using a special needle, the fluid is removed and sclerosants are injected.

Post-operative complications occur very rarely, but still it may happen:

  • Relapse;
  • A greater risk of infertility (if during the operation organs and ducts of the reproductive system were affected);
  • Atrophy (in case with circulation dysfunction).

In general, this disease has a favorable prognosis, however self-treatment of hydrocele in men it is strictly prohibited. Self-treatment will not only aggravate the disease but can lead to serious complications and infertility is the worst of them. So if you notice any symptoms or signs of the pathology, search for medical consultation without delay.

Be aware that clinical presentation of hydrocele is not specific, that is why first of all your doctor excludes tumors and hernias.