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 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 individual 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 can create 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 involving the groin or scrotum.
Hydroceles themselves are generally benign. However, not every scrotal swelling is a hydrocele. Other conditions can cause similar enlargement, so a new or unexplained 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.
- Swelling on one or both sides of the scrotum
- A feeling of heaviness or dragging
- Discomfort associated with a larger scrotum
- Difficulty comfortably exercising, walking or sitting
- Increasing scrotal size over time
- Difficulty feeling the underlying testicle when the hydrocele is large
Other causes of scrotal enlargement
- Epididymal cyst or spermatocele
- Varicocele
- Inguinal hernia
- Infection or inflammation
- Bleeding or trauma
- Testicular or paratesticular mass
- Scrotal lymphoedema
Sudden severe testicular pain is different
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 can require time-sensitive treatment.
A new or changing scrotal swelling is assessed before treatment decisions are made.
How is a hydrocele assessed?
The first priority is confirming that the swelling represents a hydrocele and assessing the underlying testicle.
History
When the swelling began, whether it changes in size, associated discomfort, previous surgery, infection and trauma are reviewed.
Examination
Examination helps establish whether the enlargement appears to arise from fluid around the testicle or another scrotal condition.
Scrotal ultrasound
Ultrasound may be appropriate when the diagnosis is uncertain, the testicle cannot be examined adequately or another abnormality needs to be excluded.
Why ultrasound can matter
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, general health and your individual priorities.
Monitoring may be all that is required
A hydrocele that has been appropriately assessed and is not causing significant symptoms may not require surgery.
Review can be arranged if it enlarges, becomes uncomfortable or changes in character.
Hydrocelectomy
Hydrocelectomy treats the fluid-filled sac surrounding the testicle rather than simply removing the fluid.
Surgery may be considered when swelling is persistent, large or causing discomfort, heaviness or practical problems.
How hydrocele surgery works →Drainage is not usually definitive
Needle drainage removes the fluid but does not remove or reconstruct the surrounding hydrocele sac, so the swelling commonly returns.
Aspiration or related non-operative approaches may have a role in selected circumstances when 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 when the hydrocele:
- Is progressively enlarging and becoming increasingly noticeable or cumbersome
- Causes discomfort or heaviness during normal activities, exercise or prolonged sitting
- Interferes with clothing, mobility, sport, work or everyday life
- Makes examination difficult because the underlying testicle cannot be assessed easily
- Continues to cause sufficient concern or inconvenience after the diagnosis has been established
There is no single size that automatically means surgery
A larger hydrocele that causes relatively little difficulty may sometimes be observed, while a smaller hydrocele can be troublesome because of its position or symptoms. The decision is individual.
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, thickness 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, commonly using dissolving sutures.
The exact technique and operative plan can vary between patients and should be discussed as part of the individual surgical consent process.
Recovery after hydrocele surgery
Recovery varies according to hydrocele size, the operation performed, your general health and your usual activities.
Swelling & bruising
Scrotal swelling, bruising and tenderness are expected following 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 generally encouraged while heavier lifting, strenuous exercise and some sporting activities are restricted initially.
Review
Follow-up allows assessment of wound healing, swelling and any symptoms that require further review.
The scrotum can initially look more swollen after surgery
This can be expected because surgery itself produces postoperative swelling and bruising. The final reduction in size is therefore not necessarily apparent immediately after the operation.
Possible risks of hydrocele surgery
All surgery involves potential risks. The relevance of each risk depends on your health, anatomy, hydrocele size, previous surgery and the procedure performed.
Swelling and bruising
These are common during the early healing period.
Bleeding or haematoma
Blood can collect within the scrotum following surgery.
Infection
Wound or deeper infection can occur after an operation.
Persistent or recurrent swelling
A hydrocele or another postoperative fluid collection can occasionally recur.
Persistent discomfort
Some patients can experience ongoing scrotal tenderness or pain.
Injury to nearby structures
Injury to the testicle, epididymis, spermatic structures or blood supply is uncommon but important to discuss.
Anaesthetic and other general surgical risks also apply. Your own potential benefits, limitations, alternatives and risks should be discussed before deciding to proceed.
Hydrocele surgery and fertility
Having a hydrocele does not automatically mean that there is a fertility problem. However, fertility goals can be 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 before surgery is planned.
Other causes of a scrotal lump or swelling
The treatment pathway depends on what is actually causing the swelling. These related pages explain several conditions that can present in a similar area.
When does a hydrocele actually need surgery?
A hydrocele does not automatically require an operation. The decision generally depends on symptoms, progressive enlargement, examination findings and how much the swelling is affecting normal activities.
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 make examination of the underlying testicle difficult and another testicular condition can occasionally coexist.
Do all hydroceles need surgery?
No. A hydrocele that has been appropriately assessed and is not causing significant symptoms can often be observed. Surgery is generally considered when its symptoms, size, progression 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 when the diagnosis is uncertain, the underlying testicle cannot be examined adequately, the swelling is new or another scrotal condition needs to be excluded.
Can a hydrocele go away on its own?
Adult hydroceles vary. Some remain relatively stable while others persist or gradually enlarge. If the diagnosis has been confirmed and the hydrocele is not troublesome, observation may remain reasonable.
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 therefore generally considered in selected circumstances rather than as the usual definitive treatment for a symptomatic hydrocele in someone suitable for surgery.
Can a hydrocele come back after surgery?
Recurrence is possible. Hydrocelectomy treats the hydrocele sac with the aim of reducing further fluid accumulation, but no operation can guarantee that swelling will never recur.
Does hydrocele surgery remove the testicle?
Standard hydrocele surgery treats the fluid-filled tissues around the testicle and is intended to preserve the testicle. Individual operative circumstances and unexpected findings should be covered during informed consent.
How long does swelling last after hydrocele surgery?
Swelling and bruising are expected after surgery and can take several weeks to settle, particularly following treatment of a large hydrocele. Recovery varies between patients.
When should scrotal swelling be assessed urgently?
Sudden severe pain, rapidly developing swelling, marked redness, fever, significant illness, nausea or vomiting should not simply be assumed to represent a hydrocele. Seek 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 first on confirming the cause of the swelling and determining whether treatment is actually required. Observation, further investigation and surgical options can then be discussed according to the individual findings and circumstances.
Travelling to Brisbane for assessment?
Existing ultrasound reports, imaging and previous specialist records can be useful when planning assessment. Where clinically appropriate, patients travelling from outside Brisbane may be able to begin with review of available information before making major travel arrangements.
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.
Medical disclaimer: This information is general educational information and does not replace individual medical advice, examination or diagnosis. Assessment, investigation and treatment of a hydrocele depend on symptoms, examination findings, medical history and individual circumstances. Surgery involves potential benefits, limitations and risks that should be discussed as part of informed consent. If you develop sudden severe testicular or scrotal pain, rapidly increasing swelling, fever or significant illness, seek urgent medical assessment.