Care ‘n’ Cure Urology Clinic

Hydroceles and inguinal (groin) hernias can create problems in males. But do they cause pain and dysfunction? When and how should they be treated? The following information should help you talk to a urologist about these two conditions.

Testicles develop near kidneys in the abdomen and descend from that location to their normal position in the scrotum towards the end of pregnancy. In order for the testicles to leave the abdomen, a muscle ring in the groin on each side opens and allows the testicles to drop down to the scrotum. As the testicle descends, the lining of the abdomen also drops to line the scrotum. This channel closes in most boys. If that channel remains open, or reopens, a small amount of fluid can go from the abdomen to the scrotum through this passage. This results in hydrocele. If the channel remains opens or reopens widely, then a portion of the intestine can pass down the channel towards the scrotum. This results in an inguinal hernia.

When a man is not sexually aroused, his penis is soft, limp or flaccid. During sexual arousal, nerve messages release chemicals that increase blood flow into the penis. The blood flows into two erection chambers made of spongy tissue (the corpus cavernosum) in the penis. The “smooth muscle” in the erection chambers relaxes, which allows blood to enter and remain in the chambers. The pressure of the blood in the chambers makes the penis firm, producing an erection. After a man has an orgasm, the blood flows out of the chambers and the erection subsides.

Hydroceles can also develop due to inflammation or injury within the scrotum. These sometimes resolve over a few months but many remain and require medical attention. Hernias can also be the result of increased pressure that forces part of the intestines through a weak spot in the abdominal wall — straining during bowel movements, heavy lifting, coughing, sneezing or obesity.

Only about 25 percent of hernias cause pain or discomfort. However, you may be able to see and feel the bulge that often occurs at the junction of the thigh and groin. About 1 percent of boys develop hernias with premature infant males having a higher incidence. Sometimes, the protruding intestine enters the scrotum and causes pain and/or swelling in the scrotum.

Surgery to repair the muscle ring that did not close properly is recommended for a hernia in a child. Hernias do not go away on their own and may cause problems with digestion leading to emergency surgery. In infants and children, a small incision is made in the groin through which a urologist sutures or sews the channel shut and repairs the muscle ring. This procedure can be done in an outpatient setting. In teenagers and adults, laparoscopic surgery may be considered.

Hydroceles require surgical repair if they cause symptoms, such as growing large or changing size significantly during the day. If the hydrocele is uncomplicated, an incision is made in the scrotum. The hydrocele is cut out, removing the tissues involved in the hydrocele. If there are complications, such as a hernia, an incision is made in the inguinal (groin) area. This approach allows repair of hernias and other complicating factors at the same time. In children it is preferable to approach the condition through an inguinal incision in order not to miss a hernia that may otherwise manifest itself later if the scrotal approach is used.

After surgery, there will be discomfort that will require pain medication. In most cases, pain is reduced during the first week so that pain medication is no longer necessary. It may be necessary to restrict full activity for a couple of weeks, depending on your child's age and whether or not both sides were treated. If your son still plays on straddle toys, such as a rocking horse, he may have to avoid them for a time. The testicle and scrotum may stay swollen for several weeks after surgery before returning to normal. After surgery, less than 1 percent of cases have a hernia or hydrocele return.