Q: I am 75 years old and have been diagnosed with a hydrocele. It is enlarged to the size of maybe a small orange. My doctor says that surgery involves opening the testicle, removing the fluid and lining, and fixing it so no more fluid can to to the testicle. Then, within two or three months, it should return to its normal size.
I have read your column for years and have never seen a question like mine so I’m asking if this is rare situation or common? It’s very uncomfortable and I would like it corrected. At 75 I still get around. I enjoy traveling with my wife but the enlargement slows me down. Is there an alternative treatment other than surgery?
A: For the benefit of other readers, a hydrocele is a fluid-filled sac that surrounds a testicle. As a general rule, a hydrocele isn’t painful, nor is it harmful. A hydrocele is more common in newborns but for the sake of this column, I will refer to the condition as it pertains to adult men who may experience pain and discomfort because of the swelling involved. Causes for development include inflammation from an infection of the small tube at the rear of each testicle, or because of injury to the scrotum. Complications may set in if there is presence of a tumor, infection, or an inguinal hernia.
Diagnosis may be made by shining a bright light into the mass in a procedure known as transillumination. If the hydrocele is believed caused by inflammation, lab and urine testing may help determine whether an infection is present or not. In some instances, the fluid that surrounds the testicle may keep the testicle from being felt. In this case, an ultrasound would be ordered to rule out the presence of a tumor, hernia, or another cause for the scrotal swelling.
In many cases a hydrocele may dissipate on its own within about six months. It’s only when it enlarges to such a degree that it causes discomfort that surgical removal is even considered. When the option of surgery is a consideration, treatment may involve removal of the hydrocele while the patient is under either spinal or general anesthesia. An incision is made into the scrotum or lower abdomen and the hydrocele is removed. This procedure may require the patient have a tube inserted temporarily for drainage and wear a dressing over the incision site for several days following. Risks for this specific form of surgery include infection, scrotal injury, and blood clots.
Then there is needle aspiration which removes the fluid present. Following aspiration, a sclerosing drug is administered to help prevent the fluid from re-accumulating but unfortunately, the fluid does re-accumulate in many cases, making this an unsuccessful procedure. Risks for this specific form of therapy include pain at the site of the scrotum and infection.
I’m sure you are quite uncomfortable moving about with the enlarged hydrocele. You and your surgeon should determine if the swelling is impairing your quality of life, which it appears to be. Therefore, the surgical procedure appears to be a reasonable approach to the situation. If you have any questions and aren’t completely satisfied with what you are told, you might choose to request a second opinion. At 75 you hopefully have many good years ahead and you should be allowed to enjoy them to the fullest. So, become educated, get your questions answered, and plan more trips with your bride.
