AUA Summit - What are Hydroceles and Inguinal Hernias?

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What are Hydroceles and Inguinal Hernias?

Hydroceles are seen when fluid fills a normal sac in the scrotum. About 10 in 100 male infants have a hydrocele at birth. Hydroceles can also appear later in infancy or childhood and rarely after injury to the scrotum.

Inguinal hernias are often split into two types, indirect and direct. An indirect inguinal hernia can also cause fluid in the scrotum, just like a hydrocele, but most often varies in size or even seems to “go away” from day to day. These inguinal hernias occur in about 1 in 100 baby boys and more often in premature infants. These hernias can also occur in girls. Direct inguinal hernias involve a weakness in the muscles and structures of the “groin” and while uncommon in children are fairly common in older adult males.

Symptoms

Hydroceles don't often cause symptoms. Even though the swelling may worry parents, it does not bother a baby. In older males, a hydrocele is most often painless, but may cause minor discomfort due to the increased size of the scrotum.

What are the Signs of a Hernia?

Only about 25% of hernias cause pain. Inguinal hernias can become be a surgical issue and should be checked out if there is an increase in swelling, redness or pain.

Causes

Hydroceles

The testicles develop near the kidneys in the abdomen. By the end of pregnancy, they move down to their normal position in the scrotum.

Before, or sometimes in the first few months of life, the testicle moves from the abdomen to the scrotum, dragging a “sac” made of the lining from the abdomen called the “peritoneum”, along with it. If this sac stays open or reopens, a small amount of fluid can move from the abdomen to the scrotum within the sac and a hydrocele can be seen. In most boys this canal closes off and the hydrocele often goes away by age one.

Diagnosis

Your doctor will often ask about your health history, do a physical exam and may use imaging tests (like ultrasound) to look closer. Your doctor may:

  • apply pressure to the abdomen and scrotum to check if they are tender and check for an inguinal hernia.
  • ask you to cough to see how the bulge changes in your groin or abdomen with pressure
  • shine a light through the scrotum (transillumination) to look for fluid. If you have a hydrocele, this test will show the clear fluid around the testicle.
  • conduct an ultrasound or x-ray to see whether or not there is a hernia, testicular tumor or other cause of scrotal swelling

In certain cases, your doctor may suggest blood and urine tests to check for other issues.

Treatment

Hydroceles can call for surgery if they cause symptoms, become large or continue to show changes in size by about a year of age. If the hydrocele is "non-communicating," meaning there is no related indirect inguinal hernia, the hydrocele sac is taken out, often through an incision in the scrotum.

If there is "communication," or a related inguinal hernia, a cut is made in the upper groin area. This lets the hernia be fixed and the hydrocele be opened and the fluid drained. Laparoscopy, which uses small instruments placed directly into the abdomen, is another common way of fixing hernias in children and adults.

A communicating hydrocele can also form later on the other side, and the risk is about 5 out of 100 cases. Some surgeons may want to check the other side of the groin at the time of fixing a hernia with a laparoscope and fix if it is present.

How are Complicated Hernias Treated?

Hernia sacs that contain things other than fluid (intestines or fat) do not go away on their own. They may cause problems if the intestines get trapped in the hernia sac and this can lead to the need for emergency surgery. This procedure can be done in an outpatient setting. In children and adults, laparoscopic surgery (performed through the abdominal wall) may be the choice of some surgeons.

After Treatment

After surgery, there will be some pain that will require drugs (often used for fevers). In most cases, the pain will go down during the first week so the drugs are no longer needed. Full activity may be restricted for a few weeks, based on your child's age and types of activity.

The testes and scrotum may stay swollen for a few weeks after surgery before going back to normal, if scrotal incision was used. After surgery, less than 1 out of 100 cases have a hernia or hydrocele return, but parents and patients should be aware this may happen.

What Questions Should I Ask My Health Care Provider?

  • What treatment options do I have?
  • Can changes in my diet help?
  • What types of surgery should I consider? Which do you suggest?
  • What will recovery look like?
  • What can I do to make recovery easier?
  • Will a hernia come back after surgery in the groin or in another area?
  • Will the hydrocele come back after surgery?

Updated March 2024.


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