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Hydrocele/Varicocele

(Processus Vaginalis; Varicose Veins—Scrotum)

Definition

Hydrocele is swelling in the scrotum due to a build-up of fluid around the testicle(s). It occurs in two forms:
  • Communicating hydroceles—associated with hernias and are usually seen in baby boys
  • Non-communicating hydroceles—collections of fluid around the testicle and may occur at any age
A varicocele is swelling in the scrotum due to a back up of blood in the main veins of the scrotum. Varicoceles are most common among teenagers and adult men.
Not all hydrocele or varicoceles require treatment. However, it is important to see your doctor for a diagnosis if you or your baby boy develops a swelling in the scrotum.
Varicocele
testicle varices
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Causes

A communicating hydrocele occurs in babies when a channel that connects the scrotum to the abdomen does not close up properly. This allows fluid to leak into the scrotum.
Non-communicating hydroceles occur when fluid builds up within the tissues that surround the testicle. Hydroceles may also be caused by injury or infection in the scrotal area. It can also be caused by a testicular tumor.
A varicocele is caused by a problem in the main vein of the scrotum. Blood normally leaves the scrotum through the vein. When this vein is not working properly, the blood gets backed up into the scrotum. Varicoceles are rarely caused by kidney tumors, or other tumors in the location of the kidney.

Risk Factors

Many newborn boys will develop a hydrocele. Communicating hydroceles are more common in premature babies. They are also more common in children who are being treated for excess fluid in the brain or who have an abdominal dialysis catheter.
Varicoceles typically develop in men between the ages of 15-25.

Symptoms

If you have any of these symptoms, do not assume it is due to hydrocele or varicocele. These symptoms may be caused by other, sometimes serious, health conditions. If you experience any one of them, see your doctor:
  • Hydrocele symptoms in adults:
    • Painless swelling in one or both sides of the scrotum, which feels like a water-filled balloon
    • May be accompanied by a persistent ache or feeling of heaviness in the scrotum
  • Hydrocele symptoms in infants:
    • Painless swelling of the scrotum
    • If the hydrocele is communicating and associated with a hernia, the amount of swelling will vary with activities such as crying
  • Varicocele symptoms include:
    • Enlarged or twisted vein in the scrotum
    • Generally appears as a visible or enlarged or twisted vein in the scrotum that you can feel
    • May be associated with shrinkage of the testicle(s) and/or infertility
    • Veins typically change in size, and are larger when standing or straining
    • Occur most often on the left side
    • Warning signs that a varicocele may be due to a tumor are sudden onset, right-sided location, or failure of the varicocele to become smaller when lying down

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Hydroceles and varicoceles are usually easily diagnosed by exam. Your doctor will want to be sure there is no evidence of a testicular tumor. Tests may include the following:
  • Transillumination—a flashlight is shone through the enlarged portion of the scrotum; if a hydrocele is present, the scrotum will light up
  • Ultrasound—a test that uses sound waves to examine the contents of the scrotum
  • Urinalysis tests
  • Testicular scintigraphy—a radioactive substance is injected into the blood, and x-rays are taken

Treatment

Treatment options include the following:

Hydrocele

In infants, non-communicating hydroceles often resolve in the first year of life without treatment.
Surgical repair is recommended if:
  • Hydrocele persists beyond the first year of life
  • Hydrocele becomes large enough to threaten a testicle's blood supply
  • You have a communicating hydrocele (associated with a hernia)
Sclerotherapy may be used for adult non-communicating hydroceles. This procedure removes fluid through a needle and replaces it with a substance that causes scarring. This is generally less effective than surgery.

Varicocele

Treatment is not required for all varicoceles. However, varicoceles can increase the risk of infertility. Treatment is generally recommended if a varicocele is causing infertility or if it occurs in adolescents. Treatment options include:
  • Open surgery—the vein is surgically cut and tied off
  • Catheter ablation—heat is applied through a catheter to destroy the vein
  • Catheter embolization—a substance is placed in the vein to block it
  • Laparoscopy—involves the use of a thin, lighted tube inserted into the abdomen to view the vessels in the body as they lead to the testicle
If you are diagnosed with a varicocele or hydrocele, follow your doctor's recommendations.

Prevention

There is no way to prevent varicoceles in adults or hydroceles in baby boys. Adult males can prevent traumatic hydrocele by avoiding injury to the scrotum.

RESOURCES

American Society for Reproductive Medicine http://www.asrm.org

American Urological Association http://www.auanet.org

CANADIAN RESOURCES

The College of Family Physicians of Canada http://www.cfpc.ca

Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

References

Hydrocele. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated April 2, 2012. Accessed September 14, 2012.

The Practice Committee of the American Society for Reproductive Medicine. Report on varicocele and infertility. American Society of Reproductive Medicine website. Available at: http://www.asrm.org/uploadedFiles/ASRM%5FContent/News%5Fand%5FPublications/Practice%5FGuidelines/Joint%5FReports/Report%5Fon%5Fvaricocele(1).pdf. Published 2001. Accessed September 14, 2012.

Varicocele. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 23, 2011. Accessed September 14, 2012.

Varicocele. American Society for Reproductive Medicine website. Available at: http://www.asrm.org/uploadedFiles/ASRM%5FContent/Resources/Patient%5FResources/Fact%5FSheets%5Fand%5FInfo%5FBooklets/Varicocele.pdf. Accessed September 14, 2012.

Wein A, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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