Hydrocele

What is a hydrocele?

A hydrocele (HI-dra-seel) is a fluid-filled sac in your scrotum that causes swelling. Your scrotum is the pouch of skin behind your penis that holds your testes (testicles). A hydrocele may affect one side of your scrotum or both sides. Another name for hydroceles around both of your testicles is a bilateral hydrocele.

Hydroceles can affect any males but they’re more common in infants.

They can also occur spontaneously in adulthood.

How serious is a hydrocele?

Hydroceles can be alarming because they cause swelling in a sensitive part of your body and can happen suddenly. In some instances, hydroceles can be bothersome depending on their size. A large hydrocele may cause discomfort while sitting or walking. However, in many people, a hydrocele isn’t serious, bothersome or painful.

What are the types of hydroceles?

There are two types of hydroceles: communicating hydroceles and noncommunicating hydroceles.

Communicating hydrocele

A communicating hydrocele has contact (communication) with the fluids in your abdominal cavity. Your abdominal cavity is the space within your abdomen that contains your stomach, intestines, liver, kidneys and other organs. Communicating hydroceles occur in fetal development.

During development, a thin membrane forms between some tissues in the fetus’s stomach lining (inguinal canal) and the scrotum. This membrane is the processus vaginalis. Normally, the testicles slide (descend) from the abdomen through the processus vaginalis into the scrotum. Tissue then forms to seal the opening (communication). If a seal doesn’t form, fluids from the abdominal cavity can flow into the scrotum and cause a hydrocele or hernia.

If you or your child has a communicating hydrocele, the scrotum will appear large or swollen, and it may change in size throughout the day.

Noncommunicating hydrocele

In a noncommunicating hydrocele, the processus vaginalis closes. But there’s still some extra abdominal fluid around the testicle in the scrotum. Noncommunicating hydroceles may be present at birth or develop years later for no obvious reason.

If you or your child has a noncommunicating hydrocele, it usually remains the same size or grows very slowly.

What are the symptoms of a hydrocele?

The main symptom of a hydrocele is swelling on one or both sides of your scrotum that may feel like a water balloon. You might notice other symptoms in your scrotum, like:

• Swelling that changes in size during the day.
• Discomfort.
• Pain.
• A feeling of heaviness.

Will a hydrocele affect fertility?

Hydroceles usually don’t cause infertility.

What causes a hydrocele?

Infants that have a hydrocele are usually born with it. Hydroceles are typically part of fetal development, when abdominal fluid can flow into the scrotum if the processus vaginalis doesn’t close. And sometimes, even if the processus vaginalis closes, abdominal fluid may remain in the scrotum. Your child’s body usually absorbs this fluid within the first two years.

Who do hydroceles affect?

Hydroceles are much more common in babies and infants, but may also occur in adolescents and adults.

About 10% of newborn infants have a hydrocele, which often clears up without treatment within the first year.

Hydroceles occur in only about 1% of adults. They often disappear on their own without treatment.

What causes a hydrocele in adults?

In older children, teenagers or adults, a hydrocele can form as a result of an injury to or inflammatory infection of the scrotum.

How is a hydrocele diagnosed?

A healthcare provider can diagnose a hydrocele in a child or adult. They’ll ask questions about your symptoms and perform a physical examination.

During the physical exam, the provider may apply pressure to the groin area or ask you to cough to see how the swelling changes. They may shine a light through your scrotum to highlight any abdominal fluid in the area. A provider can diagnose most hydroceles from a physical exam alone.

To confirm their diagnosis, the provider may order imaging tests, including:

• Pelvic ultrasound. A pelvic ultrasound uses high-frequency sound waves to create images of the soft tissues in your pelvis, including your testicles. It’s the most common imaging test providers order for a hydrocele diagnosis.
• Computed tomography (CT) scan. A CT scan is a type of X-ray that takes cross-section pictures of your body — like slices — to create 3D images of your testicles. A CT scan is more precise than a standard X-ray.

What is the best treatment for a hydrocele?

A hydrocele usually doesn’t need treatment.

Will a hydrocele go away by itself?

Most hydroceles go away on their own without treatment. But if a hydrocele doesn’t resolve on its own, a healthcare provider may recommend a hydrocelectomy. During a hydrocelectomy, a surgeon will remove the hydrocele. If you have a communicating hydrocele, they’ll close the opening between your processus vaginalis and scrotum.

What shrinks a hydrocele?

If a hydrocele doesn’t go away on its own, the only way to correct it is to have surgery. There aren’t any medications available to shrink a hydrocele.

What happens if a hydrocele is left untreated?

Though rare, an inguinal hernia can develop if the processus vaginalis opening is large and doesn’t receive treatment. An inguinal hernia causes part of your intestine or intestinal fat to push through the inguinal canal in your groin. It can be painful and, in some cases, dangerous.

What are the complications or side effects of hydrocele surgery?

A hydrocelectomy is a relatively safe procedure. But all surgeries carry some risk. Some hydrocele surgery risks include:

• Anesthesia risks.
• Infection.
• Swelling.
• Bruising.
• Scarring.
• The hydrocele comes back (recurrence).

How soon after hydrocele treatment will I feel better?

Most people can return to normal activities a few days after a hydrocelectomy, but it may take several weeks to heal fully. Your healthcare provider will give you an estimated recovery time according to your or your child’s specific condition.

Can a hydrocele be prevented?

There’s nothing you can do to prevent your baby from getting a hydrocele.

For older children, adolescents and adults, the best way to prevent a hydrocele is to protect your testicles and scrotum from injury. It’s a good idea to wear an athletic cup if you play sports or participate in other vigorous activities.

What can I expect if I have this condition?

The outlook for a hydrocele is generally very good. Most cases resolve on their own, and cases that require surgery have a high success rate.

When can I go back to work or school?

After surgery to treat a hydrocele, most people need to take about a week off work or school. You may need to take more time off if you have a physically demanding job.

Can I live a normal life with a hydrocele?

Yes. A hydrocele shouldn’t interfere with your daily activities or reduce your quality of life.

When should I see my healthcare provider?

Contact a healthcare provider if you notice swelling in your child’s scrotum. Also, be aware of the following signs:

• A lump in your child’s scrotum or just above their scrotum.
• Your child seems to be in pain.
• Your child appears nauseated or vomits.
• Your child isn’t eating as much as usual.

What questions should I ask my healthcare provider?

If you or your child has a hydrocele, you may wish to ask your healthcare provider the following questions:

• How do you know I have (my child has) a hydrocele?
• If I don’t (if my child doesn’t) have a hydrocele, what other condition do I (they) have?
• Do I need (does my child need) treatment for my (their) hydrocele?
• What treatment is best for me (my child)?
• How can I (my child) stay comfortable?
• Should I (my child) take time off school or work?
• When should I (my child) return for a follow-up appointment?

What is the difference between a hydrocele and a varicocele?

A hydrocele is a fluid-filled sac in your scrotum that causes swelling. A varicocele is when the veins in your spermatic cord swell. The spermatic cord is a band of tissues that holds your testicles in place.