Andrew Siegel MD October 27, 2018
This is the first entry in the “Big Ball” series, which provides information about common male issues that affect the contents of the scrotum.
Image above, a very large hydrocele
A hydrocele (“hydro” = water + “cele” = sac) is an accumulation of fluid within the sac that surrounds the testicle, resulting in ballooning and enlargement of the scrotum. It can vary in size from just slightly bigger than the actual testes to larger than a cantaloupe.
Each testicle is surrounded by a thin sac known as the tunica vaginalis. The tunica has an inner layer and an outer layer, with a small amount of fluid present between these 2 layers that serves a lubrication function, providing the means for the testes to rotate and move freely within the scrotum. The inner layer is responsible for the manufacture of this fluid and the outer layer for its reabsorption. This is a dynamic and ongoing process. A hydrocele is simply a disorder of production/reabsorption such that the outer layer of the tunica is unable to reabsorb all of the fluid that is produced by the inner layer, with the gradual accumulation of a collection of fluid. The fluid content of most hydroceles is straw-colored and odorless.
Hydroceles may also result from trauma, infections, tumors or operations such as a hernia and varicocele repairs. They are evaluated by physical examination and are often further characterized by an ultrasound of the scrotum, allowing for a detailed examination of the underlying testicle that often cannot be provided by physical examination because the size of the hydrocele.
Ultrasound image, public domain (testes is the ball-like structure that appears gray, hydrocele is the surrounding fluid that appears black)
Most small and moderate size hydroceles that are minimally symptomatic can be managed simply by periodic checkups. If a hydrocele progresses to the point where it causes discomfort, pain, tightness, deformity, or embarrassment, an option is to pass a needle into the hydrocele sac and drain the fluid, but this is most often just a temporary fix, as the root cause is unchanged and the fluid generally will re-accumulate.
The most definitive means of management is a relatively simple outpatient surgical procedure called a “hydrocele repair” or “hydrocelectomy.” The incision is typically through the midline “seam” of the scrotum; the involved testicle and surrounding hydrocele sac are delivered through the incision, the sac opened, fluid drained and generally the sac is excised and oversewn or alternatively, the opened sac is turned back on itself and sewn to itself. Either method results in exposing the testes to the scrotal wall (as opposed to the outer layer of the tunica), which functions to resorb the fluid produced by the inner layer of the tunica. This procedure is a highly successful means of treatment of the hydrocele.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.
Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:
MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health
PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food
These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.
Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx
New video on female pelvic floor exercises: Learn about your pelvic floor
Our Greatest Wealth Is Health 