Hydrocele of the Testicle

How hydroceles form

Before birth, each testicle develops in the abdomen and moves down into the scrotum through a channel called the processus vaginalis. This channel normally closes, leaving a thin sac (the tunica vaginalis) around the testicle that makes and absorbs a small amount of fluid.

• Communicating hydrocele: the channel stays open, so abdominal fluid flows into the scrotum. The swelling changes size, often bigger after activity and smaller after lying down. It is closely related to an inguinal hernia.
• Non-communicating hydrocele: the channel has closed, but the sac contains extra fluid. The size stays stable.

In adults, hydroceles form when the sac makes too much fluid or absorbs too little.

Causes

In babies and children

• incomplete closure of the processus vaginalis
• more common in premature babies

In adults

• often no clear cause (idiopathic)
• injury to the scrotum
• epididymitis or orchitis
• after hernia repair or varicocele surgery
• rarely, testicular cancer or torsion causing a "reactive" hydrocele
• in tropical regions, lymphatic filariasis, a parasitic infection

Symptoms

• painless swelling of one or both sides of the scrotum
• a feeling of heaviness or dragging
• discomfort from large size, especially when walking or sitting
• in a communicating hydrocele, swelling that varies through the day

Pain is not typical. Painful swelling suggests another problem, such as infection or torsion.

Hydrocele vs other scrotal swellings

Diagnosis

• Physical exam: a doctor feels the scrotum, checks whether the testicle can be felt separately, looks for a groin bulge, and shines a light through the swelling.
• Scrotal ultrasound: confirms fluid, examines the testicle (essential when it cannot be felt clearly in an adult), and rules out hernia, tumor or other causes.
• Blood and urine tests if infection or tumor is suspected.

Treatment

Watchful waiting

• Babies: most hydroceles disappear by 12 to 18 months as the fluid is absorbed.
• Adults: small, painless hydroceles can be left alone.

Surgery

• Children: surgery is advised for hydroceles persisting beyond 12 to 24 months, communicating hydroceles that keep changing size, or when a hernia is present. The surgeon closes the open channel through a small groin incision.
• Adults: hydrocelectomy removes or folds the sac through a small scrotal incision, usually as outpatient surgery. Recurrence is uncommon.

Aspiration and sclerotherapy

Draining the fluid with a needle, sometimes followed by injecting a substance to seal the sac, may be used for people who cannot have surgery. Fluid often returns after aspiration alone.

Recovery

Swelling and bruising are common for a few weeks after surgery. Supportive underwear, ice and pain relief help. Most adults return to desk work within a few days and avoid heavy lifting for 2 to 4 weeks.

Complications

Hydroceles themselves rarely cause harm and do not affect fertility. Problems come from associated conditions (hernia, tumor) or surgery (bleeding, infection, recurrence, rarely injury to the epididymis).

Frequently asked questions

Is a hydrocele serious?

Usually not. Hydroceles are a common, harmless cause of painless scrotal swelling. However, any new scrotal swelling in an adult should be checked with an ultrasound to rule out a hernia or testicular tumor.

Will a hydrocele go away on its own?

In babies, most hydroceles disappear by 12 to 18 months. In adults, hydroceles usually persist and may slowly grow, but small painless ones can be left alone. Large or uncomfortable hydroceles are treated with surgery.

Does a hydrocele affect fertility?

A hydrocele itself does not usually affect fertility or testicle function. Surgery carries a small risk of injury to nearby structures, so it is generally done only when the hydrocele causes symptoms.

How is a hydrocele different from a hernia?

A hydrocele is fluid around the testicle. A hernia is a bulge of abdominal contents, usually intestine, into the groin or scrotum. Communicating hydroceles and hernias share the same open channel in children, and both are repaired by closing it.