What is Adult Male Hydrocele?

Adult male hydrocele is an excessive collection of fluid in a sac (tunica vaginalis) next to a testicle (testis). Most adult male hydroceles are usually harmless and happen without an apparent reason. In a small number of cases, an adult male hydrocele is due to an underlying problem with a testis or other abdominal conditions.

Adult male hydrocele usually occurs on one side of the patient’s scrotum, but sometimes hydroceles form around both testicles of the same patient. Adult male hydrocele feels like a small fluid-filled balloon inside your scrotum. It is smooth and is mainly in front of the testicle. Male hydroceles vary greatly in size (usually 5 - 15 cm). Male hydroceles usually enlarge over the years. Very large male hydroceles (>20 cm) are seen in men who ignore the condition.

Causes

Majority of male hydroceles are without apparent cause (idiopathic). A small number of Male hydroceles are secondary to other diseases e.g. infection, inflammation, injury or tumors of the testis. Filariasis, a parasitic infection, accounts for most causes of hydroceles worldwide, affecting more than 120 million people in more than 73 countries. However, filariasis is rare in Hong Kong and in most developed countries. Sometimes, patients with excessive abdominal fluid can have hydroceles (e.g. peritoneal dialysis, liver failure or renal failure etc.)

Symptoms

Small male hydroceles are usually painless. Large male hydroceles may cause discomfort and pain. It may affect walking, exercise, job, or sex.

What is Female hydrocele(Hydrocele of Nuck)?

Female hydrocele (Hydrocele of the canal of Nuck / Hydrocele of Nuck) is a rare condition. It is an excessive collection of fluid in an abnormally formed peritoneal sac in the inguinal area (majority) or labia majora (minority). It usually presents as a painless swelling. It can cause discomfort or pain. It may affect daily walking, exercise, work or sex.

Causes

The peritoneum sometimes grows abnormally long and extends from female groin to the labia majora. The abnormal growth of the peritoneal membrane, with accumulation of fluid inside, forming a fluid-filled sac or cyst. The peritoneal extension is usually short, and usually located in the inguinal area; it rarely reaches the labia majora.

Symptoms

Most small female hydroceles are painless, and they usually enlarge with time. Larger female hydroceles (>3cm) may cause local discomfort with pressure effect to the surroundings. Large hydrocele may affect patient’s walking, exercise, working, or sex.

Diagnosis

he diagnosis is often confirmed by experienced surgeons via physical examination and the use of a torch shining on the fluid (transillumination test). Medical imaging (e.g. ultrasound scan, CT scan, or MRI scan) is usually performed to confirm the diagnosis and rule out other possible causes of swelling, e.g. hernia.

Indication for surgery

Surgery is recommended if the hydrocele is large, causing discomfort, affecting activities of daily living, or causing unsightliness.

Surgery

Surgeries for adult male hydrocele and female hydrocele of Nuck are usually performed under general or spinal anesthesia in the hospital operating theatre.

Male open hydrocele surgery: The scrotum skin and the hydrocele sac are opened. The fluid inside is drained. The sac containing the hydrocele fluid is partially excised, folded up, sutured, and cauterized to prevent future collection of fluid. If there is any fluid-communicating channel between the abdomen and the testis, it will be divided and ligated.

  • Traditional open hydrocele surgery requires a 5 cm - 8 cm incision.
  • Mini-incision open hydrocele surgery requires a 1.5 cm – 2.5 cm incision.

Mini-incision open male hydrocele surgery reduces postoperative pain. Patients can return to work or exercise earlier than with traditional open hydrocele surgery. Most patients recover well and can go home the next day after surgery. The surgery outcome is generally very good and the risk is low.

Female hydrocele surgery: This requires just a small cut (2 cm - 4 cm) in the groin area. The sac is opened and the fluid is then drained. The sac is excised. If there is any fluid-communicating channel between the abdomen and the sac, it will be divided and ligated. Most patients recover well and can go home the next day after surgery. The surgery outcome is generally very good and the risk is low.

Intraoperative long-acting local anesthetic injection and postoperative oral analgesic are often used to reduce postoperative wound pain to a minimum. Absorbable subcutaneous stitches are often used to close the wounds, eliminating the need to remove skin surface stitches. Patients are usually required to keep the wound dry for 2 - 3 weeks. After 3 weeks, all the wound dressing can be removed.

Patients can usually return to office work 1 to 3 days after surgery. Patients can often return to exercise 4 to 6 weeks after surgery.

Frequently Asked Questions

Q: Is it necessary to treat all adult male hydrocele or female hydrocele of Nuck?

A: No. Adult male hydrocele or female hydrocele of Nuck are usually asymptomatic in their early stages. They usually do not require treatment.

Adult male hydrocele or female hydrocele of Nuck can grow larger with time and cause discomfort or pain. If large hydroceles affect the patients’ normal living or activities, then patients should consider surgical treatment. Using the latest methods to treat hydroceles, most patients feel no pain or minor pain after surgery. Most patients can return to their favorite sports within 4 - 6 weeks. Please consult your doctor for advice.

Sometimes, inguinal hernia occurs with adult male hydrocele or female hydrocele of Nuck. As hernias carry the risk of bowel strangulation or obstruction, these patients with hydrocele and inguinal hernia should consider early surgery. Please consult your doctor for advice.

Q: Is hydrocele surgery safe?　
A: The latest hydrocele surgeries are very safe. It usually takes an hour to complete. The post operative pain is low. The risk is low. Please consult your doctor for advice.