What is a Hydrocele?

A hydrocele is an accumulation of clear fluid in the tunica vaginalis, the sac that surrounds the testicle. This results in painless, gradual scrotal swelling on one or both sides.

Types:

  • Communicating hydrocele: connected to the abdominal cavity, common in infants
  • Non-communicating hydrocele: isolated sac, common in adults

Symptoms

  • Painless scrotal swelling
  • Sensation of heaviness or dragging
  • Swelling may vary in size through the day
  • Skin over the swelling is usually normal and non-tender
  • Larger hydroceles may cause discomfort with walking or sitting

Causes

In infants:

  • Congenital, related to incomplete closure of the processus vaginalis

In adults:

  • Idiopathic (unknown cause, most common)
  • Trauma
  • Infection (epididymitis, orchitis)
  • Following surgery
  • Rarely, associated with underlying testicular condition (evaluation important)

When to See a Specialist

  • Any new scrotal swelling in an adult
  • Persistent or enlarging swelling in an infant beyond 1 year
  • Sudden painful swelling (may indicate other conditions requiring urgent attention)
  • Difficulty distinguishing hydrocele from hernia

Diagnosis

  • Clinical examination including transillumination test
  • Scrotal ultrasound to confirm diagnosis and assess underlying testis
  • Basic investigations before surgery

Treatment

Watchful Waiting

For infants (first year) and asymptomatic adults with small stable hydroceles.

Surgical Repair (Hydrocelectomy)

Definitive treatment for symptomatic or large hydroceles.

  • Approach: through a small scrotal incision
  • Duration: 30 to 60 minutes
  • Anaesthesia: spinal or short general
  • Admission: same day or overnight
  • Recovery: return to office work in 1 week, physical activity in 2 to 3 weeks

Aspiration

Simple aspiration of the fluid is generally not recommended as the fluid re-accumulates. Aspiration with sclerosant injection has limited role in select cases.

Recovery

  • Scrotal support for 1 to 2 weeks
  • Ice packs in the first 24 to 48 hours
  • Avoid heavy lifting for 3 to 4 weeks
  • Return to office work: 1 week
  • Follow-up at 1 week and 6 weeks

Related Conditions

Hernia