Hydrocele: Symptoms, Causes, Treatment and Cost

This is best understood through the description of fluid accumulating in the protective tissue surrounding the testicle. A protective tissue, that is soft and smooth, surrounds each testicle or testis. This tissue produces a 'lubricating' fluid in small quantities for permitting free movement of the testis.

Any excess of this fluid drains out in normal course into the veins of the scrotum. An imbalance between the quantum of fluid produced and the amount drained, accumulates within the sac i.e. between the tissue and the testicle, causing a hydrocele to develop. Mostly a hydrocele develops in a single testicle, but at times, it may happen simultaneously in both the testicles.

Hydrocele may be congenital or acquired. Hydroceles are cast into two different varieties –

• Communicating hydrocele
• non-communicating hydrocele.

The development of the testicles in a male child happens before birth. The testicles descend from the abdomen. When the thin membrane passing through the inguinal canal into the scrotum fails to close off, a communicating hydrocele potential arises.

You are affected with hydrocele through collection of the fluid flowing from the abdomen in the tissue that encloses one or both testicles. This is termed as communicating hydrocele. Communicating hydrocele is very frequently observed in infants. Infantile hydrocele rarely persists and often heals by itself over time.

Non-communicating hydrocele occurs due to retention of fluid in the sac for no particular reason at all, or, it may also be due to reasons like:

• Filariasis infection
• Tuberculosis of the epididymis (the intricate duct behind the testis for the passage of the sperm)
• Syphilis infection
• Injury or trauma like one arising out of a surgical repair of a hernia
• Malignancy

Secondary or acquired hydrocele is generally small, except a hydrocele arising of filariasis, which may grow quite large.

When you feel a hydrocele in your scrotum you might think of it as a small balloon as if filled with some fluid. It is You feel it mainly in front of one of your testicles (testes). The feeling you get when you touch it is quite even and soft..

Hydroceles come in varied sizes. They may not be visible to the eye unless grown substantially. Hydroceles arising due to filariasis are known to grow very large and appear as a bulge of your scrotum on your clothing.

Hydrocele is essentially a male disease. Infants with fluid flowing from their abdomen into their scrotum are common targets for hydrocele. Teenagers or adults may also develop the disease due to fluid accumulation around their testicles for any reason, including infection, hernia surgery, malignancy, etc.

Older boys and adult men contracting an injury affecting the internals of their scrotum may get hydrocele from it. At times, an inflammation in the scrotum too may cause hydrocele.

Hydrocele, epididymal cysts and varicocele are similar conditions and often confused with each other. They all fall in the category of testicular lumps and swellings. Varicoceles, a condition arising of enlarged, dilated veins in the testicles and not of any fluid retention, is often confused as hydrocele.

An inguinal hernia feels like a hydrocele at times on physical examination. A hydrocele of the cord often appears to be a trapped (stuck) hernia also known as an incarcerated hernia.

Some typical hydrocele symptoms are:

• Swelling of the scrotum: Perhaps the most common and often, visible symptom of hydrocele. The scrotum appears extremely swollen and appears to be bulging quite visibly.
• Heaviness of the scrotum: As the bulge increases, a hydrocele is likely to cause a very heavy feeling in the scrotum as it descends / hangs much more than usual.
• Scrotum pain: Pain is not a very common symptom of hydrocele. Pain may happen due to the hydrocele disrupting the testicles, twisting them or pressing against them. The pain may be cause for substantial discomfort.
• Infantile or child hydrocele: Hydrocele is more common among infants and child males than adult males. Your male child may develop sudden, severe scrotal pain or swelling following any injury to his scrotum. If so, it is good to keep a vigil for such symptoms. If born with or developing swelling of the scrotum of testis, track if the swelling appears larger in the morning and lessens as the day progresses. More often than not, hydrocele in children self-heals or disappears by itself. If the conditions persist beyond a year, treatment may be needed.

Hydroceles primarily develop through these mechanisms.

• Hydrocele develops due to the connection between the abdominal tunnel and scrotum not getting severed. This is a congenital defect.
• Accumulation of fluid in the sac around the testicles, either from excess secretion or failure in drainage is secondary hydrocele.
• Filarial hydroceles happen due to interference with the drainage of the structures within the scrotum.
• Post herniorrhaphy (surgical repair of hernia) trauma is often the cause of adult hydrocele.
• In adult males, injury may cause hydrocele.
• Infections like syphilis may also cause hydrocele in adult males.
• Among children, the continued flow of the peritoneal fluid into the scrotum, that ought to cease once the testicles have descended from the abdomen to the scrotum, is the main cause of hydrocele.

Hydroceles do not cause any harm in most cases. They call for treatment only when they become the cause for infection or discomfort. Hydroceles arising of hernia in the groin (inguinal hernia) need early fixing with surgery (herniorrhaphy) as soon as possible. Persistent hydroceles, i.e. those that do not go away in a few months, need surgical intervention.

• Infection of the fluid and gradual decrease in size of the testicles (testicular atrophy) may happen from untreated hydroceles.
• A large hydrocele may create obstruction of blood supply to the testicles. This too may lead to shrinkage or decline (atrophy) in the testicles.
• A large hydrocele may also negatively impact fertility arising of testicular atrophy.
• Testicular trauma may happen from haemorrhage into the hydrocele.

There is no prevention for infantile and child testicular hydrocele as it is a congenital condition. For adolescent and adult men, one of the foremost means of protection against a hydrocele is always making certain of safety of their scrotum and the testicles against any injury.

Use of abdominal guard in cricket, athletic cups in contact sports, wearing of tight briefs, etc. are a few instances of such protection.

A physician usually determines a hydrocele through physical examination on understanding of your symptoms. At times, some diagnostic procedures and tests may be done.

All the arrangements including consultations with various doctors, diagnostic tests and surgery of your hydrocele are taken care of by the professionals of Pristyn Care.

A thorough diagnosis of your symptoms is undertaken for suggesting the treatment for testicular hydrocele. There will be a clinical examination of the enlarged scrotum as part of the diagnostic process. This helps to understand the measure of succulence of your hydrocele.

The doctor will usually examine your swelling keeping you in both an upright and supine (lying on your back) positions. In the process of the examination, your doctor would be seeking to rule out the possibility of hernia.

Tests for hydrocele include shining a light through the scrotum (transillumination test), ultrasound and others. At times, it may be necessary to pick a hole and drain out some quantum of fluid to gain better access and feel of the testicles. Blood and urine tests may be prescribed and the results will be checked to rule out infections to the testicles as the cause of swelling.

A communicating hydrocele commonly disappears on its own. If this does not happen, then seeking treatment is the way out. Left without treatment, you may get afflicted with an inguinal hernia. Inguinal or groin hernia is a condition when some portion of the intestine or intestinal fat ingresses into the groin region. This ingress usually happens through a fissure, termed as an inguinal canal, in the groin.

Untreated hydroceles may contaminate the fluid. It may also cause degeneration of the testicle or testicular atrophy. A large hydrocele may become an obstruction for blood supply to the testicles, also leading to testicular atrophy. Such a condition may result in loss or impairment of male fertility. Testicular trauma may cause haemorrhage into the hydrocele creating further complications.

At the outset, let it be known that hydroceles do not cure, either by medicine or through home remedies. However, some relief may be brought to a growing or swelling hydrocele with home remedies that reduce discomfort:

• In a tub filled with warm water, add about two to three cups of Epsom salt and immerse yourself in the water for about 15-20 minutes with your legs well apart so that the warm water has complete access to your genitalia. The warmth of the water helps stimulate the circulation of blood as well as body fluids. The Epsom salt content aids in draining the fluid from the hydrocele. This will bring some relief to the discomfort and help control the swelling.
• Application of ice-packs or a cold compress about thrice a week brings relief to the discomfort and swelling.
• Applying a paste of about 5 grams of black pepper and cumin powder, mixed in warm water, to the scrotum and leaving it for a few minutes before washing off with warm (not hot) water will bring relief.
• Wear a scrotal support to get relief from the discomfort related to hydrocele.

• The inclusion of fruits like apples, oranges, peaches, pineapple, and grapes to your daily diet helps in hydrocele. It is believed that a diet consisting solely of fruits over a three to four day period brings substantial relief in cases of hydrocele.
• Boiled vegetables.
• Juice of aloe vera and amla.
• Black tea with ginger.
• Plenty of water and fluids.

Like in most ailments, you would do well to avoid eating the following:

• Junk food.
• Heavy, spicy food.
• Caffeine.
• Pickles.
• Processed food.
• Preserved food.

There is no medication for hydrocele. In infants and children, if a hydrocele does not go away on its own, around 6 to 12 months of his age, surgery is recommended. For communicating hydroceles, surgery using an incision in the groin is enough to fix it.

Adult hydrocele treatment depends on its size. Small hydroceles are best left as they are, since they usually cause no discomfort or pain. They will continue to be present for years without causing any trouble.

For larger hydroceles that increase in size over time, as well as those that cause pain, ache, “dragging” sensation, etc., surgery is the best solution.

Pristyn Care has comprehensive facilities for determining your requirement for surgery and taking you through a hassle-free surgical process with pre-surgery and post-surgery care, guidance and support included. All you need to do is get in touch with Pristyn Care.

A surgery known as hydrocelectomy (removal of sac lining) removes hydrocele. The needle aspiration is sometimes considered a surgical procedure, but by and large it is not within the ambit of surgery and fluid refills in the sac quite often in this process.

Hydrocelectomy causes a fair amount of swelling. The swelling subsides with time, although it may be 4 to 6 months before all the swelling goes off completely. There may be instances of bleeding, infection and repeat hydrocele formation.

Use of aspirin and any other blood thinners as well as alcohol are prohibited for a few days after surgery. This ensures prevention of bleeding. At times, hematoma arising of bleeding, could occur. This may call for drainage through another surgical method.

Cost of hydrocele treatment (surgery) in India varies between Rs. 20,000/- to Rs. 40,000/-. This variation happens based on location of treatment and complexities etc.

For a most comprehensive, cost-effective package for hydrocele treatment, with complete expert guidance and care, speak to or contact Pristyn Care.

Surgery has proven to be the most effective and a permanent treatment for hydrocele.

All male children who have symptoms of hydrocele and individuals in whom hydrocele has not healed within 6 to 12 months of age, are best treated with surgery.

In teens and adults, surgery is the best option for permanent cure from symptomatic hydrocele.

Infants or children who are below 12 months of age are best kept under observation as mostly their condition heals off by the age of 12 months. Teens and adults who have asymptomatic hydrocele i.e. the hydrocele is small and bereft of any pain or discomfort are usually left untreated.

• No bathing or swimming for about a week after surgery, or, until cleared by your surgeon, whichever is later.
• Your surgeon will clear you for resumption of school or work, as may be,as she deems correct. Normally, 4 to 7 days period is all it requires.
• Avoid strenuous activities until cleared.
• No cycling or bicycle riding until advised.
• No jogging or running, until advised.
• No weight lifting without medical approval..
• Resume aerobic exercise once cleared by your doctor.
• No alcohol or alcoholic beverages for about 7 to 10 days after surgery, or as advised.
• Consume a diet rich in fibre, minerals and balanced with protein.
• Avoid spicy, fried and oil/fat rich foods.
• Increase intake of fruits like apples, pineapple and grapes.
• Have plenty of water and fluids but not canned beverages.
• Restrict tea and coffee for about a week to ten days.

Untreated hydrocele may lead to:

• A hernia developing.
• An infection.
• A trauma / injury.
• A tumor of the testes, in isolated cases.

Hydrocelectomy causes a fair amount of swelling. The swelling subsides with time, although it may be 4 to 6 months before all the swelling goes off completely. Aspirin intake, including any other blood-thinners, are advised against from about ten days prior to surgery. Alcohol too is asked to be stopped during this period as alcohol too dilates the blood.

Other complications that may happen, albeit extremely rarely, are:

• Blood clots and bleeding
• Infection
• Injury to the scrotum
• Loss of the testicle
• Long-term (chronic) pain
• Continuous swelling
• Formation of repeat hydrocele.

Congenital hydrocele has excellent prognosis with a vast majority of children showing spontaneous resolution between 6 to 12 months of age. In adults, hydrocele occurs due to several underlying causes. Adult hydroceles do not, commonly, clear away on their own. Surgery is the permanent solution. Hydrcelectomy is an easy procedure with extremely good outcomes. There may be a recurrence of hydrocele even after surgery on rare occasions.

Overall, the prognosis for hydrocele is very good.