A hydrocele is a collection of clear fluid in the thin sac that surrounds a testicle, causing a smooth swelling of the scrotum. It is benign and does not harm the testicle or fertility.
In babies it is common and usually disappears in the first one to two years. In adult men it tends to grow slowly and is treated only if its size or weight is a nuisance. The important step is confirming that nothing else lies underneath.
Symptoms
- A painless, smooth swelling on one side of the scrotum, occasionally both
- A feeling of heaviness or dragging
- Swelling that is larger by evening in infants with a communicating hydrocele
- Discomfort with walking, sitting or sex when large
- The testicle may be difficult to feel through the fluid
Causes and risk factors
In infants, the channel through which the testicle descended from the abdomen has not closed, so abdominal fluid tracks down. This communicating type is closely related to an inguinal hernia. In adults the sac produces more fluid than it absorbs, usually for no clear reason. Secondary hydroceles follow infection of the epididymis or testicle, injury, torsion, hernia or varicocele surgery and, occasionally, a testicular tumour. In tropical regions filarial infection is a leading cause.
How it is diagnosed
- Examination with transillumination: A light shone through the scrotum glows through clear fluid.
- Scrotal ultrasound: Confirms the fluid and, most importantly, shows that the testicle underneath is normal. It is recommended in all adults with a new hydrocele.
- Urine test and infection screen: When the swelling is tender or appeared suddenly.
- Groin examination: Looks for an accompanying hernia, especially in children.
Treatment options
- Observation: Appropriate for infants up to about two years and for small, painless adult hydroceles.
- Hydrocelectomy: Through a small scrotal incision the sac is opened and either turned back on itself and stitched (Jaboulay) or pleated (Lord's). A day-case operation of 30 to 45 minutes.
- Inguinal repair in children: The open channel is tied off through a small groin incision, as for a hernia.
- Aspiration with sclerotherapy: Draining with a needle and injecting a sclerosing agent, for men unfit for surgery. Recurrence is more frequent, and simple aspiration alone nearly always refills.
- Treatment of the cause: Antibiotics for infection, or the appropriate pathway if a tumour is found.
When it is urgent
Sudden severe testicular pain, with or without swelling, may be torsion and needs emergency surgery within hours. A hard lump within the testicle, or a hot red painful scrotum with fever, needs urgent local assessment.
Travelling to Türkiye for treatment
An adult hydrocele repair is a minor planned procedure and is usually easiest to have near home. If you travel for it, perhaps combined with other care, allow 5 to 7 days. Scrotal swelling and bruising after surgery are normal, can be marked, and take several weeks to settle, so supportive underwear and avoiding heavy lifting for two to three weeks are advised. For an infant, waiting is normally the right course and travel is not warranted.
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الأسئلة المتكررة
Can a hydrocele affect fertility?
A simple hydrocele does not. The scan checks for other conditions that might.
Will it go away by itself?
Commonly in babies, rarely in adults.
Can it return after surgery?
Recurrence after a proper hydrocelectomy is uncommon.
Why not just drain it with a needle?
The fluid usually comes back within weeks, and each puncture carries a small infection and bleeding risk.