Hydroceles andInguinal Hernia
Overview
Hydroceles are a condition wherein the scrotum swells due to the accumulation of fluid. This fluid collects within the thin sheath that surrounds each testicle. They are common in newborn infants and generally resolve before the age of one, without the need for any treatment. In men and older boys, the condition can develop in cases of inflammation or injury.
Inguinal hernias are a condition where a part of the intestines or the membrane that lines the abdominal cavity protrudes through a weakened point of the abdomen. That can occur along the inguinal canal, where the spermatic cord is. The condition will not go away without treatment and can cause life-threatening complications.
An inguinal hernia can be the underlying cause of hydroceles, and the swelling apparent from hydroceles is often a key indicator that an inguinal hernia is present. Untreated, an inguinal hernia can lead to bowel obstructions and intestinal strangulation, where blood flow to the intestine is cut off.
Symptoms
The primary symptoms of inguinal hernias include:
- A noticeable bulge on one side of the pubic bone that is more obvious when standing
- Groin pain, particularly when bending, lifting, or coughing
- Pressure in the groin
Pain or swelling of the scrotum can be a sign of an inguinal hernia or a hydrocele.
Diagnosis
In most cases, a physical examination is sufficient to diagnose an inguinal hernia. A physician will be able to identify the bulge in the groin area quickly. They will often ask a patient to stand and cough, as those actions make the inguinal hernia more noticeable.
When the inguinal hernia is not apparent but symptoms are present, an abdominal ultrasound or other imaging tests may be necessary. You may require an MRI or CT scan in some cases.
For hydroceles, the physician checks for enlargement and tenderness in the scrotum. By shining a light through the scrotum, the physician can verify the presence of fluid surrounding the testicle. When a hydrocele or symptoms are present, the physician will check for an inguinal hernia that could be the cause.
Treatment
If the hernia is not causing significant pain or discomfort, a physician might opt to monitor for further development and prescribe a supportive truss. If it is clear that the hernia is becoming larger or causing pain, surgery is typically required to prevent more severe complications from occurring.
Hydrocele Removal
Surgery is often required to remove a hydrocele. In this procedure, the surgeon makes an incision in the lower abdomen or scrotum to remove the hydrocele. In some cases, a surgeon will remove hydroceles during inguinal hernia surgery.
Hydrocele Repair
Hydroceles are collections of fluid that accumulate in the scrotum around the testicle and can be found in infants, children, and adults. In infants and young children it can involve a hernia resulting from a channel communicating with the abdominal cavity that fails to close after the testicle descends into the scrotum around the time of birth. In older children and adults, it often results from an infection or injury to the scrotum or after prior inguinal surgery such as a hernia repair or varicocele ligation. Hydroceles can resolve spontaneously over time. They can also become uncomfortable and bothersome as they grow in size.
Treatment of hydroceles typically involves surgical removal of the hydrocele sac. This requires a general or spinal anesthesia, takes approximately 30-60 minutes, and is done on an outpatient basis. Surgical correction of hydroceles in infant and young children involves a small incision along the groin with the hernia sac dissected out and repaired while the hydrocele fluid and sac are removed. In teenagers and adults an incision is made along the scrotum. The fluid is removed and the sac is obliterated to avoid recurrent accumulation of fluid. Aspiration is a rarely used treatment for hydroceles. This is a technique in which the fluid is simply removed by placing a needle through the skin with no incision. It can be done under local anesthesia in the office but is associated with a high recurrence rate.
What to expect afterwards:
After surgery it is very common to have swelling of the testicle for several weeks to months. The swelling can be significant depending on the size of the original hydrocele. With larger hydroceles, a drain may be used for several days after surgery to minimize the swelling. After surgery it is important to use a scrotal support and ice regularly. One should avoid vigorous exercise and lifting for at least one to two weeks after surgery. Antibiotic ointment should be applied to the scrotal incision twice a day for the first few weeks.
FAQ's
The key signs to watch for that will require immediate medical attention are:
- Nausea
- Vomiting
- Fever
- The hernia bulge darkens or turns red or purple
These are indicators that there is either severe bowel obstruction or intestinal strangulation. These conditions can lead to death if left untreated and require immediate surgical intervention to repair the inguinal hernia.
Patients suffering from the symptoms of a hydrocele, including a swollen and sore scrotum, should avoid sexual contact. Infections, notably sexually transmitted infections, can cause inflammation that leads to hydroceles. Any sexual activity during this time risks spreading to the patient’s sexual partner.
Many risk factors can contribute to the chance of developing an inguinal hernia. Men are often more likely to develop hernias due to the opening in the groin muscles where the spermatic cord passes to the testicles. Age is also an essential factor as muscles begin to weaken.
A family history of hernias in relatives often predicts inguinal hernias. Those born prematurely or with a low birth weight are also more likely to develop inguinal hernias. One of the most prominent predictors of inguinal hernias is having developed a hernia or undergone hernia repair in the past.