(Processus Vaginalis, Varicose Veins–Scrotum)
Two causes of swelling of the scrotum include hydrocele and varicocele. A hydrocele is fluid build-up around the testicle(s), while a varicocele occurs when blood backs up in the main vein that drains the scrotum. Hydrocele is usually seen in baby boys, and varicocele is most common among teenagers and adult men.
Both conditions are usually painless. Hydroceles often resolve during the first year of life and usually require no treatment. Varicoceles, increase the risk of infertility, and are generally treated if they occur in infertile men. In any event, it is important to see your doctor for a diagnosis if you or your baby boy develops a swelling in the scrotum.
A hydrocele occurs when the channel that connects the scrotum to the abdomen (which allows the testicles to descend in baby boys) does not close up properly. This allows fluid to “leak” into the scrotum. Hydroceles may also be caused by injury or infection in the scrotal area.
A varicocele occurs when the valve in the main vein of the scrotum doesn’t work properly, allowing blood to back up (much the same as a varicose vein).
Many newborn boys will develop a hydrocele. However, hydroceles are more common in premature babies. They are also more common in children who are being treated for excess fluid in the brain (by draining the fluid into the abdomen), or who have an abdominal dialysis catheter.
Varicoceles typically develop in men between the ages of 15-25. Men with kidney tumors are more at risk of developing a varicocele.
If you experience any of these symptoms do not assume it is due to hydrocele or varicocele. These symptoms may be caused by other, more or less serious health conditions. If you experience any one of them, see the physician:
- The primary symptom of a hydrocele is a painless swelling in one or both sides of the scrotum, which feels like a water-filled balloon. This may be accompanied by a persistent ache or feeling of heaviness in the scrotum.
- A varicocele generally appears as a visible or palpable (able to be felt) enlarged or twisted vein in the scrotum. It may be associated with shrinkage (atrophy) of the testicle(s) and/or infertility. Varicoceles occur more commonly on the left side.
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Hydroceles and varicoceles are usually easily palpable. Your doctor will want to be sure there is no evidence of a testicular mass (eg cancer). Tests may include the following:
- Transillumination: a flashlight is shone through the enlarged portion of the scrotum; if a hydrocele is present, the scrotum will light up
- Ultrasound: a test that uses sound waves to examine the contents of the scrotum
- Urinalysis Tests
- Testicular Scintigraphy: a radioactive substance is injected into the blood and x-rays are taken
Treatment options include the following:
Most hydroceles eventually disappear. Surgical repair is recommended if they:
- persist beyond the first year of life,
- become large enough to threaten a testicle's blood supply, or
- are associated with a hernia (a portion of the intestine pushes through from the abdomen into the scrotum).
Treatment is not required for all varicoceles; however, it is generally recommended if a varicocele is felt to be the cause of infertility. Treatment options include:
- Incisional Ligation: the vein is surgically cut and tied off
- Catheter Ablation: heat is applied through a catheter to destroy the vein
- Catheter Embolization: a substance is placed in the vein to block it
- Laparoscopy: use of a thin, lighted tube inserted into the scrotum to view it
There is no way to prevent hydroceles in baby boys.
To help reduce the chances of developing hydroceles or varicoceles, take the following steps:
- Avoid injury to the scrotum
- Avoid risk factors for kidney tumors:
- Sedentary lifestyle
- Occupational exposures to certain chemicals—discuss these with your doctor