Hydrocele: Assessment & Treatment
A hydrocele is a collection of fluid around the testicle that causes scrotal swelling. It is usually benign, but a new or changing scrotal swelling should be properly assessed to confirm the diagnosis and examine the underlying testicle.
Management depends on the size of the hydrocele, your symptoms, examination findings and personal circumstances. Some hydroceles can simply be observed, while surgery may be considered when swelling becomes troublesome.
Urology consultations in Greenslopes and Springwood, Brisbane
What is a hydrocele?
A hydrocele develops when fluid collects within the tissues surrounding the testicle. This creates a smooth enlargement of one side of the scrotum, although hydroceles can occasionally occur on both sides.
In adults, a hydrocele may develop without an obvious cause. It can also occur following inflammation, trauma or previous surgery in the groin or scrotum.
Hydroceles themselves are generally benign. However, not every scrotal swelling is a hydrocele. Other conditions can produce a similar change in size or appearance, which is why a new or unexplained scrotal swelling should be assessed rather than self-diagnosed.
What does a hydrocele feel like?
Hydroceles often enlarge gradually and may cause relatively few symptoms initially.
Not every scrotal swelling is a hydrocele
Scrotal enlargement can also be associated with conditions such as:
A hydrocele more commonly causes painless swelling or heaviness. Sudden severe testicular or scrotal pain — particularly with nausea, vomiting or rapid swelling — requires urgent medical assessment because other conditions such as testicular torsion may need emergency treatment.
Do not wait for a routine specialist appointment if you develop sudden severe testicular pain.
How is a hydrocele assessed?
The first priority is confirming that the swelling represents a hydrocele and assessing the underlying testicle.
History
Your doctor may ask when the swelling started, whether it is changing in size, whether there is discomfort, and whether there has been previous surgery, infection or trauma.
Examination
Examination helps determine whether the swelling appears to arise from fluid around the testicle and whether other causes of scrotal enlargement need to be considered.
Scrotal ultrasound
Ultrasound may be recommended where the diagnosis is uncertain, the testicle cannot be adequately examined, the hydrocele is new, or another underlying testicular problem needs to be excluded.
A large hydrocele can make it difficult to feel the underlying testicle clearly. Ultrasound can help confirm that the swelling is fluid-filled and assess the testicle itself.
Does every hydrocele need treatment?
No. Treatment is generally guided by symptoms, size, progression, examination findings and your preferences.
Observation
A small hydrocele that has been appropriately assessed and is not causing significant symptoms may not require surgery.
Review can be arranged if the swelling enlarges, becomes uncomfortable or changes in character.
Hydrocele surgery
Hydrocelectomy is an operation that treats the fluid-filled sac surrounding the testicle.
Surgery may be considered when the hydrocele is large, persistent or causing discomfort, heaviness or practical problems.
How hydrocele surgery works →Aspiration
Draining the hydrocele with a needle does not remove the sac that produces or contains the fluid, so the swelling commonly returns.
Aspiration or other non-operative approaches may occasionally be considered in selected circumstances where surgery is unsuitable.
When might hydrocele surgery be considered?
The presence of a hydrocele alone does not mean an operation is necessary. Surgery may become reasonable to discuss if the hydrocele:
Your individual reasons for treatment, general health and examination findings should be considered before deciding whether an operation is appropriate.
What happens during hydrocele surgery?
Hydrocelectomy is generally performed through an incision in the scrotum.
The hydrocele sac is opened and the fluid released. Depending on the anatomy and size of the hydrocele, the sac may then be removed, folded or repositioned to reduce the likelihood of fluid collecting again.
The testicle is inspected during the procedure and is normally preserved. The incision is then closed, usually with dissolving sutures.
The exact technique varies between patients and will be discussed as part of the surgical consent process.
Recovery after hydrocele surgery
Recovery varies according to hydrocele size, the operation performed and your usual activities.
Swelling and bruising
Some scrotal swelling, bruising and tenderness are expected after hydrocele surgery and can take time to settle.
Scrotal support
Supportive underwear may improve comfort during the early recovery period. Individual postoperative instructions will be provided.
Gradual return
Walking is usually encouraged, while heavier exercise, lifting and strenuous activity are restricted initially according to your surgeon's advice.
Review
Follow-up allows assessment of wound healing, swelling and any symptoms that require further review.
Possible risks of hydrocele surgery
All surgery involves potential risks. The significance of each risk depends on your health, anatomy, the size of the hydrocele and the procedure performed.
Anaesthetic and other general surgical risks also apply. Your own risks and alternatives should be discussed before deciding to proceed.
Hydrocele surgery and fertility
Having a hydrocele does not automatically mean there is a fertility problem. However, fertility goals are relevant when planning any operation around the testicle, epididymis and spermatic structures.
If you are currently trying to conceive, have an abnormal semen analysis, have only one functioning testicle or have previously experienced fertility difficulties, mention this during your assessment before surgery is planned.
Explore Male Fertility AssessmentCould the swelling be a varicocele?
A varicocele is an enlargement of veins around the testicle rather than a collection of fluid. It has a different assessment and treatment pathway.
Learn about varicocele →Hydrocele FAQs
Is a hydrocele cancer?
A hydrocele itself is a fluid collection and is not testicular cancer. However, a new scrotal swelling should still be assessed because a hydrocele can occasionally make examination of the underlying testicle difficult and other testicular conditions can coexist with scrotal fluid.
Do all hydroceles need surgery?
No. A hydrocele that has been appropriately assessed and is small or not causing significant symptoms can often be observed. Surgery is generally considered when symptoms, size or other clinical factors make treatment worthwhile.
Do I need an ultrasound for a hydrocele?
Not every patient requires exactly the same investigation. Ultrasound may be appropriate if the diagnosis is uncertain, the underlying testicle cannot be examined adequately, the swelling is new or there are features suggesting another scrotal condition.
Can a hydrocele go away on its own?
The behaviour of adult hydroceles varies. Some remain relatively stable while others persist or gradually enlarge. If a hydrocele is not troublesome, observation may remain reasonable after the diagnosis has been confirmed.
Will draining a hydrocele with a needle cure it?
Needle drainage removes the fluid but does not remove or reconstruct the surrounding hydrocele sac, so fluid commonly accumulates again. It is generally reserved for selected circumstances rather than being the usual definitive treatment for a fit patient with a symptomatic hydrocele.
Can a hydrocele come back after surgery?
Recurrence is possible following hydrocele surgery, although the purpose of hydrocelectomy is to treat the sac in a way that reduces further fluid accumulation. Your individual recurrence risk depends on the underlying situation and surgical findings.
Does hydrocele surgery remove the testicle?
Standard hydrocele surgery treats the fluid-filled tissues around the testicle and is intended to preserve the testicle. Any unexpected findings or circumstances that could change the planned operation should be discussed as part of informed consent.
When should scrotal swelling be assessed urgently?
Sudden severe pain, rapidly developing swelling, significant redness, systemic illness, nausea or vomiting should not be assumed to be a simple hydrocele. These symptoms warrant prompt medical assessment.
Hydrocele assessment in Brisbane
Dr Jack Crozier is a Brisbane urologist whose practice includes adult scrotal and testicular conditions such as hydrocele, epididymal cysts, varicocele and testicular masses.
Consultation focuses on confirming the cause of the swelling, determining whether treatment is actually required, and discussing the reasonable management options, expected recovery and potential risks relevant to your circumstances.
Not sure whether the swelling is a hydrocele?
A urological assessment can help establish the cause and whether observation, further investigation or treatment should be considered.