From the Guidelines
An encysted hydrocele is a fluid-filled sac that forms along the spermatic cord, separate from the testicle, and is typically a benign condition that requires no treatment unless it causes discomfort or grows large. Unlike a regular hydrocele which surrounds the testicle itself, an encysted hydrocele (also called a spermatocele) develops higher up along the cord. It occurs when fluid becomes trapped in a remnant of embryonic tissue called the processus vaginalis, which normally closes during development. These cysts typically contain a milky or clear fluid and feel like a smooth, firm lump above the testicle. Most encysted hydroceles are painless and benign, requiring no treatment unless they cause discomfort or grow large. If treatment is needed, surgical excision (called a spermatocelectomy) is the definitive option, performed as an outpatient procedure under local or general anesthesia. Recovery typically takes 1-2 weeks with minimal complications. These cysts differ from varicoceles (dilated veins) and epididymal cysts (cysts in the epididymis) in their location and composition, though they may appear similar on physical examination. Any testicular or scrotal mass should be evaluated by a healthcare provider to rule out more serious conditions, such as testicular torsion or epididymitis, which can be diagnosed using ultrasound (US) imaging, as recommended by the American College of Radiology 1.
Some key characteristics of encysted hydroceles include:
- They are typically painless and benign
- They feel like a smooth, firm lump above the testicle
- They contain a milky or clear fluid
- They are separate from the testicle itself, developing higher up along the spermatic cord
- They can be distinguished from other scrotal conditions, such as varicoceles and epididymal cysts, through physical examination and imaging studies, such as US 1.
It is essential to evaluate any testicular or scrotal mass by a healthcare provider to rule out more serious conditions, and to use the contralateral asymptomatic testicle as an internal control during US imaging 1.
From the Research
Definition of Encysted Hydrocele
- An encysted hydrocele is a non-communicating inguinal hydrocele, with a collection of fluid throughout the spermatic cord, which is separate and lies above the testes and epididymis 2.
- It is a type of funiculus hydrocele, which is an uncommon anomaly characterized by obstruction in the closure of the processus vaginalis 2.
Characteristics of Encysted Hydrocele
- Encysted hydrocele is usually painless and rarely dangerous, but it can become larger over time 2.
- It can be diagnosed clinically, and scrotal ultrasound can be used to distinguish it from other scrotal lesions if any uncertainty exists 2.
- The treatment for non-communicating inguinal hydrocele, including encysted hydrocele, can be surgery, especially if the hydrocele becomes larger 2.
Comparison with Other Types of Hydroceles
- Hydroceles can be divided into two types: primary and secondary 3.
- Primary hydroceles result from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis, while secondary hydroceles are caused by other factors such as injury or infection 3.
- Encysted hydrocele is a type of primary hydrocele, which is not related to the peritoneal cavity 2.
Treatment Options for Hydroceles
- Treatment options for hydroceles include conservative treatment, fluid aspiration, or hydrocelectomy 3.
- Aspiration and sclerotherapy is a minimally invasive treatment option for hydroceles, which can be effective in relieving symptoms and avoiding surgery 4, 5.
- The choice of treatment depends on the individual case and the patient's preferences and medical history 6.