hydroceles

A hydrocele is a fluid-filled sac surrounding one or both testicles, leading to swelling of the scrotum. It occurs when fluid accumulates in the tunica vaginalis or along the spermatic cord. Most hydroceles are benign and not associated with cancer.

There are congenital and acquired forms. Congenital hydroceles often result from persistence of the processus vaginalis and may be classified as communicating or noncommunicating. Acquired hydroceles can follow infection, trauma, surgery, or tumors, and may be idiopathic. In males, hydroceles can be associated with an inguinal hernia; in females a related condition is the hydrocele of the canal of Nuck.

Symptoms typically include a painless, soft swelling in one side of the scrotum. A feeling of heaviness may occur. Acute pain is unusual but may appear with trauma; fever suggests infection. Diagnosis starts with a physical examination and may be aided by transillumination. Scrotal ultrasound with Doppler is often used to distinguish a hydrocele from hernia, testicular tumor, or other causes of scrotal swelling.

Treatment depends on age, size, symptoms, and underlying cause. Many congenital hydroceles in infants resolve spontaneously within the first year and require only observation. Persistent or symptomatic hydroceles in children and adults are commonly treated with surgery to remove the hydrocele sac (hydrocelectomy) and repair any patent processus vaginalis. In selected cases, aspiration with sclerosant therapy may be considered, though recurrence can occur.

Prognosis is generally favorable after appropriate management. Recurrence is possible, and large or bothersome hydroceles may affect comfort or quality of life if left untreated. See also hydrocele testis, inguinal hernia.