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
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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.
Factors that may increase the chances of a hydrocele:
- Premature birth
- Injuries to the testicles or scrotum
- Infections, including those that are sexually transmitted
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
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 options include:
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.
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.
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.
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.
Healthy Children—American Academy of Pediatrics
Urology Care Foundation
Canadian Urological Association
The College of Family Physicians of Canada
Hydrocele. Patient website. Available at: https://patient.info/doctor/hydrocele. Accessed January 29, 2021.
Hydrocele in adults and adolescents. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T116012/Hydrocele-in-adults-and-adolescents. Accessed January 29, 2021.
Hydrocele in infants and children. EBSCO DynaMed website. Available at:http://www.dynamed.com/topics/dmp~AN~T913127/Hydrocele-in-infants-and-children. Accessed January 29, 2021.
Last reviewed March 2020 by EBSCO Medical Review Board Adrienne Carmack, MD Last Updated: 1/29/2021