Hydrocele

Definition

A hydrocele is a fluid-filled sac in the scrotum.

Alternative Names

Processus vaginalis; Patent processus vaginalis

Causes

Hydroceles are common in newborn infants.

During a baby's development in the womb, the testicles descend from the abdomen through a tube into the scrotum. Hydroceles occur when this tube does not close. Fluid drains from the abdomen through the open tube and gets trapped in the scrotum. This causes the scrotum to swell.

Most hydroceles go away a few months after birth. Sometimes, a hydrocele may occur with an inguinal hernia.

Hydroceles may also be caused by:

• Buildup of the normal fluid around the testicle. This may occur because the body makes too much of the fluid or it does not drain well. (This type of hydrocele is more common in older men.)
• Swelling or injury of the testicle or epididymis

Symptoms

The main symptom is a painless, round-oval shaped swollen scrotum, which feels like a water balloon. A hydrocele may occur on one or both sides. However, the right side is more commonly involved.

Exams and Tests

You will have a physical exam. The health care provider will find that the scrotum is swollen, but not painful to the touch. Often, the testicle cannot be felt because of the fluid around it. The size of the fluid-filled sac can sometimes be increased and decreased by putting pressure on the abdomen or the scrotum.

If the size of the fluid collection changes, it is more likely to be due to an inguinal hernia.

Hydroceles can be easily seen by shining a flashlight through the swollen part of the scrotum. If the scrotum is full of clear fluid, the scrotum will light up.

You may need an ultrasound or CT scan to confirm the diagnosis.

Treatment

Hydroceles are not harmful most of the time. They are treated only when they cause infection or discomfort.

Hydroceles from an inguinal hernia should be fixed with surgery as soon as possible. Hydroceles that do not go away on their own after a few months may need surgery. A surgical procedure called a hydrocelectomy (removal of sac lining) is often done to correct the problem. Needle drainage is an option, but the fluid will come back.

Outlook (Prognosis)

Simple hydroceles in children often go away without surgery. In adults, hydroceles usually do not go away on their own. If surgery is needed, it is an easy procedure with very good outcomes. After surgery, a hydrocele can sometimes reoccur.

Possible Complications

Risks from hydrocele surgery may include:

• Blood clots
• Infection
• Injury to the scrotum
• Loss of the testicle
• Long-term (chronic) pain
• Continuous swelling

When to Contact a Medical Professional

Contact your provider if you have symptoms of hydrocele. It is important to rule out other causes of a testicular lump.

Pain in the scrotum or testicles is an emergency. If you have pain and your scrotum is enlarged, seek medical help right away to prevent the loss of the testicle.

References

Aiken JJ. Inguinal hernias. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 373.

Elder JS. Disorders and anomalies of the scrotal contents. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 560.

Germann CA, Holmes JA. Selected urologic disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 89.

Malek M, Mollen K, Richardson W. Surgery. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 18.

Palmer LS, Palmer JS. Management of abnormalities of the external genitalia in boys. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 44.