Hydrocele Symptoms: Recognising and Treating

Hydrocele Signs: Scrotal Swelling, Pain & Fluid Accumulation Explained

Hydrocele symptoms mainly cause swelling, pain or discomfort due to fluid accumulation surrounding the testicles. The primary treatment options involve needle aspiration and surgical intervention to prevent the accumulation of fluid and remove the hydrocele sac.

You may not feel pain, but a sudden swelling or discomfort in your scrotum can be alarming. The usual suspect? Hydrocele, a fluid-filled condition that is more common in newborn boys than in adults. While not dangerous, it can cause concern. Let us dive into the hydrocele symptoms, causes, diagnosis, and treatment to help you stay informed and in control of your health.

What are the symptoms of hydrocele?

Hydroceles often do not cause signs. However, some men notice a sense of scrotum fullness and may experience difficulties while performing regular activities or walking. The following hydrocele symptoms can be usual in adults:

• Enlarged scrotum
• Painless swelling on both or only one scrotum
• Uncomfortable and heavy scrotum due to excessive fluid collection and swelling
• Rarely, pain in a severely inflamed scrotum
• Diurnal changes in swelling
• Mild discomfort in the inguinal area with high chances of radiating to the back
   

Hydroceles are typically benign and do not restrict blood flow. However, a sudden, painful scrotal swelling requires immediate medical attention to rule out emergencies like testicular torsion. Many men also report that scrotal swelling feels more uncomfortable in the morning than in the evening.

Newborns, especially those born prematurely and under 3 weeks old, are at a higher risk of developing this condition. Common symptoms of hydrocele in children may include:

• Painless swelling
• A small and smooth lump on the sides of the scrotum
• Temporary changes in scrotum size
   

How Common is Hydrocele?

A hydrocele is an accumulation of fluid in the membrane, a thin layer surrounding both or one of the testes, that results in scrotum enlargement and swelling. This condition may affect both sides or one side of the scrotum.

The global prevalence of hydrocele varies significantly. In non-tropical regions, it most commonly affects newborns and is less common in adults. However, in tropical and endemic areas, a major cause of hydrocele in adults is lymphatic filariasis, a parasitic infection. According to the World Health Organization (WHO), lymphatic filariasis remains a significant public health problem, and in 2021, India accounted for a substantial portion of the global burden, with filarial hydrocele being a common clinical manifestation.

Around 10% of newborn boys may face hydrocele, but it disappears without any treatment when they are 1 year old. For older boys and adults, hydrocele carries a social stigma that may cause isolation and psychological distress for the people affected.

What are the types of hydrocele?

Here is a brief on two types of hydrocele: communicating and non-communicating.

1. Communicating Hydrocele: A communicating hydrocele occurs when there is a connection between the scrotal sac and the abdominal cavity, allowing fluid to flow in and out. In a communicating hydrocele, the sac surrounding the testicle has an open connection to the abdominal (peritoneal) cavity, allowing abdominal fluid to flow down and accumulate.  
   
   As a result, the scrotum may change in size throughout the day and become noticeably enlarged, causing discomfort. Additionally, this condition increases the risk of developing an inguinal hernia.
    
2. Non-communicating Hydrocele: In this condition, excess fluid can remain trapped in the scrotum around the testicle after the inguinal canal closes. Non-communicating hydrocele may usually be present from birth but may appear or develop later without any clear cause.
    

Apart from these two types, hydrocele is often classified into several types. Primary hydrocele has no known cause, whereas secondary hydrocele occurs from infection, such as tuberculosis, filarial syphilis or trauma.

What Causes Hydrocele?

The causes of hydrocele vary depending on the age of the affected person.

• Hydrocele in Men: Hydrocele in males mainly occurs due to an inflammation or injury in the scrotum. Inflammation occurs due to infection in a coiled-shaped, small tube at the testicles’ back or in the testicles. Therefore, any injury or inflammation contributes to an increased risk of hydrocele.
• Hydrocele in Babies: In babies, this condition develops before birth. Normally, testicles are placed into the scrotum surrounded by a protective sheath that allows fluid to hold them. The protective sheath closes and absorbs excessive fluid, which may lead to a hydrocele. In case a sheath does not close perfectly and fluid absorption remains, this situation causes fluid accumulation and swelling in the scrotum.

However, premature babies are highly susceptible to hydrocele due to their weak or underdeveloped organ function. In addition to fluid accumulation, post-herniorrhaphy complications, Wuchereria bancrofti, syphilis, and tuberculosis increase the risk of hydrocele.

How to Diagnose Hydrocele?

Doctors may perform physical examinations to measure swelling changes by applying pressure to the groin. To confirm the situation and growth of this disease, doctors may recommend laboratory examinations, such as:

• Computer Tomography (CT) Scan: CT scans are beneficial to get cross-sectional images of a particular area and 3D images of the testicles. The healthcare providers can assess the progression of hydrocele and capture the amount of the intra-abdominal component.
• Pelvic Ultrasound: It presents a visualisation of soft tissues in the pelvis and testicles. Doctors prefer this test to assess the fluid-filled sheath surrounding the testicle and confirm the development of a hydrocele.
   

What are the similar conditions of hydrocele?

Here is the list of similar conditions to hydrocele. The following cause similar symptoms to hydrocele, such as lumps or swelling in the scrotum. Conversely, these conditions have different characteristics and causes.

• Testicular tumour
• Inguinal hernia
• Spermatocele
• Scrotal oedema
• Epididymal cyst
• Varicocele
• Epididymitis
   

Hence, males should seek a urologist if they experience swelling. In this situation of living with similar symptoms, anyone can suffer from the wrong treatment. However, proper diagnosis can determine the underlying cause, and doctors can guide appropriate treatment for a particular disease.

What are the medical care options for treating hydrocele?

In most cases, a hydrocele does not need any treatment. In children, it goes away within a year of the occurrence, and in adults, hydroceles typically do not resolve on their own and may require treatment if they become large, symptomatic, or if the underlying cause needs to be addressed.  

1. Needle Aspiration: Needle aspiration is a non-surgical method that uses a long and large needle to drain excess fluid from the scrotum. This process has a high chance of faster fluid reaccumulation and other health complications.
2. Eversion and Excision: It is suitable for thick and large-walled hydroceles. This surgical technique involves the removal of the tunica vaginalis and the eversion of the sac, creating a new pocket. Taking care of this treatment is crucial to prevent any damage to the epididymis, vas deferens or testicular vessels.
3. Plication: This surgical option is ideal for treating thin-walled hydroceles. In this treatment, the tunica vaginalis is bandaged with a series of catgut sutures that help stimulate the formation of fibrous tissues. Plication minimises dissection and reduces the risk of infectious complications and hydrocele.
    

Sometimes, healthcare providers suggest a clinical process of suctioning fluid from the scrotum. Surgical procedures like hydrocelectomy (which includes techniques like plication or excision) have a high success rate and a low chance of recurrence. In contrast, needle aspiration has a very high recurrence rate.

What Happens if a Hydrocele is Left Untreated?

If a hydrocele is left untreated, it may cause several complications, such as:

• Anaesthesia risk
• Infection
• Bruising
• Swelling
• Reoccurrence of hydrocele
• Scarring
   

However, after surgery to treat hydrocele, some patients may face further health issues, as follows:

• Pyocele
• Infection
• Haematocele
• Hernia
• Atrophy of the testes
• Rupture
• Rarely, surgical complications may lead to injury of the vas deferens or the blood supply to the testis, which could potentially impair spermatogenesis and lead to infertility.
   

Hydrocele is a condition characterised by fluid accumulation in the scrotum. It commonly occurs in newborn boys and rarely in adult males due to inflammation or injury. Hydrocele signs and symptoms include painless swelling, heaviness of the scrotum, enlargement and discomfort. Treatment includes needle aspiration and surgeries, such as eversion, excision and plication.