Hydrocele: Diagnosis and Symptoms

What is a Hydrocele?

A hydrocele is a collection of watery fluid that builds up in a sac around one or both testicles and causes the scrotum to swell. It can be uncomfortable, but it is usually not painful. It can be unsightly, but a hydrocele is rarely dangerous. Hydroceles occur most commonly in newborns, although they can occur at any stage of life. In newborns, a hydrocele results from an opening between the abdomen and the scrotum that usually closes before birth or just afterwards. If it appears later in life, it may be the result of inflammation or infection in the epididymis or the testicles. It can also result from surgery or injury to the scrotum or groin. In rare cases, it can occur with cancer of the testicle or left kidney.

Symptoms of Hydrocele

Hydroceles usually do not cause any symptoms. If symptoms occur, they can include enlargement, redness, or pain in the scrotum or a feeling of pressure at the base of the penis. Hydroceles that are caused by an open communication between the scrotum and abdomen will generally be smaller in the morning and increase in size during the day, as gravity allows fluid to collect. Coughing, crying, or other activities that increase intraabdominal pressure will increase the size of a communicating hydrocele.

Diagnosis of Hydrocele

Hydroceles are normally diagnosed by examination of the scrotum. Your physician will use the technique of trans illumination, which refers to shining a light behind each testicle. Since they are filled with fluid, light will pass through. In the case of a solid mass or tumor, light will not pass through. An ultrasound is sometimes used to confirm the diagnosis of hydrocele.

Treatment of Hydrocele

Hydroceles are normally treated only when they cause pain or interfere with normal activities. Ninety-five percent of hydroceles that are present at birth will gradually and completely resolve by the end of the first year of life. Those that don’t resolve will usually need surgical repair.

In the case of hydroceles that develop later in life, if the size of it causes embarrassment, it can be treated. If the it is obstructing the blood supply to the penis, it will also be treated. In most cases, particularly in men under the age of 65 years, hydroceles resolve without treatment. Treatment is unnecessary if the hydrocele is getting smaller, as the body is reabsorbing the fluid. If you and your doctor decide your hydrocele needs treatment, a urologic surgeon can remove the fluid from the hydrocele through a needle, by aspiration. However, fluid that is aspirated from a hydrocele will often return, and surgery may become necessary. Most doctors will recommend surgery if the hydrocele is large or uncomfortable.