Hydrocele
Treatment for fluid collection around the testicle when it causes discomfort, enlargement or other concerns
What is hydrocele?
A hydrocele is fluid between the two layers of the tunica vaginalis, the smooth sac that wraps the testis. A small amount of fluid there is normal and lets the testis move; a hydrocele is what happens when production and reabsorption stop balancing.
In adults it is usually idiopathic, appearing over months for no clear reason and more often after middle age. It can also follow inflammation, injury or surgery in the groin. In infants it comes from a channel to the abdomen that failed to close, and most of those close on their own in the first year or two.
The important question at the first visit is whether the fluid is all there is. A hydrocele can form around a testis that has something else going on, and a tense sac hides the testis from the examining hand entirely.
What you might notice
- A swelling of the scrotum that has grown slowly
- A dragging ache in the scrotum
How it is diagnosed
The examination distinguishes fluid from solid. Fluid transilluminates, so a light held against the scrotum glows through it, and the examiner can get above the swelling, which separates it from a hernia coming down from the groin.
An ultrasound is done in most adults. It confirms the fluid and, more importantly, shows the testis inside it. Where the scan raises any question about the testis itself, blood tumour markers follow before anything is planned.
Where the collection has appeared abruptly, the scan also excludes infection and a twisted testis, which are managed on a different timescale altogether.
Recovery
Drainage with a needle takes minutes in the clinic and you walk out afterwards, with an ache for a day or two and a scrotum that stays firm for about a week.
An operation on the sac is day-case work. Expect the scrotum to be swollen and bruised for two to three weeks, which is normal and often looks worse than the original swelling did. Supportive underwear and ice for the first forty-eight hours make a real difference.
Desk work resumes in three to five days, driving once you can brake without hesitating, and sport and heavy lifting at four weeks. A review at six weeks confirms the sac has not refilled.
If it is left untreated
A hydrocele is benign and there is no obligation to treat one. Many men live with a small one indefinitely, and once a scan has confirmed what it is, watching it is a reasonable plan.
Left alone it tends to enlarge slowly. A large one becomes heavy, awkward to sit with and difficult to conceal, and the skin can break down where it rubs. It also makes examining the testis impossible, so a change inside it would go unnoticed.
Very occasionally a tense hydrocele compromises the blood supply to the testis. A collection that appears quickly, or one alongside any change in the testis itself, is assessed before it is watched.
Questions about hydrocele
Can it just be drained with a needle instead of an operation?
It can, and aspiration takes a few minutes in the clinic. The difficulty is that drainage alone leaves the sac behind, so the fluid almost always returns within weeks to months. Adding a sclerosant, which irritates the lining so the walls stick together, improves on that and is a reasonable choice for a man whose heart or lungs make an anaesthetic risky, though it may need repeating. For a fit man, a hydrocelectomy deals with the sac itself in one day-case operation and is much less likely to need doing again.
Will a hydrocele affect my fertility or damage the testis?
A hydrocele on its own does not usually affect sperm production or hormone levels, and most men need no treatment for that reason. Very large or tense collections are the exception, where sustained pressure and the raised temperature around the testis can matter, and treatment is offered on those grounds in men who are trying to conceive. The more practical problem is that a large collection makes it impossible to examine the testis, so a change developing inside it would go unnoticed, and that is one reason a scan is done at the outset.
How long before the swelling settles after surgery?
Longer than most people expect. The scrotum is swollen and bruised for two to three weeks after a hydrocelectomy and frequently looks bigger at first than the hydrocele did, which is normal and settles. Supportive underwear day and night for two weeks, and ice for the first forty-eight hours, make a genuine difference. Desk work resumes in three to five days, sport and heavy lifting at four weeks, and the final result is judged at the six-week review and not in the first fortnight.
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Day CareTalk to a care coordinator about hydrocele
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one