Hydrocele: Definition, Causes, Symptoms, Diagnosis, Treatment and Prognosis

It is an inflammation of the scrotum that occurs when fluid accumulates in the thin lining that surrounds the testicle.

A hydrocele can only appear in the testicle and in the spermatic cord .
There is a primary hydrocele, that is, innate, as well as an acquired secondary hydrocele. Therefore, it can arise in the course of life due to different causes.
Primary hydrocele can be unilateral or bilateral and often diminishes without treatment during the first months of life.
It can be caused by trauma, bleeding, or infection.
This form differs from the other two in the form of severe pain. Even if a hydrocele is generally painless, it should be examined on a case-by-case basis and treated if necessary.


A hydrocele can be innate or only in late childhood or adulthood.
In congenital hydrocele (also called primary hydrocele) the peritoneum does not close properly over the scrotum, so fluid from the abdominal cavity can penetrate the testicles.
The causes of hydrocele are of different types: in the case of primary hydrocele, the cause is due to a developmental phase in the uterus.
The peritoneum inverts into a funnel shape in the scrotum, takes place in the body of the fetus, and then returns. There, water can collect, creating a hydrocele.
The boy’s testicles descend shortly before birth or during the first year of life from the abdominal cavity into the scrotum.
They must slide through the aforementioned bulge, which is normally closed afterwards. If this is not the case, a hydrocele can form there or, in the absence of complete occlusion, even an inguinal hernia.
Secondary hydrocele can affect male children or adults throughout life. There are several triggers for this, such as inflammation of the testicles or the epididymis.
Also, testicular lesions or tumors can lead to a hydrocele. Even after surgery for the removal of varicose veins in the testicles (varicoceles) a hydrocele can occur as a result.
A hydrocele acquired in childhood or adulthood (also called a secondary hydrocele) can have other causes, such as:
  • Hernias.
  • Blunt trauma, such as a kick or blow.
  • Inflammation of the testicle, epididymis, or spermatic cord.
  • Testicular torsion.
  • Tumores testiculares.
However, it is not always possible to find a cause for an acquired hydrocele, sometimes it occurs for no apparent reason.

Symptoms of a hydrocele

A hydrocele can present with very different symptoms.
The degree of inflammation of the testicle depends mainly on the location and expression of the accumulation of fluid.
The accumulation of fluid in the scrotum causes it to swell on the affected side or both sides.
This increase can be quite small or very large, depending on the amount of fluid accumulated. The scrotum often feels swollen and stretchy.
In the early stages, a hydrocele usually doesn’t cause many symptoms, just an enlarged testicle, but other symptoms, such as shooting pain, pressure, or heaviness, may occur.
In severe cases, it can also lead to bleeding, which is manifested by a partial red color of the scrotum.
In a congenital hydrocele, the swelling is usually stronger when standing than lying down and increases in babies when they cry.
In a hydrocele there is also an increased risk of infertility.
An innate hydrocele occasionally heals on its own. However, it can also lead to a tear or hernia, which can cause serious complications. In the worst case, the tissues of the affected testicle die.


The doctor can feel the hydrocele with the fingers.
Then, using a small flashlight, you can examine the scrotum to see if it was actually the fluid that caused the swelling, or if the discomfort was caused by a hernia or varicocele.
In inguinal hernias, the doctor with a stethoscope can often hear bowel sounds in the area of ​​the swelling.
Since it is not always possible to feel or taste the testicles well in large hydroceles, if there is a suspicion of a hydrocele in the testicles, an additional imaging procedure is used such as:
  • A high resolution ultrasound.
  • Magnetic resonance imaging.
The course of a hydrocele is generally positive, as it is a benign change in the testicle.
Primary hydrocele can usually heal and no treatment is necessary. For high school, however, the cause must be treated. Surgery may also be necessary if the hydrocele persists and the prognosis is positive.


Treatment of a congenital hydrocele

If the hydrocele is not too large in a newborn, it usually does not need immediate treatment. The development of the hydrocele is observed for a few months, sometimes even up to the second year.
In most cases, the connection between the abdomen and the scrotum closes on its own at this time, and the body reabsorbs the fluid.
If this does not happen, it is treated surgically in the second or third year of life. If the problems are very pronounced, even a previous operation may make sense.

Treatment of acquired hydrocele

If hydrocele in an adult occurs against the background of another disease, then this basic disease is treated first. In many cases, the hydrocele will recur.
If the fluid accumulation is not great and there are no further symptoms, treatment can be dispensed with.
In many cases, however, an operation is necessary. It is done from the scrotum: the operating doctor opens the scrotum and removes the fluid. Then the testicles are also removed or turned back, which is not disadvantageous.
After the operation, the patient usually stays in the hospital for a few more days and then has to use cold compresses to avoid swelling.
Depending on the individual situation, outpatient surgery is often possible. Surgery is especially recommended when there are complaints of walking or sitting, when the swelling is excessive or for cosmetic reasons.
Older treatment methods such as puncture or sclerotherapy are rarely done today because they cause too much inconvenience such as:
  • When drilling to puncture, the site of the accumulation of water is penetrated to drain the fluid. In this treatment, however, the breakdown of the water often reappears in many cases. Also, the risk of infection is great.
  •  In the case of sclerotherapy, the place of the accumulation of water is penetrated but then it does not extract the liquid, but substances are introduced. In this case, however, the testicular sheaths may be different. Also with this method, the risk is high that the hydrocele will reappear soon.
What possible complications of the surgery can occur:
  • Hematomas.
  • Inflammation of the testicles or epididymis.
  • Recurrence of hydrocele.
Affected people should be careful in the first two weeks after discharge and avoid physical exertion.
Hot baths or immersion baths are taboo at this time, even sauna sessions or the use of hot water bottles or heating pads are contraindicated in the postoperative period.

Prognosis and course of a hydrocele

Without treatment, a hydrocele can lead to serious complications. In the worst of cases, it comes to fertility when a large accumulation of fluid hinders the circulation of the testicle, however, these complications are rare.
Even after surgery, the prognosis is good. Swelling of the testicle is common after surgery, it may be necessary to wear tight-fitting briefs to limit swelling.
Other possible complications after surgical treatment are rebleeding and infections, however these occur rarely.
After surgery, the risk of relapse is low, in most cases the problem has disappeared permanently.