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Hydrocele

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

Alternative Names

Processus vaginalis; Patent processus vaginalis

Causes, incidence, and risk factors

Hydroceles are common in newborn infants.

During a baby’s development in the womb, the testicles descend from the abdomen through 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.)
  • Inflammation or injury of the testicle or epididymis

Symptoms

The main symptom is a painless, swollen testicle , which feels like a water balloon. A hydrocele may occur on one or both sides.

Signs 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 sack 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 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 does not work well because the fluid will come back.

Expectations (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.

Complications

Risks from hydrocele surgery may include:

  • Blood clots
  • Infection
  • Injury to the scrotum

Calling your health care provider

Call your health care provider if you have symptoms of hydrocele. This important to rule out other causes of a testicle 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

Elder JS. Disorders and anomalies of the scrotal contents.In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 539.

Wampler SM, Llanes M. Common scrotal and testicular problems. Prim Care. 2010. 37(3):613-626.

Kavoussi PK, Costabile RA. Surgery of the scrotum and seminal vesicles. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 37. 

Barthold JS. Abnormalities of the testes and scrotum and their surgical management.In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 132. 

Updated: 10/2/2013

Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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