The scrotum is the pouch below the skin that contains the male testicles, the male reproductive glands that produce sperm. The two most common disorders to affect this part of the man's anatomy are a hydrocele, or the collection of fluid within a section of the scrotum called the tunica vaginalis, and a varicocele, or varicose vein(s) in the scrotum. Strangely enough, hydrocele is usually found in a newborn or a man over 40 years of age. In babies, the condition is thought to occur because fluid leaks into the scrotum as the testicles move into the area from the abdomen during fetal development.
It is more difficult to pinpoint a cause for the phenomenon in older men who represent about one percent of the male population. Some possible causes include trauma to the scrotal area from injury, infections, or radiotherapy; inflammation or infection; the presence of a tumor; tuberculosis; renal transplantation; or testicular torsion. Hydrocele can also result from a variococelectomy, the procedure to remove a varicocele, or a vasectomy, a male contraceptive surgery performed to permanently suspend a man's sperm flow to the prostate so that sperm cannot be ejaculated.
Typically painless, hydrocele commonly affects only one side of the scrotum. In some cases, both sides are affected. The fluid accumulation may cause few symptoms, such as a bulky, achy feeling in the scrotum that gets worse over the course of the day.
HYDROCELE MAY RESOLVE ON ITS OWN
To diagnose the hydrocele and distinguish it from other scrotal disorders called spermatocele or hematocele, which are two benign masses that may appear in the scrotum, physicians will physically examine the scrotum and may order an ultrasound. During physical examinations, physicians can tell if scrotal enlargement is due to fluid build-up if they shine a light at the scrotum and the area lights up. The abnormality is usually a solid tumor if it blocks light transmission, but this does not imply anything regarding the presence or absence of cancer in the mass.
Treatment for hydroceles may not be necessary. Often, in newborns, hydroceles resolve within 18 months and in adult men the condition only needs treating if it causes discomfort or embarrassment, or the area so enlarges that it interferes with the testicle?s blood supply, comfort, walking or clothing.
If the hydrocele must be addressed, it can be surgically removed through a procedure known as hydrocelectomy. Performed on an outpatient basis, a hydrocelectomy entails making a small incision in the groin (in infants and children) or the scrotum itself (in adults), removing fluid, and then stitching or partially removing the wall of the hydrocele sac to prevent the hydrocele from coming back.
SURGERY WON?T AFFECT FERTILITY, SEXUALITY
The procedure is often performed on an outpatient basis but with general or spinal anesthesia. Men return from the surgery with a scrotal drainage tube implanted and covered with a large scrotal dressing. For some time after surgery, men will need to wear some form of scrotal support.
A hydrocelectomy does not lead to problems with fertility or sexual function.
Needle aspiration of hydrocele fluid is another treatment option for adult men, but it is often a temporary solution as the fluid may re-accumulate. Sometimes aspiration is necessary to allow the physician to carefully examine the testicles. Medications that thicken or harden the tissue in the area are often injected after needle aspiration to close off the opening through the scrotal sac.
