Hydrocele refers to the collection of fluid around the testicle, often causing swelling in the scrotum. It’s a relatively common condition that can affect males at any stage of life—from infancy through adulthood. To manage it effectively, it’s crucial to understand the types of hydrocele, as each type can signal different causes and lead to different treatment for hydrocele options.
The main hydrocele types, explain how they differ, and walk you through their symptoms, diagnosis, and management.
Why It’s Important to Understand the Types of Hydrocele
Each hydrocele type reflects a different underlying cause and course of development. For instance, a hydrocele in a newborn usually results from a developmental issue, while in adults, it often signals an injury, inflammation, or infection. Recognising the different types of hydrocele allows you to spot early warning signs and seek appropriate medical care.
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Primary Categories of Hydrocele
Hydroceles are broadly categorised into two main types:
- Congenital hydrocele
- Acquired hydrocele
Each category includes subtypes that relate to how the fluid enters and remains around the testicle.
1. Congenital Hydrocele
This form appears at birth or shortly after and is mainly seen in infants. It develops due to an issue in the processus vaginalis—a membrane that forms as the testicles descend into the scrotum during foetal development.
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a) Communicating Hydrocele
This occurs when the processus vaginalis remains open, allowing fluid from the abdomen to pass into the scrotum. The size of the swelling may change throughout the day, often increasing when the baby is crying or straining.
Key Signs:
- Scrotal swelling that varies in size
- Soft, painless lump
- More noticeable at the end of the day
Why it needs attention:
A communicating hydrocele can increase the risk of hernia, as abdominal contents may slide into the open space.
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b) Non-Communicating Hydrocele
This type appears when the processus vaginalis closes, but fluid remains trapped around the testicle. The body usually reabsorbs the fluid within the first year of life.
Key Signs:
- Constant swelling
- No fluctuation in size
- Typically painless
If the swelling doesn’t resolve by age one or continues to grow, surgical intervention may be necessary.
2. Acquired Hydrocele
Acquired types develop later in life, typically due to an injury, infection, inflammation, or as a complication of other scrotal conditions.
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a) Primary Acquired Hydrocele
This is the most common form in adults and doesn’t have an identifiable cause. It develops when there’s an imbalance between the secretion and absorption of fluid by the tunica vaginalis (the membrane surrounding the testicle).
Key Features:
- Painless scrotal swelling
- Gradually enlarging
- Transillumination possible (light passes through the fluid-filled sac)
Men often report heaviness or discomfort rather than pain.
b) Secondary Hydrocele
This type develops due to an underlying issue such as:
- Epididymitis or orchitis (infections)
- Trauma or injury to the scrotum
- Testicular torsion
- Testicular tumours
- Post-surgical complications
Key Features:
- Swelling associated with pain or tenderness
- Possible redness and warmth
- Often appears suddenly
Management focuses on treating the root cause. In some cases, the hydrocele resolves once the underlying condition is controlled.
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Special Classifications Based on Anatomy
Medical professionals also classify types of hydroceles based on anatomical variations. These include:
a) Encysted Hydrocele of the Cord
Here, fluid collects along the spermatic cord rather than around the testicle. It’s more common in children and presents as a non-tender, firm swelling that doesn’t change in size.
b) Funicular Hydrocele
Similar to the communicating type, but the fluid is confined above the testicle. This occurs when only a portion of the processus vaginalis remains open.
c) Hydrocele of the Canal of Nuck (in females)
Though rare, females can develop hydroceles too. In women, the equivalent of the processus vaginalis is the canal of Nuck. If it stays open, it may fill with fluid, forming a lump in the groin or labia.
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Symptoms to Watch For
Regardless of the hydrocele type, most present with similar symptoms:
- Swelling in one or both sides of the scrotum
- Feeling of heaviness or discomfort
- Soft, smooth, and usually painless mass
- Increase in swelling over time
- In infants, swelling that appears and disappears
If you notice rapid enlargement, pain, or redness, it’s essential to consult a healthcare provider promptly. These symptoms could indicate an infection, torsion, or other urgent conditions.
Diagnosis: How Hydrocele Types Are Identified
Doctors typically diagnose a hydrocele using:
1. Physical Examination
They check for swelling, tenderness, and whether light passes through the scrotum (transillumination). This simple test often confirms a fluid-filled sac.
2. Ultrasound
An ultrasound rules out other scrotal conditions like hernia, tumour, or testicular torsion. It also helps distinguish among hydrocele types based on fluid location and anatomy.
Treatment Options Based on Hydrocele Type
a) Observation
For infants and those with small, asymptomatic hydroceles, especially non-communicating types, no treatment may be needed. Most resolve on their own.
b) Surgery (Hydrocelectomy)
This is the preferred treatment for persistent or symptomatic hydroceles. The procedure involves draining the fluid and removing the sac to prevent recurrence. It’s especially recommended for:
- Communicating hydroceles in infants over 1 year
- Adult hydroceles causing discomfort
- Secondary hydroceles linked to underlying issues
c) Aspiration and Sclerotherapy
For patients unfit for surgery, aspiration (draining the fluid with a needle) followed by sclerotherapy (injecting a solution to prevent recurrence) may be offered. However, this method carries a higher risk of recurrence and infection.
Complications to Be Aware Of
While most hydroceles are harmless, ignoring them can lead to:
- Increased discomfort and mobility issues
- Psychological stress from visible swelling
- Risk of testicular damage if linked to infection or torsion
- Hernia (in communicating hydroceles)
Timely intervention helps prevent these outcomes.
Prevention and Self-Care
Although you can’t always prevent hydrocele types that are congenital, adults can reduce their risk by:
- Avoiding scrotal trauma
- Promptly treating scrotal infections
- Wearing supportive underwear during strenuous activity
- Attending regular health checks if prone to swelling or testicular discomfort
Monitoring for changes in scrotal size, shape, or consistency helps you detect problems early.
Final Thoughts
Understanding the different types of hydrocele empowers you to seek the right care at the right time. Whether the cause is congenital or acquired, most cases are manageable and often curable. Always consult a healthcare provider if you notice swelling or discomfort in the scrotum, especially if the symptoms are new or worsening.
