Hydrocele at a glance
- A hydrocele is a fluid-filled sac surrounding a testicle, and sometimes both testicles can have a hydrocele.
- Most people do not report pain from the hydrocele, and the most common symptom is a swollen scrotum.
- Hydroceles are most common in newborns, but can also occur in men as they age or due to trauma or infection.
- They sometimes go away without treatment, but at times surgery or aspiration (draining) is needed to remove the fluid.
What is a hydrocele?
A hydrocele is a buildup of fluid around a testicle that causes the groin area or scrotum to swell. Sometimes both testicles can have a hydrocele. The swelling is usually not painful or dangerous but some men do report it being uncomfortable.
The swollen area might be smaller in the morning and grow throughout the day. The swelling in the scrotum can be described as feeling like a filled water balloon.
Hydroceles are most common in newborns and are present in around 10 percent of babies. A boy born prematurely has a higher risk of developing a hydrocele. Hydroceles can also occur later in life, often in men over age 40.
Our urologists are skilled in diagnosing and effectively treating hydroceles.
The cause of hydroceles in newborns is thought to be due to a malfunction in the descent of the testicle from the abdomen to the scrotum toward the end of pregnancy. The testicle moves down through a tract that sometimes does not close properly, allowing fluid in from the abdomen. Usually the excess fluid is absorbed gradually by the newborn’s body.
About 1 percent of men get hydroceles, usually later in life. In most cases, no definite cause is identified, but they may be caused by an injury, obstruction of the spermatic cord or surgery to the scrotum or groin area. Hydroceles can also be caused by infection, including sexually transmitted infections, or by inflammation of the testicles or of the epididymis, which is a duct behind the testicle that carries sperm. In rare cases hydroceles may occur with cancer of the testicles or of the left kidney.
Symptoms of hydrocele
There are often no symptoms of hydrocele. Symptoms that may be present include swelling, pain or redness of the scrotum or a feeling of pressure at the base of the penis.
It is important that men who notice swelling in the scrotum see a doctor. The physician will be able to rule out other causes and evaluate if treatment is needed.
Men should get immediate medical attention if the scrotum has severe pain or swelling several hours after an injury to the scrotum. These symptoms could occur with a number of conditions including blocked blood flow in a twisted testicle.
Hydroceles could also be associated with an inguinal hernia. This involves the intestine being trapped in the abdominal wall or dropping into the scrotum with the testicles, which can lead to life-threatening complications.
Hydroceles do not affect fertility, but they can be associated with an underlying testicular condition, such as an infection or tumor that can reduce sperm production or function.
Diagnosis of hydrocele
Physicians usually diagnose a hydrocele by an exam of the scrotum. The doctor will check for tenderness of the enlarged scrotum and the abdomen. As a part of the exam, the doctor may also shine a light behind each testicle. Hydroceles are filled with fluid so the light will shine through them. If the problem is being caused by a solid mass, such as cancer of the testicles, the light will not pass through.
The doctor could also order blood or urine tests to help determine if an infection is present. An ultrasound may be used to confirm the diagnosis of hydrocele and rule out other possible causes for the scrotal swelling.
Treatment of hydrocele
Hydroceles are generally not dangerous and often not treated. Hydroceles are only treated when they cause pain, result in embarrassment due to the swelling, do not go away on their own in a year, or very rarely when the size of the hydrocele could affect the function of other parts of the scrotum.
Hydroceles in men under 65 often go away on their own. In older men, a hydrocele frequently does not go away without treatment.
Hindered by a Hydrocele
Robert waited nearly 20 years to get his hydrocele fixed! Dr. Sethi took the time to explain to Robert his options; surgery vs. aspiration. Now, Robert is happy that the surgery is over and grateful for Dr. Sethi’s work.
Surgery – hydrocelectomy
If the hydrocele does need to be removed, the most common surgery option is a hydrocelectomy. A small incision is made in the lower scrotum to remove the hydrocele fluid and lining. This procedure can be performed on an outpatient basis with general or regional anesthesia. The patient will be able to go home a few hours after surgery.
Depending on the size and location of the hydrocele, after surgery a tube to drain fluid may be needed, along with dressing to cover the incision. To ease discomfort, surgeons recommend use of a scrotal support strap and an ice pack to help reduce swelling.
Pain after surgery tends to last about a week. The doctor may prescribe pain medication if deemed necessary. It will take a few weeks for the patient to return to normal activity. Ask your surgeon about any postoperative activity limitations.
As with any surgery, risks include blood clots, blood loss, infection, pain and complications from anesthesia.
Fluid can also be removed from a hydrocele with a long needle in a process called aspiration. It is common that a hydrocele will return if treated by aspiration. In some cases, a drug may be injected to prevent the sac from refilling. Aspiration is recommended only for men who are not physically cleared for surgery, do not want surgery or who want immediate decompression.
The side effects that are most commonly associated with aspiration are risk of infection and temporary pain in the scrotum.