By Neus Ferrando Gilabert BSc, MSc (embryologist).
Last Update: 11/14/2014

The testicles are found within a sac known as scrotum, where they are surrounded by a small quantity of fluid, helping them being motile and less vulnerable to be damaged.

Hydrocoele occurs when this amount of fluid increases due to a swelling of one or both testes. The obstruction of a blood or lympth vessel may also cause an enlargement of the scrotal sac.

The different sections of this article have been assembled into the following table of contents.

How common is it?

Hydrocoeles are common among newborns. During their normal development, the boy’s testes descend through a duct from the abdomen to the scrotum. In this case, hydrocoeles are formed when this duct fails to close, since the fluid goes from the abdomen through the open duct and finally accumulates within the scrotum. This is the reason why there is swelling.

Hydrocoele may be accompanied by an inguinal hernia.

Types

There exist two types of hydrocoele:

Congenital hydrocoele
is occurs when the tunica vaginalis (TV) does not close completely, since it remains communicated with peritoneal cavity. The fluid flows then towards the scrotal sac. It usually disappears by 18 months of age.
Acquired or secondary hydrocoele
it is believed to be due to a history of testicular swelling. It may be owing to different reasons, such as a tumor, epididymitis, testicular torsion, or mainly a blunt or penetrating trauma. Acquired or secondary hydrocoele is more common among older children and adults.

Symptoms

Its main symptom is scrotal swelling. Hydrocoele may appear in one or both sides.

The testis cannot be detected during the medical check-up because of the circulating fluid. Its size may increase depending on each case. A variation in the amount of this fluid may be due to an inguinal hernia.

Hydrocoeles can be easily shown if the largest scrotal area is illuminated. If there is a hydrocoele, the scrotum is perfectly illuminated because of the clear fluid it contains. An ultrasound can be done to confirm the diagnosis.

Lightening up hydrocele

Treatment

Usually, hydrocoeles are not severe. Treatment is only applied if it causes annoyances, embarrassment, or its size is so big that it may block the blood flow to the testicle.

Today, surgery is the most common solution. A slight incision is performed within the scrotum or the lower abdomen in order to remove the excess fluid. Then, the volume of the tissue is reduced to avoid the scrotum to be filled again with fluid. The procedure is carried out on an outpatient basis under general anesthetic.

Another option may be to remove the fluid from the scrotum by means of a needle. This process is known as “aspiration”. However, due to the increased risk for infection and the strong likelihood of resurgence, surgery is usually preferable. Nonetheless, aspiration may be the best alternative for men presenting surgical risks.

After aspiration, injection of sclerosing medications (hardening or thickening) may help close the opening, which prevents the scrotum to accumulate fluid again later.

Hydrocoeles associated with an inguinal hernia should be surgically repaired as soon as possible. Hydrocoeles which do not disappear naturally after a few months should be evaluated for possible surgery. A surgical procedure called “hydrocelectomy” is often performed in order to remove the hydrocoele.

Diagnosis

A simple hydrocele may disappear naturally without having recourse to surgery. However, in case it was necessary, it is a simple procedure for a skilled surgeon whose result is usually excellent.

A severe testicular or scrotal pain may be a medical emergency. In case this severe pain is accompanied by a scrotal swelling, you must seek medical care right away.

Complications

Treatment of hydrocoele may lead to complications. Risks associated with hydrocoele surgery may include:

  • Blood clots
  • Infection
  • Injuries within the scrotal tissue or layers

Risks associated with aspiration and sclerosis or hardening may include:

  • Fibrosis
  • Infection
  • Mild to moderate pain in the scrotal area
  • Resurgence of hydrocoele

Hydrocoele and fertility

Hydrocoele testis does not usually affect men’s fertility, although it could be a symptom derived from other factors which do affect male fertility.

Authors and contributors

 Neus Ferrando Gilabert
BSc, MSc
Embryologist
Bachelor's Degree in Biology from the University of Valencia (UV). Postgraduate Course in Biotechnology of Human Assisted Reproduction from the Miguel Hernández University of Elche (UMH). Experience managing Embryology and Andrology Labs at Centro Médico Manzanera (Logroño, Spain). More information