Hydrocele of the Testicle
A collection of fluid around the testicle that causes painless swelling in the scrotum, commonly affecting newborns and older men
Quick Facts
- Type: Fluid accumulation
- ICD-10: N43.0-N43.3
- Common in: Newborns, older men
- Treatable: Yes
Overview
A hydrocele is a fluid-filled sac that forms around one or both testicles, causing the scrotum to swell. It occurs when fluid accumulates in the thin sheath that surrounds the testicle (tunica vaginalis). While hydroceles are typically painless and benign, they can cause discomfort due to their size and may require treatment if they become large or symptomatic.
Hydroceles are common in newborn males, affecting up to 10% of male infants. In babies, hydroceles often occur because the passage between the abdomen and scrotum hasn't closed properly during development. Most infant hydroceles resolve on their own within the first year of life. In adults, hydroceles typically develop after age 40 and may result from inflammation, injury, or occur spontaneously without a clear cause.
There are two main types of hydroceles: communicating and non-communicating. Communicating hydroceles maintain a connection with the abdominal cavity, allowing fluid to flow back and forth, which can cause the swelling to vary in size throughout the day. Non-communicating hydroceles are closed off from the abdomen, and the fluid remains constant. While hydroceles themselves are not dangerous, they can sometimes be associated with underlying conditions that require medical attention, making proper evaluation important.
Symptoms
Hydroceles typically present as painless swelling, but can cause various symptoms depending on size and any associated conditions.
Primary Symptoms
Associated Symptoms
- Testicular pain - Usually mild if present
- Groin pain - From large hydroceles
- Lower abdominal discomfort
- Difficulty walking with large hydroceles
- Cosmetic concerns
- Difficulty with sexual activity
Size Variations
- Communicating hydrocele: Size changes throughout the day
- Larger in evening: After being upright all day
- Smaller in morning: After lying flat overnight
- May increase with straining or physical activity
Complications
- Urinary retention - From very large hydroceles
- Infection (rare)
- Rupture (very rare)
- Psychological distress
- Difficulty with clothing fit
Causes
Hydroceles can develop through different mechanisms depending on age and underlying factors.
Congenital Causes (Infants)
- Patent processus vaginalis: Failure of the passage between abdomen and scrotum to close
- Incomplete descent: Testicles not fully descended
- Prematurity: Higher risk in premature infants
- Low birth weight: Associated with various developmental issues
Acquired Causes (Adults)
Inflammatory Conditions
- Epididymitis: Inflammation of the epididymis
- Orchitis: Testicular inflammation
- Infections: Bacterial or viral
- Sexually transmitted infections
Trauma and Injury
- Direct blow to the scrotum
- Post-surgical complications
- Sports injuries
- Occupational injuries
Other Causes
- Tumors: Testicular or paratesticular tumors
- Radiation therapy: To the pelvic area
- Filariasis: Parasitic infection in tropical areas
- Idiopathic: No identifiable cause (most common in adults)
- Inguinal hernia repair: Post-operative complication
Secondary Hydroceles
May develop due to:
- Testicular torsion
- Varicocele surgery
- Kidney transplantation
- Peritoneal dialysis
- Ventriculoperitoneal shunt
Risk Factors
Several factors increase the likelihood of developing a hydrocele:
Age-Related Factors
- Newborns: Especially premature infants
- Men over 40: Increased risk with age
- History of undescended testicles
- Previous scrotal surgery
Medical Conditions
- Inguinal hernia
- Chronic infections
- Connective tissue disorders
- Heart failure (fluid retention)
- Liver disease with ascites
- Kidney disease
Environmental Factors
- Living in areas endemic for filariasis
- Occupational hazards (heavy lifting)
- Contact sports participation
- Previous pelvic radiation
Lifestyle Factors
- Activities causing repeated trauma
- Chronic straining
- Inadequate protection during sports
Diagnosis
Diagnosing a hydrocele typically involves physical examination and imaging studies to confirm the diagnosis and rule out other conditions.
Medical History
- Duration and progression of swelling
- Pain or discomfort levels
- Size variations throughout the day
- Previous scrotal trauma or surgery
- History of infections
- Associated urinary symptoms
- Impact on daily activities
Physical Examination
Inspection and Palpation
- Visual assessment of scrotal size and symmetry
- Palpation for consistency and tenderness
- Evaluation of testis position within hydrocele
- Assessment of inguinal region
- Examination for hernias
Transillumination Test
- Key diagnostic test for hydrocele
- Light passes through fluid-filled sac
- Positive transillumination suggests hydrocele
- Solid masses do not transilluminate
Imaging Studies
- Ultrasound: Gold standard for scrotal imaging
- Confirms fluid collection
- Evaluates testicular structure
- Rules out tumors or other pathology
- Assesses blood flow with Doppler
Additional Tests
- Blood tests: If infection suspected
- Urinalysis: To check for UTI
- Tumor markers: If malignancy suspected
- STI screening: If indicated by history
Differential Diagnosis
Conditions to distinguish from hydrocele:
- Inguinal hernia
- Testicular tumor
- Epididymal cyst
- Spermatocele
- Varicocele
- Hematocele
- Testicular torsion
Treatment Options
Treatment depends on the size of the hydrocele, symptoms, and patient preference. Many hydroceles require no treatment.
Conservative Management
Observation
- Appropriate for small, asymptomatic hydroceles
- Infant hydroceles often resolve by age 1-2
- Regular monitoring for size changes
- Patient education about warning signs
Supportive Care
- Scrotal support or athletic supporter
- Avoiding activities that worsen discomfort
- Ice packs for temporary relief
- Over-the-counter pain relievers if needed
Surgical Treatment
Hydrocelectomy
- Indications:
- Large or symptomatic hydroceles
- Failed conservative management
- Cosmetic concerns
- Interference with daily activities
- Procedure: Surgical removal of hydrocele sac
- Success rate: Over 95%
- Recovery: 2-4 weeks typically
Surgical Techniques
- Scrotal approach: Most common for adults
- Inguinal approach: For children or when hernia suspected
- Lord's procedure: Plication of sac
- Jaboulay procedure: Eversion of sac
Aspiration and Sclerotherapy
- Needle drainage of fluid
- Injection of sclerosing agent
- Higher recurrence rate than surgery
- Option for patients not suitable for surgery
- May require multiple treatments
Post-Treatment Care
- Scrotal support for comfort
- Ice packs to reduce swelling
- Activity restrictions for 2-4 weeks
- Follow-up appointments
- Watch for signs of infection
- Gradual return to normal activities
Prevention
While many hydroceles cannot be prevented, certain measures may reduce risk:
Injury Prevention
- Wear protective cups during contact sports
- Use proper lifting techniques
- Avoid direct trauma to the groin
- Safety equipment in hazardous occupations
Infection Prevention
- Practice safe sex to prevent STIs
- Prompt treatment of urinary infections
- Good personal hygiene
- Avoid sharing personal items
General Health Measures
- Regular medical check-ups
- Early treatment of hernias
- Management of chronic conditions
- Maintain healthy weight
- Stay hydrated
Post-Surgical Care
- Follow post-operative instructions carefully
- Attend all follow-up appointments
- Report any unusual symptoms promptly
- Gradual return to activities
When to See a Doctor
While hydroceles are usually benign, certain symptoms require medical evaluation:
Seek Immediate Care For
- Sudden, severe scrotal pain
- Rapidly increasing scrotal size
- Fever with scrotal swelling
- Redness and warmth of scrotum
- Nausea and vomiting with scrotal pain
- Inability to urinate
Schedule an Appointment For
- New scrotal swelling or mass
- Gradually increasing hydrocele size
- Discomfort interfering with activities
- Hydrocele in an infant over 12 months
- Changes in testicular consistency
- Concern about appearance
Regular Monitoring
- Known hydroceles should be monitored
- Annual check-ups for stable hydroceles
- Self-examination monthly
- Report any changes to doctor
Frequently Asked Questions
Hydroceles themselves are not dangerous and are benign fluid collections. However, they can sometimes be associated with underlying conditions like infections, hernias, or rarely, tumors. Any new scrotal swelling should be evaluated by a doctor to ensure proper diagnosis and rule out serious conditions.
Simple hydroceles typically do not affect fertility or hormone production. The testicle continues to function normally despite the surrounding fluid. However, very large hydroceles or those associated with infections might potentially impact fertility. Additionally, underlying conditions causing the hydrocele could affect fertility.
Recurrence rates depend on the treatment method. Surgical repair (hydrocelectomy) has a low recurrence rate of less than 5%. Aspiration alone has a high recurrence rate (nearly 100%), while aspiration with sclerotherapy has intermediate results. Proper surgical technique and post-operative care minimize recurrence risk.
Most patients can return to normal daily activities within 1-2 weeks after hydrocele surgery. Complete healing typically takes 4-6 weeks. During recovery, patients should avoid heavy lifting, strenuous exercise, and sexual activity as directed by their surgeon. Swelling and mild discomfort are normal initially.
Small, asymptomatic hydroceles often don't require treatment and may be monitored. In infants, many hydroceles resolve spontaneously by age 1-2. For adults, aspiration with or without sclerotherapy is a non-surgical option, though it has higher recurrence rates than surgery. The best treatment depends on size, symptoms, and patient preference.
References
- Dagur G, Gandhi J, Suh Y, et al. Classifying Hydroceles of the Pelvis and Groin: An Overview of Etiology, Secondary Complications, Evaluation, and Management. Curr Urol. 2017;10(1):1-14.
- Tsai L, Milburn PA, Cecil CL, Lowry PS, Hermans MR. Comparison of Recurrence and Postoperative Complications Between 3 Different Techniques for Surgical Repair of Idiopathic Hydrocele. Urology. 2019;125:239-242.
- Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA. Adult hydrocele and spermatocele. BJU Int. 2011;107(11):1852-1864.
- American Urological Association. Diagnosis and Treatment of Hydroceles. AUA Guidelines. 2022.
- European Association of Urology. Guidelines on Paediatric Urology. EAU Guidelines. 2023.