I've developed a hydrocele, at the age of 68. It's unsightly, but not bothersome. Is there much chance that it will resolve without surgery? Or is there a nonsurgical treatment that might help? Thank you for your generous help.
Jack, surrounding the testicle is a thin layer of tissue folded upon itself with a potential (but empty) space between these leaves. This membrane is called the tunica vaginalis. The cells of the inner lining of this membrane have the potential to secrete fluid in response to trauma, allergies, infections, local tumors, etc. If fluid is produced, the space becomes filled as the walls of the membrane separate more from each other. This is called a simple hydrocele. Hydroceles do not resolve on their own without intervention. Most are perfectly benign conditions and require no treatment. However, there are 2 exceptions:
1. If there is an associated tumor of the testicle that stimulated the hydrocele to form. It is, therefore, important to establish that the associated testicle is normal either by physical examination or ultrasound of the scrotum. One simple test is to hold a flash light against the scrotum. Hydroceles transilluminate (let light pass through) whereas solid masses do not. If there is any question about the diagnosis, it can be confirmed on an ultrasound of the scrotum.
2. If there is a hernia that is contiguous with the hydrocele. This is called a "communicating hydrocele" and requires repair via an inguinal (groin) as opposed to a trans-scrotal approach for a simple hydrocele. Typically these hydroceles are smaller in the morning after lying in bed at night and enlarge during the day as the they fill by gravity from the normal fluid inside of the abdominal cavity.
Generally, there is no pain with a simple hydrocele, just a local heaviness because of the increased weight of the lesion. Hydroceles can be treated either for cosmetic reason or because of increased weight and local anatomic distortion and bulging. The traditional treatment is surgical excision which is generally done on an outpatient basis. Usually the discomfort is gone by 1-2 weeks and normal activity can be resumed shortly thereafter. However, there is often residual swelling that gradually subsides over 2-4 months. Another treatment method used widely in Europe and somewhat in the USA, is needle aspiration of the fluid followed by the injection of a sclerosing agent (such as 2.5% phenol) . The latter damages the secreting cells in an effort to prevent reaccumulation. Aspiration alone provides only temporary relief as the fluid always recurs over time. Each repeated aspiration increases the risk of introducing infection into the hydrocele and is, therefore, not considered a good alternative for definitive care. Again, no treatment is necessary for a simple benign hydrocele. Good luck!