What is a Hydrocele of the Spermatic Cord?
The testicles originate from the peritoneal (abdominal) cavity in the fetus. Before the baby is born the testicles descend to the scrotum outside the abdominal cavity via the inguinal canal. It is accompanied by a part of the peritoneal membrane which is later obliterated into a cord called tunica vaginalis. This becomes part of the contents of the spermatic cord, which also contains the nerves, artery and veins connected to the testicle. The communication between the abdomen and the scrotum is eventually sealed by the time the baby is two years old, and no fluids or tissues from the abdomen can pass through the inguinal canal into the scrotum.
There are cases, however, when there exists an abdominal wall defect, and the membranes connecting to the testicles are not obliterated. The fluids from the abdomen can, therefore, leak into the scrotum and result in swelling of the sac, called a hydrocele. When the source of the swelling is through the incompletely sealed tunica vaginalis in the spermatic cord, one is said to have a leaky hydrocele of the spermatic cord. This causes the inguinal area at the top portion of the scrotum to get swollen.
A hydrocele is a painless collection of fluid around one or both testicles in the scrotal sac. It is sometimes mistaken for or accompanied by an inguinal hernia. Although hydroceles are usually found among newborn males and young boys, they can also occur in adults. The condition may come and go or resolve entirely on its own when the defect or the communication is eventually sealed.
How Is It Treated?
The delay in obliteration or closure of the tunica vaginalis in the spermatic cord is usually temporary, and the defect is usually small. Thus, the swelling of the scrotum may be small and eventually disappear when the fluids are absorbed by the child’s own tissues. Treatment may not be necessary.
Careful examination should be considered, however, when there is the possibility of trauma, infection or hernia as the cause or accompanying condition of a hydrocele. Also, a hydrocele that does not resolve by the age of two years, grows bigger, or is accompanied by pain, may need surgical intervention. Unless there is an infection present, medical therapy or the use of antibiotics is not necessary. The child must be observed, however, for increasing pain, discomfort, nausea or vomiting, which may indicate the presence of an inguinal hernia.
Surgery is usually done on an outpatient basis. The child is given general anesthesia. Then, with a small incision in the groin area, the fluid in the hydrocele is drained, and the sac is sealed. The abdominal wall is then repaired to prevent further leakage of fluids into the scrotal area.
After the child recovers from anesthesia, he may be sent home. Home treatment consists of caring for the surgical incision, with attention to signs of infection like excessive redness, swelling, pain and fever.
In adults a simple hydrocele must be differentiated from an inguinal hernia, a swollen testicle, a testicular tumor or torsion of the testicle. A hydrocele may need to be aspirated or surgically repaired if it causes discomfort or poses a risk for reduced blood circulation to the testicles.
WebMD, “Congenital Hydrocele - Topic Overview”, https://www.webmd.com/parenting/baby/tc/congenital-hydrocele-topic-overview
eMedicine, “Pediatric Hydrocele and Hernia Surgery”, https://emedicine.medscape.com/article/1015147-overview