Introduction
A hydrocele is a buildup of fluid in the thin pouch that holds the testicles. This causes swelling in the scrotum. Men of any age can get hydroceles, but they’re most common in newborns and older men. Most hydroceles don’t cause pain and often clear up without medical help. Still, it’s important to know when treatment might be needed.
“Hydroceles are among the most common scrotal conditions we see in clinical practice,” says Dr. Rebecca Chen, a urologist who specializes in male reproductive health. “While they’re typically harmless, they can sometimes point to other issues that need attention.”
This article covers everything you need to know about hydroceles—what causes them, their symptoms, how doctors diagnose them, treatment options, and when to see a doctor.
What Is a Hydrocele?
A hydrocele is a collection of watery fluid inside the tunica vaginalis, a membrane that surrounds the testicle. The term “hydrocele” comes from Greek: “hydro” means water and “cele” means swelling.
How Hydroceles Form
Before birth, testicles develop in the baby’s abdomen. They then move down into the scrotum shortly before birth. As they move down, each testicle brings along a part of the abdominal lining called the processus vaginalis. This creates a small sac-like structure. Normally, this structure closes up, separating the belly from the scrotum.
“Hydroceles form when this process doesn’t work right,” explains Dr. Michael Rivera from Northwestern University. “If the sac doesn’t close fully or reopens later in life, fluid can build up around the testicle. This creates a hydrocele.”
Types of Hydroceles
Doctors group hydroceles into several types:
Communicating Hydrocele: Connects to the belly through an open pathway. Fluid from the abdomen can flow into the scrotum. The swelling often gets bigger during the day and smaller when lying down.
Non-communicating Hydrocele: A closed sac of fluid around the testicle with no link to the belly. The size stays fairly constant.
Congenital Hydrocele: Present at birth because the sac didn’t close properly during development.
Secondary Hydrocele: Develops later in life due to injury, infection, or other conditions affecting the testicle.
How Common Are Hydroceles?
Hydroceles affect about 1-2% of adult men. They’re more common in newborns (10%) and men over 40. The American Urological Association notes that hydroceles occur more often in areas with higher rates of filariasis, a parasitic infection.
Dr. Sarah Johnson, who studies men’s health conditions, points out that “congenital hydroceles usually go away within the first year of life. But adult-onset hydroceles tend to last and may slowly get bigger over time.”
Factors that increase your risk of getting a hydrocele include:
- Premature birth (for babies)
- Older age
- Injury to the scrotum
- Infections
- Inflammation from testicular conditions
- Radiation therapy for pelvic cancers
- Complications from hernia repair
Signs and Symptoms
The main symptom of a hydrocele is painless swelling of the scrotum. This may affect one or both sides. This swelling typically:
- Feels smooth and uniform
- Has a soft or firm texture
- Appears see-through when checked with a light
- May change size throughout the day (especially in communicating types)
“Most hydroceles don’t cause symptoms beyond the swelling itself,” says Dr. Chen. “But if a hydrocele gets very large, men may feel discomfort from the weight. They might have trouble with physical activities or sex.”
Other symptoms that might come with a hydrocele include:
- Dull ache or heaviness in the scrotum
- Discomfort during exercise or when standing for long periods
- Visible difference between testicles
- Redness or tenderness (if there’s an infection)
Diagnosis
To diagnose a hydrocele, doctors start with a thorough health history and physical exam. “The key sign is being able to feel the testicle separately from the fluid around it,” explains Dr. James Wilson from University Hospital.
Doctors use several methods to confirm a hydrocele:
Physical Examination
During an exam, the doctor will:
- Feel the scrotum to check the size and location of swelling
- Shine a light through the scrotum to tell fluid-filled hydroceles from solid masses
- Apply gentle pressure to see if the swelling reduces
Ultrasound
Ultrasound is the best imaging test for confirming hydroceles and ruling out other conditions. “Ultrasound lets us see the fluid around the testicle and check for any other problems,” notes Dr. Wilson.
A recent medical review found that ultrasound is over 95% accurate in telling hydroceles apart from other scrotal conditions.
Other Tests
Sometimes doctors may recommend:
- Blood tests to check for infection
- Urine tests to rule out urinary tract infections
- CT scan or MRI in complex cases
Similar Conditions
Several conditions can look like a hydrocele. Doctors need to rule these out for proper treatment. According to medical guidelines, these include:
- Inguinal hernia: Abdominal contents bulging into the scrotum
- Varicocele: Enlarged veins in the scrotum
- Epididymal cyst: Fluid-filled cyst in a part of the testicle
- Testicular torsion: Twisting of the spermatic cord (requires emergency care)
- Testicular cancer: Cancer growth in the testicle
- Epididymitis: Inflammation of the epididymis
“Being able to tell these conditions apart is crucial for proper care,” stresses Dr. Wilson. “While hydroceles are usually harmless, some of these other conditions need urgent treatment.”
Treatment Options
The right treatment for a hydrocele depends on several factors. These include the patient’s age, the size and type of hydrocele, symptoms, and any underlying conditions.
Watchful Waiting
For hydroceles without symptoms, especially in babies under one year, doctors often recommend just watching and waiting.
“About 80% of congenital hydroceles go away on their own within the first 12-18 months of life,” states Dr. Emily Rodriguez, a pediatric urologist. “For adults with small hydroceles that don’t cause problems, regular check-ups may be all that’s needed.”
Needle Drainage
Doctors can remove fluid from the hydrocele using a fine needle. This gives temporary relief, but studies show the fluid comes back in over 50% of cases within six months.
“We usually only drain hydroceles for patients who can’t have surgery or need quick relief,” explains Dr. Chen. “Sometimes we inject a special solution to prevent fluid buildup, but this can cause inflammation.”
Surgery
Surgery is the definitive treatment for persistent or troublesome hydroceles. The main surgical options include:
Hydrocelectomy: Traditional surgery with an incision in the scrotum or lower abdomen to remove the hydrocele sac and drain the fluid.
Lord’s Procedure: A technique where the surgeon folds the sac rather than removing it, causing less trauma.
Laparoscopic Repair: Minimally invasive surgery, especially useful for communicating hydroceles in children.
“The surgical approach depends on the patient’s age, hydrocele type, and the surgeon’s expertise,” notes Dr. Marcus Thompson, a urological surgeon. “Hydrocelectomy works well over 90% of the time, but we carefully weigh the benefits against possible complications, especially in older patients.”
A recent study found that complications from hydrocele surgery happen in 5-15% of cases. The rate is higher in elderly patients and those with very large hydroceles.
Recovery After Surgery
Most hydrocele surgeries are outpatient procedures. Patients can go home the same day. Recovery typically follows this timeline:
- First week: Expect swelling, bruising, and discomfort
- 1-2 weeks: Gradually return to light activities
- 2-4 weeks: Return to most normal activities
- 4-6 weeks: Complete recovery, including exercise and sex
“I tell my patients to wear supportive underwear, use ice packs, and take pain medications as needed during recovery,” says Dr. Thompson. “Most patients heal well, but temporary swelling during recovery is normal. It doesn’t mean the hydrocele is coming back.”
Complications and Special Cases
While hydroceles themselves are usually harmless, they can sometimes lead to problems or require special care in certain groups.
Possible Complications
- Infection: Rarely, the fluid in a hydrocele may get infected
- Atrophy: Very large hydroceles might affect testicular function if left untreated
- Fertility concerns: Hydroceles don’t directly cause infertility, but related conditions might
- Emotional impact: Some men feel distress about the appearance of their scrotum
Special Groups
Children: “For kids with hydroceles, we focus on figuring out whether the hydrocele connects to the abdomen,” explains Dr. Rodriguez. “We usually wait until after the child’s first birthday before considering surgery for congenital hydroceles.”
Older men: Elderly patients may have higher surgery risks and might choose non-surgical options unless symptoms greatly affect quality of life.
Tropical regions: In areas with filariasis (a parasitic disease), hydroceles may be part of a condition called elephantiasis. This requires specific treatments.
When to See a Doctor
Get medical help right away if you notice:
- Sudden or painful scrotal swelling
- Hardness or lumps within the testicle
- Redness, tenderness, or warmth in the scrotum
- A hydrocele in a child that hasn’t resolved by age two
- Rapidly growing hydrocele at any age
- Return of a hydrocele after treatment
“Any swelling in the scrotum should be checked by a doctor,” cautions Dr. Wilson. “While many causes are harmless, early diagnosis of conditions like testicular cancer is vital for successful treatment.”
Living with a Hydrocele
For men managing a hydrocele without surgery, these tips may help reduce discomfort:
- Wear supportive underwear or athletic supporters
- Avoid standing for long periods when possible
- Take over-the-counter pain relievers for occasional discomfort
- Apply cold packs if mild inflammation occurs
“Many of my patients successfully manage small to medium hydroceles without surgery,” shares Dr. Chen. “Regular check-ups are important to make sure the condition doesn’t get worse.”
Research and New Treatments
Current research focuses on less invasive approaches and better understanding of risk factors. “New techniques like microsurgical hydrocelectomy show promise for reducing complications and recovery time,” notes Dr. Thompson.
A recent review highlighted ongoing research into genetic factors that may make some men more likely to develop hydroceles. This could lead to prevention strategies in high-risk groups.
Frequently Asked Questions
Can a hydrocele go away on its own?
In babies, congenital hydroceles often clear up without treatment within the first 12-18 months of life. “About 80% of childhood hydroceles resolve on their own,” notes Dr. Rodriguez. Adult hydroceles rarely disappear without treatment. However, they may stay the same size for years and cause no problems. In these cases, you might only need regular check-ups.
Does a hydrocele affect fertility?
A hydrocele itself usually doesn’t affect fertility. “The fluid collects around the testicle, not inside it. This generally doesn’t interfere with sperm production,” explains Dr. Wilson. However, if the hydrocele is caused by another condition like an infection or injury, that underlying problem might affect fertility. If you’re concerned about fertility, talk to your doctor.
How can I tell the difference between a hydrocele and testicular cancer?
While both cause scrotal swelling, they feel different during an exam. “Hydroceles feel smooth and uniform. Light passes through them when checked with a flashlight,” says Dr. Chen. “Testicular tumors feel firm and irregular within the testicle itself and don’t let light through.” Only a proper medical exam, often including an ultrasound, can tell these conditions apart for sure.
What is the success rate of hydrocele surgery?
Hydrocele surgery has a high success rate, with studies showing 90-95% permanent cure after hydrocelectomy. “The chance of a hydrocele coming back after proper surgery is quite low, typically less than 5% when done by experienced surgeons,” states Dr. Thompson. Factors that affect success include the surgical technique, surgeon’s experience, patient’s age, and the size of the hydrocele.
Is hydrocele surgery major surgery?
Hydrocelectomy is considered intermediate rather than major surgery. “Most procedures are done on an outpatient basis. They take 30-60 minutes and you can go home the same day,” explains Dr. Thompson. “While recovery requires several weeks of limited activity, most patients return to daily routines within a week or two.” As with any surgery, discuss risks and recovery expectations with your surgeon.
Conclusion
A hydrocele is a common scrotal condition that is usually harmless. Still, it’s important to get it checked out to rule out more serious causes. Understanding the types, symptoms, and treatment options helps men make informed choices about their care.
As Dr. Chen puts it, “While the swelling can be concerning, patients should know that with proper evaluation and treatment—whether watching and waiting or surgery—outcomes are generally excellent.”
If you’re a parent worried about a child’s hydrocele or an adult with symptoms, talk to your doctor. They can provide the right diagnosis and create a treatment plan just for you.