hydrocele
WHAT IS A HYDROCELE?
A hydrocele is fluid around the testicle that develops in response to trauma, infection or surgery to the testicle. It can also occur without an identifiable cause. The swelling typically grows over several days to a couple of weeks, producing an enlargement of the scrotum.
IS A HYDROCELE DANGEROUS?
A hydrocele does not harm the testicle. Rather, patients have hydroceles treated because of symptoms such as pain, heaviness, or large size.
HOW IS A HYDROCELE TREATED?
A hydrocele is best treated by surgical removal of the fluid. The fluid can be drained by placing a needle into the scrotum and drawing off the fluid (aspiration) but the fluid often returns. After surgical removal there is only a 5% of recurrence.
HOW IS THE SURGERY PERFORMED?
Under anesthesia, a small incision is made in the scrotum to gain access to the testicle and the sac that holds the fluid. The sac is opened and the fluid removed. The incision is the sewn in a manner to help prevent the recollection of the fluid. The surgery itself takes about a half-hour, but the total time in the operating room is about an hour.
ARE THERE RISKS TO THE SURGERY?
Yes. The surgical risks include bleeding(5%), infection,(1%) injury to the testicle(<1%), and recurrence of the fluid(5%).
HOW LONG WILL IT TAKE TO RECOVER FROM SURGERY?
After 48 hours of activity limited to watching t.v., reading, and moving around the house most patients are able to return to work with light duty (limited movement, no lifting more than 10 pounds). After 2-3 weeks there may still be some swelling, but most patients are able to return to regular duty and normal exercise routine. Please refer to our handout for minor surgical procedures in the scrotum for more specific instructions.
WHAT ARE HYDROCELES AND SPERMATOCELES?
They are both harmless, fluid-filled cysts around the testis. Both are fairly common, have similar treatments, do not lead to cancer, do not cause sexual or fertility problems, and usually cause no symptoms. Sometimes they may be painful or be of cosmetic concern where treatment is necessary. They can be confused with each other because of their similar appearance on physical exam, and sometimes an ultrasound is necessary for diagnosis.
A spermatocele is a cyst of the epididymis (a gland above and behind the testis where sperm are processed). These are usually a marble-sized swelling found just above the testis.
A hydrocele is a cyst around the entire testis and may make the entire testis seem larger, often 2-3 times the size of the other testis.
The cause of both is usually unknown, but may be related to prior genital infection, trauma or surgery. Rarely, a testis tumor may lead to cyst formation and may often be confused on physical exam with a cyst.
HOW ARE THEY TREATED?
Fortunately, most of these cysts require no treatment and can be left alone. However, they often slowly enlarge with time and do not go away on their own. There are no medications, exercise or dietary ways to prevent or treat these cysts. Rarely, they are aspirated with a needle, but this treatment is usually discouraged because it provides temporary relief at best and may lead to infection or scarring. Both cysts are best treated with surgical incision, which usually requires an anesthetic, and takes 15-30 minutes as an outpatient procedure. Most patients need to stay off their feet for a couple of days afterwards and reduce their activities for a couple of weeks. The risks include bleeding and infection, as with any surgical procedure, and the recurrence rate of either is about 5%. While treatment will not lead to erectile problems, fertility could be affected (especially with spermatocele surgery), so treatment may be delayed until child bearing is completed.