Varicocele vs Hydrocele: Key Differences and Insights for Patients

Varicocele vs hydrocele” is a comparison often explored to distinguish between these two common conditions affecting the male reproductive system, each with distinct causes, symptoms, and treatments. When it comes to men’s health, particularly issues affecting the scrotum, two common conditions often cause concerns – varicocele and hydrocele. The stereotypical man doesn’t like to talk about his health, especially surrounding issues that he considers private. But these two conditions can lead to noticeable changes and discomfort had have implications regarding fertility.

Understanding the key differences between varicocele vs hydrocele is critical for anyone experiencing symptoms or working to support a partner through the diagnosis and treatment stages.

In this article, we’ll break down the key aspects of these two medical conditions and help you navigate the path with confidence. Let’s start by defining them.

Varicocele: Swollen Veins of the Spermatic Cord

A varicocele is a medical condition characterized by enlarged veins inside the scrotum. They might be compared to varicose veins often seen in a person’s lower extremities who may have vascular issues. Ultimately, that’s because it’s due to a similar problem.

Faulty valves in certain veins – the pampiniform plexus – in the spermatic cord don’t allow blood flow to efficiently take place. This can lead to scrotal swelling caused by blood pooling inside the veins in the testicles. Varicoceles are often noticed during the teen years but can affect anyone with testicles at any age. They are most often found in the left testicle.

Varicoceles are particularly concerning when it comes to male infertility. A condition where the temperature is elevated in the scrotum caused by improper blood flow can affect sperm count and sperm production. In rare cases, severe varicoceles may result in testicular atrophy, or shrinkage.

Hydrocele: Fluid-Filled Sac Surrounding the Testicle

A hydrocele is a condition where fluid collects in the thin sac, or tunica vaginalis, surrounding the testicle which results in a swollen scrotum. Hydroceles can form in one or both testicles and are usually painless.

Hydroceles are more common in newborns and often resolve on their own without surgical intervention. This is thought to be because of fluid leading into the scrotum as testicles move into the scrotum from the abdomen during fetal development. However, due to injury, infection, or inflammation hydroceles can also develop in adults.

Communicating Hydrocele

Broadly, there are two categories of hydroceles. The first kind is called a communicating hydrocele. This occurs when there is an open passage, or processus vaginalis, between the scrotum and the abdominal cavity. Fluid can flow freely back and forth, leading to fluctuating scrotal swelling during the day or with changes in activity.

A communicating hydrocele is often present at birth and is because the processus vaginalis fails to close completely during fetal development. So, it is more common in infants and young boys.

Non-Communicating Hydrocele

A non-communicating hydrocele occurs when the processus vaginalis closes properly but fluid gets trapped around the testicle. There is no connection to the abdominal cavity. Swelling will remain constant and not change with activity or position. This type of hydrocele can

Causes of Varicocele vs Hydrocele

While both varicoceles and hydroceles affect the scrotum and involve the testicles, their origins and different.

Varicoceles are primarily caused by blood flowing inefficiently in the scrotum. Valves within the blood vessels are supposed to regulate the blood flow, but if they malfunction this flow can be disrupted. Blood begins to pool in the veins and more blood leads to the vessels becoming enlarged. Contributing factors include:

• High Blood Pressure: Increased pressure in the veins can cause the valves to malfunction.
• Genetics: A family history of varicocele or vascular issues can increase your risk.
• Puberty: Varicoceles often develop during puberty when blood flow to the testicles increases dramatically.

On the other hand, hydroceles form when the production and absorption of fluid within the tunica vaginalis, or thin membrane around the testicles is imbalanced. This may be due to congenital issues where the pathway for fluid drainage fails to close. Alternatively, an acquired hydrocele may develop due to trauma, infection, or scrotal inflammation.

Symptoms of Varicocele vs Hydrocele

Understanding the symptoms of varicoceles and hydroceles is essential for early detection and treatment. They often present with distinct symptoms that will help differentiate them.

However, some common symptoms may be shared between the two conditions. Both are most common on the left side of the scrotum. Either can lead to a dull ache or discomfort that worsens after long periods of standing or physical activity. However, scrotal pain is more common with varicocele than hydrocele. A feeling of heaviness, either due to pooled blood in the case of varicocele or fluid accumulation from a hydrocele, is a common symptom.

Varicocele Symptoms

The appearance of veins with a varicocele is distinctive. As the affected veins become twisted and enlarged they create a noticeable “bag of worms” look and feel. The affected testicle may appear smaller due to impaired blood flow.

Because varicocele can negatively impact sperm production by changing scrotal conditions like temperature, infertility may be another symptom noticed by patients. Other complications like low testosterone are also possible.

Hydrocele Symptoms

A hydrocele is sometimes a painless swelling of the scrotum. It often feels like a water balloon rather than the telltale “bag of worms” seen in a varicocele. A doctor may shine a line through the scrotum to visualize the fluid-filled sac. Other symptoms may include a fluctuating swelling in the case of a communicating hydrocele.

How to Diagnose Varicoceles and Hydroceles

Diagnostic procedures differ based on the unique characteristics of varicocele venous issues and hydrocele scrotal masses. However, both will begin with a physical exam.

Physical Examination

Your healthcare worker will examine the scrotum for the characteristic feel of varicoceles by palpating the area while you are standing. When hydrocele is indicated, the doctor may use a flashlight to shine a bright light through the scrotum to check for extra fluid around the testicle in the tunica vaginalis.

Valsalva Maneuver

One diagnostic procedure that your doctor may have you perform is the Valsalva maneuver. You’ll be asked to stand, take a deep breath, plug your nose and mouth and strain to push air out. The doctor will feel your scrotum for enlarged veins while you do this as it temporarily raises venous pressure.

Scrotal Ultrasound

One type of imaging technology will help your doctor arrive at the right diagnosis. A non-invasive ultrasound uses sound waves to create images of the scrotum and its contents to assess the veins and degree of obstruction. A Doppler ultrasound is a specialized form of imaging that can help the medical professional see blood flow and determine the extent of abnormality.

Differential Diagnoses

Medical professionals will want to rule out other conditions that may closely resemble varicocele or hydrocele symptoms. For example, with an inguinal hernia a piece of the intestines may protrude through the abdominal wall into the inguinal canal where the spermatic cord is housed. It can also present with pain or swelling around the testicles if the tissue descends into the scrotum. While often not life-threatening, a doctor may want to address inguinal hernias in order to relieve pain and other symptoms.

Treatment Options

Varicoceles and hydroceles have several effective treatments depending on the severity of symptoms and individual patient needs. Let’s take a brief look at three different medical procedures.

Varicocele Embolization – Blocking Blood Flow

Embolization is a minimally invasive procedure that targets the problematic veins in the scrotum. After you receive local anesthesia, a small catheter is inserted into a vein in the groin or neck and guided to the affected veins using X-ray imaging technology.

Your doctor will inject tiny coils or a special sclerosing solution to block the veins, redirecting blood flow to healthy veins. This method is effective in reducing pain and improving fertility, with a shorter recovery time compared to traditional varicocele surgery.

Varicocelectomy – Removing the Affected Veins

A varicocelectomy is a surgical procedure where the enlarged veins are tied off or removed to prevent blood pooling. In some cases, this varicocele surgery can be performed laparoscopically but a traditional surgery may require a larger incision to access and tie off the veins.

Hydrocele Sac Removal

Under general or local anesthesia, a surgeon can drain the fluid and remove or repair the sac surrounding the testicle to keep the fluid from reaccumulating. This procedure has a relatively quick recovery time with patients resuming normal activity within a week or so.

Conclusion

Recognizing the differences between varicocele and hydrocele is crucial for men with these medical conditions. While both affect the scrotum and can cause discomfort, their causes, impact, and treatment are distinct.

Varicocele is often linked to infertility. If your doctor finds an issue with fertility during a semen analysis, they may begin the diagnostic process to confirm varicocele is the underlying condition. Varicocele treatment will involve removing or closing the affected veins and redirecting blood to healthier ones.

Speak with your doctor today to help determine if your varicocele or hydrocele requires treatment and what options fit your situation.