A hydrocele is a medical condition characterised by the accumulation of fluid in the scrotum, which leads to swelling or enlargement of the testicle.

Though it is generally harmless and often resolves on its own in infants, it can cause discomfort or other complications in adults.

While a hydrocele might sound concerning due to the visible swelling, the condition itself is typically benign and treatable.

Want to know more about hydrocele?

In this blog, Mykare Health will explore what a hydrocele is, its causes, symptoms, diagnosis, treatment options, and key takeaways.

What is a Hydrocele?

A hydrocele is an abnormal buildup of fluid around one or both of the testicles, resulting in swelling in the scrotum. The condition is most common in newborns but can occur in adults as well.

In infants, a hydrocele often resolves on its own within the first year of life. However, in adults, it may persist or develop due to various causes, including injury, infection, or inflammation.

Hydroceles are generally painless, but they can cause noticeable swelling, which may be alarming. In some cases, they can lead to discomfort or pain, particularly if the swelling becomes large or if there is increased pressure on surrounding structures.

Causes of Hydrocele

The exact cause of a hydrocele depends on the patient’s age and the underlying factors contributing to the fluid buildup. Broadly, hydroceles can be classified into two categories: congenital and acquired.

1. Congenital Hydrocele (in Infants)

In newborns, hydroceles are often congenital, meaning they are present at birth. During fetal development, the testicles develop inside the abdomen and gradually descend into the scrotum. As they descend, a small passageway, called the processus vaginalis, forms in the abdominal wall.

This passage allows fluid to move between the abdomen and the scrotum. Normally, the processus vaginalis closes after birth, preventing fluid from accumulating in the scrotum. However, in some infants, the passage remains open, and fluid continues to flow into the scrotum, causing a hydrocele.

Congenital hydroceles are generally harmless and often resolve without treatment within the first year of life. However, if the hydrocele does not disappear or if complications arise, surgical intervention may be required.

2. Acquired Hydrocele (in Adults)

In adults, hydroceles can develop due to various factors, including

• Injury or Trauma: Any injury to the scrotum or testicles can lead to fluid buildup, resulting in a hydrocele.

• Infection: Infections, particularly those affecting the testicles or epididymis, such as epididymitis or orchitis, can cause inflammation and fluid accumulation, leading to a hydrocele.

• Inflammation: Conditions like varicocele or inguinal hernias can cause inflammation, which in turn can lead to the formation of a hydrocele.

• Ageing: As men age, they may develop a hydrocele as a result of gradual changes in the scrotal area or due to weakening of the tissue surrounding the testicle.

• Tumours: In rare cases, a tumour in the scrotal area can cause fluid buildup, resulting in a hydrocele. This is more common in cases where the hydrocele is accompanied by pain or rapid enlargement.

Symptoms of Hydrocele

In most cases, a hydrocele is painless and does not cause significant discomfort. However, as the fluid accumulates, it can lead to noticeable swelling or enlargement of the scrotum. The primary symptoms of a hydrocele include

• Swelling in the Scrotum: The most common symptom of a hydrocele is swelling in one or both testicles. This swelling may be gradual or sudden and can vary in size.

• Feeling of Fullness or Heaviness: Some individuals with a hydrocele report a feeling of fullness or heaviness in the scrotum, which can be uncomfortable, especially if the hydrocele is large.

• Tenderness or Discomfort: While hydroceles are usually painless, they can occasionally cause mild discomfort, particularly if the swelling presses against other areas of the scrotum.

• Asymmetry: The affected testicle may appear larger than the unaffected one. The scrotum may also look noticeably uneven.

• Changes in Size: The size of the hydrocele can fluctuate throughout the day. It may appear larger in the morning and smaller at night.

In adults, if the hydrocele is caused by an underlying infection, tumor, or trauma, additional symptoms may include pain, redness, or heat in the scrotum.

Diagnosing Hydrocele

If you notice swelling or any other symptoms in the scrotal area, it’s important to consult a healthcare provider for an accurate diagnosis. The doctor will typically perform a physical examination and may use various diagnostic tools to determine the cause of the swelling.

• Physical Exam: The doctor will gently palpate the scrotum to check the size and consistency of the swelling. A hydrocele typically feels smooth and soft.

• Transillumination: One common diagnostic test for hydrocele is transillumination, which involves shining a bright light through the scrotum. If the swelling is caused by a hydrocele, the fluid filled sac will allow the light to pass through, making it glow. This test helps distinguish a hydrocele from other conditions, such as a solid tumour.

• Ultrasound: If the diagnosis is unclear, or if the doctor suspects other underlying conditions such as a hernia or testicular tumour, an ultrasound may be ordered. Ultrasound provides detailed imaging of the scrotum and can confirm the presence of fluid or any other abnormality.

Treatment of Hydrocele

The treatment of hydrocele depends on several factors, including the size of the hydrocele, the age of the patient, and whether there are any complications.

Most hydroceles do not require treatment, especially in infants. However, in adults, or if the hydrocele becomes large, painful, or causes complications, intervention may be necessary.

1. Observation (Watchful Waiting)

In infants, most congenital hydroceles resolve on their own within the first year of life, and no treatment is needed. In cases where the hydrocele persists beyond the first year or causes discomfort, surgery may be recommended.

For adults, small and asymptomatic hydroceles may not require treatment, especially if they do not cause significant pain or discomfort. Regular followup with a healthcare provider is typically advised to monitor the condition.

2. Surgical Treatment (Hydrocelectomy)

If the hydrocele is large, causes pain, or interferes with daily activities, surgery may be recommended. The surgical procedure to remove the fluid filled sac is called a hydrocelectomy. During this procedure, the surgeon makes a small incision in the scrotum and removes the sac of fluid.

There are two main types of hydrocelectomy:

• Open Hydrocelectomy: The surgeon makes an incision in the scrotum, removes the fluid filled sac, and then stitches the tissue back together. This procedure is most commonly used for larger hydroceles.

• Minimally Invasive Hydrocelectomy: In this procedure, the surgeon uses a smaller incision or a laparoscope to remove the hydrocele. This method is often used for smaller hydroceles and offers a quicker recovery time.

The success rate for hydrocelectomy is high, and most people experience significant relief from symptoms after surgery. However, like all surgeries, hydrocelectomy carries some risks, including infection, bleeding, or recurrence of the hydrocele.

3. Needle Aspiration

In some cases, particularly when surgery is not immediately necessary, a doctor may use a needle to drain the fluid from the hydrocele. This procedure is known as needle aspiration and can provide temporary relief from swelling and discomfort. However, there is a risk that the hydrocele may recur since the underlying cause of the fluid buildup is not addressed.

4. Sclerotherapy

Sclerotherapy involves injecting a sclerosing agent into the hydrocele after aspiration. This agent causes the walls of the hydrocele to scar and stick together, preventing fluid from reaccumulating. Sclerotherapy is less commonly used than surgery but may be an option for some patients who are not candidates for surgery.