Hydrocele and Varicocele
Hydroceles and varicoceles are two relatively common disorders affecting the male reproductive tract. Specifically, a hydrocele is a pear-shaped cyst in the groin. It develops when there is a buildup of the fluid that is normally found between the two layers of membrane that enclose the testicles. A varicocele is a tangle of varicose veins surrounding a testicle. It can usually be felt as a lump or swelling, most commonly on the left side of the testicle.
Hydroceles are often present at birth or develop shortly thereafter, occurring in about 10 percent of all boys. They may be located on one or both sides of the groin and are caused during birth by pressure on the abdomen; it pushes amniotic fluid down to the testicles through the channel surrounding the spermatic cord and blood vessels. These cysts are generally harmless and painless. If pain does develop, it is usually a sign that the hydrocele is infected. A hydrocele in an adult male may be secondary to epididymitis, an inflammation of the tubes that carry sperm from the testes. Other possible causes include a testicular tumor, injury, or infection. A sexually transmitted disease, especially gonorrhea, can also cause a hydrocele to develop.
Varicoceles are exceedingly common, affecting 10 to 15 percent of all adult men, and 20 to 40 percent of those with fertility problems. Although they do not affect general health, they impair a man's fertility because the accumulation of blood in the swollen vein raises the temperature of the affected testicle, thereby hampering sperm production.
Diagnostic Studies and Procedures
A doctor can detect a hydrocele or varicocele during a physical examination of the groin and testicles, but additional tests are needed to rule out tumors and other causes of swelling. A hydrocele can usually be diagnosed by transillumination, a procedure in which a strong light is passed through the swelling to show that it is filled with fluid. Ultrasound is also used to differentiate a hydrocele from a solid mass, and also to diagnose a varicocele. If there is suspicion of a tumor, a biopsy is necessary to rule out testicular cancer, a relatively common malignancy in young men.
In most cases, a hydrocele in a newborn will resolve itself by the time a baby is 12 to 15 months old, as fluid is reabsorbed into the body. In the meantime, the lump should be checked regularly to make sure that the swelling is not expanding. If it becomes enlarged or tender, a doctor should be seen to rule out a hernia.
Aspiration of the fluid is not recommended because it increases the risk of infection. In some cases, however, surgery may be necessary. In infants and young children, the operation is performed through an incision in the groin, and may require general anesthesia and an overnight hospital stay. If the baby has a hernia, as is often the case, it can be repaired at the same time. In adults, surgery is done through an incision in the scrotum. Part of the double membrane that holds the excess fluid is cut away, and the fluid is drained. The operation may be performed with local anesthesia on an outpatient basis.
A varicocele usually does not require treatment unless it is causing fertility problems, such as a low sperm count or a large number of defective sperm. In such a case, a simple procedure to remove it may be recommended.
Hydroceles and varicoceles do not lend themselves to alternative therapies.
There is no self-treatment for these conditions, but beginning with the late teens, all males should examine their testicles monthly for the presence of lumps, swelling, or other abnormalities. This is done by slowly rolling each testicle between a thumb and forefinger. If a lump or other change is noted, a doctor should be consulted.
Other Causes of Testicular Swelling
In babies, an inguinal hernia can cause swelling similar to that of a hydrocele. In older males, cancer, an injury, or infection can produce testicular lumps.