A hydrocele is a build-up of clear fluid between the layers that surround the testicle. The result is swelling of one side of the scrotum, less often both, which usually does not hurt.
It occurs at any age: in newborn boys it is common and usually goes away on its own, while in adult men it develops gradually. An examination is important, because a painless swelling sometimes has another cause behind it – inflammation, injury or, rarely, a testicular tumour.
What a hydrocele is
The testicle is wrapped in a thin two-layered membrane, and normally there is a drop of fluid between its layers; when more fluid is produced than is drained away, a hydrocele forms. A communicating hydrocele is congenital – the channel between the abdomen and the scrotum has not closed, and the swelling is smaller in the morning and larger in the evening. A non-communicating hydrocele is closed off and is the typical form in adults.
Symptoms
- a painless, soft and smooth swelling of one side of the scrotum, sometimes with a feeling of heaviness;
- slow growth over months or years;
- in the congenital form – the size changing during the day or when the child cries;
- with a large hydrocele – discomfort when walking, sitting and during sex.
When it is urgent: a sudden, very painful swelling of the scrotum, especially with nausea, is not a hydrocele but most likely testicular torsion – go to an emergency department or call 112 (the European emergency number) without waiting for an appointment. A painful swelling with a high temperature points to acute inflammation of the epididymis (the tube behind the testicle), and in a baby a hard, painful swelling in the groin may be a trapped (incarcerated) hernia – both need immediate help.
Causes and risk factors
In children the cause is a channel between the abdomen and the scrotum that has not closed, which can also lead to a hernia. In adults the fluid builds up:
- with no identifiable cause – the most common variant in adulthood;
- after inflammation of the epididymis or the testicle;
- after injury or torsion of the testicle;
- around a testicular tumour – rare, but this is why an ultrasound scan is essential;
- after operations for varicocele or hernia.
Diagnosis
A consultation with Dr Penev begins with questions about when the swelling appeared, whether it changes and whether there has been an injury or inflammation, after which the scrotum is examined lying down and standing up.
An ultrasound scan of the scrotum is the key test – it is painless, is done during the consultation and shows the amount of fluid, the testicle behind it and whether there is a solid lump. This distinguishes a hydrocele from an epididymal cyst, a varicocele and a hernia, and most importantly rules out a tumour, as described in the article on a testicular lump.
Treatment
A small hydrocele without symptoms and with a normal ultrasound picture is simply monitored; when the cause is an inflammation, the inflammation is treated.
Aspiration – drawing off the fluid with a needle – gives only short-term relief: the space almost always fills up again, and every puncture carries a risk of infection and bleeding. So it is not a solution and is used only in exceptional cases.
The lasting treatment in adults is hydrocelectomy. Through a small incision in the scrotum the fluid is removed, and the membrane is cut away or turned inside out and stitched so that it does not fill up again. Dr Penev performs scrotal operations at Kaspela University Hospital (UMBAL Kaspela) in Plovdiv, most often as a day case; possible complications include a haematoma (a collection of blood), infection and, rarely, recurrence.
In children, a hydrocele that has not gone away by the end of the second year, is growing or occurs together with a hernia is operated on through a small incision in the groin crease; the child is assessed and referred during a paediatric urology consultation.
When to see a urologist
Book a consultation for any new swelling of the scrotum, even if it does not hurt – the aim is to rule out a serious condition. Do not delay either if a known hydrocele starts to grow, becomes painful or hard, or if the swelling in your child does not go away after the first year.
Prevention
A hydrocele cannot be prevented. The risk of the acquired form is lower when inflammation of the epididymis is treated in time and injuries to the scrotum are not ignored; a monthly self-examination of the testicles helps you notice any change early.
A hydrocele is a benign condition with effective surgical treatment, but the first step is always an examination with ultrasound. Book an appointment with Dr Penev in Plovdiv or Karlovo to find out whether monitoring is enough in your case or whether it is time for treatment.
Frequently asked questions
Is a hydrocele dangerous?
In itself it is not dangerous and, at the usual sizes, it does not damage the testicle. Its significance lies elsewhere – the fluid sometimes hides an inflammation or, rarely, a tumour, so every new swelling is checked with an ultrasound scan.
Can a hydrocele be treated without surgery?
There are no medicines that remove the fluid. A small hydrocele without symptoms is monitored, and in adults only surgery gives a lasting solution. Draining the fluid with a needle is almost always followed by the fluid building up again.
Does a hydrocele affect fertility and erections?
At the usual sizes it affects neither sperm production nor erections. A very large hydrocele can make intercourse difficult because of its bulk, which is also a reason for surgery.
How quickly will I recover after hydrocele surgery?
You usually go home the same day or the next day. The swelling of the scrotum goes down gradually over two to four weeks, and work without physical exertion is possible after a few days.
Does a baby with a hydrocele need surgery?
In most cases, no. A congenital hydrocele is often reabsorbed by the end of the first or second year. Surgery is considered if it persists beyond this age, grows or occurs together with a hernia.
The information on this website is for general education and does not replace an examination and consultation with a doctor. If you have urgent symptoms, seek medical help immediately or call 112.