A hydrocele is a collection of fluid in the scrotum. This article will look at the prevalence, symptoms, diagnoses, and treatment of hydroceles in infant, children, and adult males.

What is a hydrocele?

A hydrocele is the name for fluid filled sac that forms in the tissue surrounding the testicle. Fluid in the scrotum can occur on one or both sides and is common in babies, affecting up to 1 in 10 newborn male infants.

Hydroceles occur more often in babies born prematurely. If a baby is born before the testicles have descended, it increases the chance of a hydrocele developing.

They occur less often later in life, affecting around 1% of adult men. Hydroceles are generally not considered to reduce sperm production; however, medical advice is recommended to rule out any underlying testicular condition.

Non-communicating hydrocele and communicating hydrocele

There are 2 types of hydrocele: non-communicating hydroceles and communicating hydroceles.

A communicating hydrocele has an opening to the abdominal cavity through the inguinal canal, which allows fluid within the scrotum to flow in and out. The amount of fluid inside the sac changes throughout the day and night. Scrotal swelling occurs when excess fluid collects in the sac, after long periods of standing or physical activity. The hydrocele might appear smaller while the person is lying down.

In a non-communicating hydrocele, there is no opening in the sac, and the collection of fluid stays within the scrotum. The swelling from a non-communicating hydrocele typically stays the same, regardless of the time of day or there amount of physical exertion, because the amount of fluid in the sac remains the same.

What are the hydrocele symptoms?

In the majority of cases, the only symptom of a child’s hydrocele is painless swelling in one or both testicles. Adult males might experience pain or discomfort in addition to a swollen scrotum.

If you notice anything unusual about the appearance of your child’s scrotum or testicles, or any part of his external genitalia, it is important to seek medical help from an appropriate healthcare professional.

Your child’s doctor should perform a physical exam to determine the underlying cause of the scrotal swelling and to rule out any underlying testicular condition or other health conditions.

Testicular torsion (a twisted testicle) occurs when one of the testicles rotates and causes sudden onset pain and scrotal swelling. A twisted testicle is a medical emergency that requires surgery.

Delaying medical treatment can affect fertility or result in the loss of the testicle.

How is a hydrocele diagnosed?

As well as taking a medical history, a healthcare provider will perform a physical exam to diagnose a hydrocele. They might use a light to check for transillumination, to make sure there is only fluid present within the swelling in the scrotum. A hydrocele is different from a solid mass.

Your healthcare provider might also check for an inguinal hernia, by applying pressure to the abdomen and scrotum. Like hydroceles, inguinal hernias are more common in premature babies.

An ultrasound might be recommended for a more definite diagnosis.

For adult men, further testing should be carried out to rule out a sexually transmitted infection.

Is an inguinal hernia a hydrocele?

An inguinal hernia is not the same as a hydrocele. A inguinal hernia is a weak point in the abdominal muscles through which abdominal fluid, fat, and tissue can protrude.

If a hydrocele doesn’t go away on its own and is left untreated, it can turn into an inguinal hernia.

Hernias can cause discomfort, pain, or heaviness in the groin.

How is Hydrocele treated?

Most hydroceles in baby boys resolve on their own within 6 to 12 months.

A hydrocele that doesn’t disappear on its own might require surgical repair.

If the hydrocele is still present at 12-18 months of age, surgery might be performed, so as to avoid a inguinal hernia. An inguinal hernia isn’t necessarily dangerous but could get bigger without treatment.

For an older child or adult male with a hydrocele, it might be necessary to seek treatment in the following circumstances:

The hydrocele is very large or firm
There is pain in the scrotum
Symptoms get worse
New symptoms arise.

It is not possible to prevent a hydrocele from developing. Hydroceles are more common in premature infants, though, and there are steps you can take to lower your risk of giving birth to your baby early.

You can read more about this in BellyBelly’s article Preterm Birth | Ways To Reduce Preterm Birth.

How is hydrocele surgery done?

If a hydrocele requires surgical repair, the procedure will be done under general anesthesia by a urologist.

The repair of a hydrocele is called a hydrolectomy.

To repair or remove the hydrocele, an incision is made in the groin and the fluid is drained from the sac. The channel connecting the scrotum to the abdominal wall is removed and reinforced with stitches.

A 2012 study looked into the effectiveness of aspiration and sclerotherapy as alternatives to surgery to repair hydroceles. There was an 84% success rate from one round of treatment, with the remaining cases requiring further treatment after the hydrocele reoccurred.

After surgery, there is a lower reoccurrence rate and therefore it is recommended for the most effective treatment.