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Hydrocele

Definition

A hydrocele is a build-up of fluid in the membrane that surrounds the testicle.

Types of hydrocele include:

  • Communicating—present at birth, generally found in infants and young children
  • Noncommunicating—acquired, occurs at any age, mostly in adults

Male Anatomy

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Causes    TOP

A communicating hydrocele is more common in infants and children. It occurs during fetal development. Testicles develop in the abdomen. They eventually move into the scrotum through a small channel. This channel should close after the testicles pass through it. When the channel does not close, fluid can pass from the abdomen into the membrane covering the testicle.

A noncommunicating hydrocele is more common in adults. It may be caused by an injury or infection that causes fluid build-up. It can also be a complication of surgery. In some cases, the cause is unknown.

Risk Factors    TOP

Factors that may increase the chance of a hydrocele include:

  • Premature birth
  • Injuries to the testicles and/or scrotum
  • Infections, including those that are sexually transmitted

Symptoms    TOP

A hydrocele may not always cause symptoms. When they do appear, a hydrocele may cause:

  • Swelling of the scrotum
  • Feeling of heaviness or soreness in the scrotum
  • Swelling with activity or standing—especially with a communicating hydrocele

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. A hydrocele is usually diagnosed by physical exam. The doctor may want to do tests to confirm a cause or rule out other conditions.

Tests may include:

  • Transillumination—A bright light is shined through the swollen part of the testicle.
  • Ultrasound—May be done if the diagnosis is unclear or to rule out other causes such as a testicular mass.

Treatment    TOP

Treatment options include:

Watchful Waiting

A communicating hydrocele generally goes away on its own during the first year of life. A noncommunicating hydrocele may also resolve on its own or with treatment of a related condition. Watchful waiting is simple monitoring for any changes with treatment if the problem worsens or does not go away.

Aspiration

Fluid may be removed with a needle. It may be done for a large hydrocele that causes discomfort or obstruction. Aspiration may need to be done more than one time because fluids can return.

For adults with a hydrocele, fluid aspiration may be followed by sclerotherapy. A needle is inserted into the same area with a sclerosing agent. The sclerosing agent causes scar tissue in the channel which blocks the flow of fluid.

Surgery

A hydrocelectomy may be advised if the hydrocele:

  • Remains or develops after the first year of life
  • Becomes large enough to threaten testicular blood supply or to cause discomfort
  • Is associated with a hernia

During a hydrocelectomy to treat a noncommunicating hydrocele, an incision is made into the scrotum (or groin area). The fluid is drained, and the hydrocele sack is removed. During a hydrocelectomy to treat a communicating hydrocele, the incision is made in the groin, the fluid is drained, and the hydrocele sack is removed. Surgery usually corrects the problem without recurrence.

Prevention    TOP

Some hydroceles cannot be prevented. However, avoiding testicular trauma, such as by wearing protective gear during contact sports, may reduce the chances of developing some types of hydroceles.

RESOURCES:

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org
Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org
The College of Family Physicians of Canada
http://www.cfpc.ca

References:

Hydrocele. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116012/Hydrocele. Updated March 26, 2016. Accessed October 3, 2016.
Hydrocele. Patient UK website. Available at:
...(Click grey area to select URL)
Updated February 26, 2016. Accessed March 3, 2016.
Painless scrotal mass. Merck Manual Professional Version website. Available at:
...(Click grey area to select URL)
Updated July 2013. Accessed March 3, 2016.
Last reviewed March 2016 by Adrienne Carmack, MD
Last Updated: 10/3/2016

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