Hydrocele: Specialists and Information

A hydrocele can be congenital or may develop later in childhood or adulthood.

In a congenital hydrocele (also called a primary hydrocele), the peritoneum over the scrotum does not close properly. This allows fluid from the abdominal cavity to enter the testicle.

An acquired hydrocele (also known as a secondary hydrocele) can have various causes, such as:

• inguinal hernias,
• blunt force trauma, such as from kicks or blows,
• surgery,
• inflammation of the testicle, epididymis, or spermatic cord,
• testicular torsion, or
• testicular tumors.

However, it is not always possible to identify the cause of an acquired hydrocele. Sometimes it occurs for no apparent reason.

The accumulation of fluid in the scrotum causes it to swell on the affected side (or on both sides). This enlargement can be relatively subtle or very pronounced, depending on the amount of fluid accumulated. The scrotum often feels firm and elastic.

Smaller hydroceles usually do not cause any further symptoms.

If the fluid buildup is large, however, it can lead to

• a feeling of tightness,
• pressure, or
• pain

.

In the case of a congenital hydrocele, the swelling is usually more pronounced when standing than when lying down. In infants, the swelling increases when they cry.

In a hydrocele, fluid accumulates in the testicle, leading to significant swelling © Artemida-psy | AdobeStock

In rare cases, a serious medical condition can trigger the development of a hydrocele. Therefore, a urologist should always examine the swelling.

The diagnosis is made by palpating the testicle and performing an ultrasound examination.

In isolated cases, magnetic resonance imaging (MRI) may also be necessary. In most cases, however, a hydrocele can be diagnosed with an ultrasound examination alone. This also makes it possible to detect or rule out a testicular tumor or a hematoma.

If the hydrocele in a newborn is not too large, it usually does not require immediate treatment. The development of the hydrocele is monitored for several months, sometimes even until the child’s second birthday.

In most cases, the connection between the abdominal cavity and the scrotum closes on its own during this time. The body then breaks down the fluid buildup on its own.

If this does not happen, the opening is surgically closed during the child’s second or third year of life. If the child experiences severe symptoms, earlier surgery may be advisable.

If the diagnosis identifies a cause for the hydrocele, that underlying condition must be treated. In many cases, the hydrocele will then resolve on its own.

For a small hydrocele that causes no symptoms, treatment may not be necessary. In many cases, however, surgery is required. It is performed through the scrotum: The surgeon opens the tunica vaginalis and removes the fluid. The tunica vaginalis is then either removed or folded back, which does not cause any complications.

After the surgery, the patient usually stays in the hospital for a few days. Afterward, he must keep the testicle cool and elevated to prevent swelling. Depending on the individual situation, outpatient surgery is often an option.

Surgery is particularly recommended if

• discomfort occurs when walking or sitting,
• the swelling is severe, or
• for cosmetic reasons.

Older treatment methods, such as puncture or sclerotherapy, are rarely performed today. They have too many drawbacks, including:

• In puncture, a needle is inserted into the fluid collection to drain the fluid. With this treatment, however, the hydrocele often recurs shortly thereafter. There is also a high risk of infection.
• In sclerotherapy, a needle is also inserted into the fluid-filled sac. However, instead of draining the fluid, the surgeon injects sclerosing agents. This can cause scarring of the testicular membranes. With this method, too, there is a high risk that the hydrocele will recur soon.

Without treatment, a severe hydrocele can lead to serious complications: 

• the testicles may twist,
• infertility, if a large accumulation of fluid impedes blood flow to the testicle.

However, these complications are rare. In many cases, primary hydrocele in particular resolves on its own. The prognosis is also good after surgery.

Swelling of the testicle is common after surgery but usually subsides quickly. To help with recovery, the scrotum should be cooled and elevated. In addition, wearing tight-fitting underwear may be necessary to keep the swelling under control.

Other possible complications following surgical treatment include postoperative bleeding and infections. However, these occur only rarely.

After surgery, the risk of recurrence is low; in most cases, the problem is permanently resolved.