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The Facts About Hydroceles

If your scrotum is swollen, you may have a hydrocele. Here's what you need to know.

An x-ray of a testicle shows a hydrocele in yellow.

A hydrocele is an accumulation of clear fluid around one or both testicles that leads to swelling in the scrotum. In adult men, this swelling can lead to the sensation of heaviness and a bit of discomfort, but the condition is actually most common in newborn babies: Approximately 10 percent of newborn males have a hydrocele.

A hydrocele feels like a small, smooth balloon filled with fluid inside the scrotum, mostly in front of the testicles or one testicle. They vary in size, and are typically painless but can cause discomfort as the size increases. Hydroceles typically resolve in six months for adults or up to a year in infants, but a doctor may take more proactive steps if the condition is causing you discomfort or disrupting your day-to-day life.

A closer look at hydroceles

In babies, the formation of hydroceles may begin before birth. When a fetus is still growing, the testicles develop near the kidneys in the abdomen. By the time of birth, the testicles drop into the scrotum via a short channel, called the inguinal canal. In this process, a sac called the tunica vaginalis, containing fluid, is formed around each testicle. Typically, the sac closes naturally and the body absorbs the fluid inside, but when this isn't the case, a hydrocele results. Premature babies are at greater risk for hydroceles at birth.

Adult hydroceles, which are those that occur in adolescence or beyond, are less understood and can occur for several reasons. The inguinal canal may have never closed or reopened at an older age, or inflammation, infection or injury may cause an overproduction of fluid in the scrotum. Hydroceles can sometimes occur after surgery, such as that to repair a hernia.

Types of hydroceles

Hydroceles are classified into two types: communicating and noncommunicating. The two present differently and can indicate different underlying causes or problems. The key difference is the status of the tunica vaginalis, the thin pouch formed during fetal development that holds the testicles in place within the scrotum.

If a hydrocele is communicating, the tunica vaginalis has not completely closed. This means fluid can flow in and out of the hydrocele. A communicating hydrocele is distinct because it will change size and position throughout the day. This type tends to last longer and may require surgery.

If a hydrocele is noncommunicating, the tunica vaginalis is closed; there is no connection between the scrotum and the abdomen. This type can happen at birth, but if it happens at a later age or adulthood, it may be the result of another issue, such as infection, testicular torsion or potentially a tumor.

What it's not

Many conditions can cause the scrotum to swell in similar ways to hydroceles. Seeing a change in your scrotum may be alarming, but you can rule out certain problems based on how they're different:

  • Testicular cancer often starts as a lump in the testicles, but the lump will typically feel hard and rough, not smooth and fluid like a hydrocele.
  • Spermatoceles are fluid-filled cysts, similar to a hydrocele, but these sit above the testicle rather than in front of it.
  • Epididymitis may actually contribute to a hydrocele, but it's an inflammatory condition, meaning you will likely feel pain, unlike with a hydrocele.
  • Orchitis, like epididymitis, causes pain in addition to swelling. Remember, a hydrocele may feel uncomfortable but it does not cause sharp pain.
  • Inguinal hernias are closely related to communicating hydroceles, and your doctor will likely keep an eye out for one if the other is present. Because the tunica vaginalis is not closed, there is a chance part of the intestine can slip from the abdomen, through the inguinal canal and potentially into the scrotum. During the diagnosis process, your doctor will check for a hernia.

Diagnosis and treatment

To diagnose a hydrocele, the doctor will physically examine the scrotum and look for telltale signs, such as swelling and smoothness. The doctor will not be able to feel the testicles, or feel them well, through the fluid. It's at this stage the doctor will check the scrotum, groin and abdomen for an inguinal hernia. The doctor will likely use transillumination to check for fluid, shining a bright light on one side of the scrotum so it passes through the area. Fluid will allow the light through, where a solid mass would not.

Hydroceles that persist after the first year of a child's life or develop later in adulthood may require treatment in select cases. A doctor may prescribe pain relievers for individuals with discomfort or suggest a support garment be worn to reduce swelling. In some instances, surgery may be encouraged, or required, if the hydrocele is large enough to interfere with other parts of the scrotum or the doctor suspects other complications are present.

While needle aspiration or drainage was common in the past, the treatment of choice currently is a hydrocelectomy, or surgery to remove or drain the hydrocele. A hydrocelectomy offers the best chance of preventing the recurrence of a hydrocele, though it still may occur. Generally, the procedure is considered minor surgery and can be done using local or general anesthesia on a same-day outpatient basis.

The surgeon will remove or drain the hydrocele through a small incision on or near the affected area. In the days following surgery, a drainage tube may be used to continue the process. As with any incision, swelling and tenderness during recovery is to be expected, but this typically dissipates within a few weeks as the area heals.

No cause for concern

While scrotum swelling may initially be alarming, a hydrocele is generally not a big deal for infants or adults. Typically, it goes away on its own, is usually harmless, and comes and goes without any effect on fertility. In the rare case where treatment is needed, the surgical procedure has a short recovery time and alleviates discomfort from inflammation.