Fluid accumulation in a testicle: is surgery necessary?

• Fluid accumulation in the testicle is what we commonly refer to as a testicular hydrocele.
• The most common symptom of fluid accumulation in the testicle is discomfort caused by enlargement of the scrotal sac. It is not usually painful.
• To eliminate the discomfort caused by this accumulation of fluid, hydrocelectomy, surgery to remove the hydrocele, is usually performed.

The accumulation of fluid around the testicle corresponds to the medical term testicular hydrocele. Hydrocele can be of two types depending on the causes that have led to the accumulation of this fluid, differentiating between congenital and acquired or chronic. Below we explain everything you need to know about the accumulation of fluid in the testicle.

The accumulation of fluid in the testicle to form the hydrocele as we know it occurs around the spermatic cord, which consists of the vas deferens that connects the testicle to the urethra for ejaculation, the arteries and veins that feed the testicle and other elements necessary for the proper functioning of the male reproductive system.

This accumulation, as previously mentioned, can be congenital or acquired. Here are the differences:

• Congenital hydrocele: In this case, the accumulation of fluid in the testicle occurs from the first moment of the child's life, mainly due to communication between the inside of the abdomen and the scrotum, which is called communicating testicular hydrocele.
• Acquired hydrocele: On the other hand we find the accumulation of fluid in the testicle due to an injury to the testicle or epididymis as well as an infection. Hydrocele is also common following varicocele surgery.

The main symptom of fluid accumulation in the testicle is the discomfort caused by a lump in the scrotal area, as well as possible aesthetic problems.

It is important to mention that if the testicular hydrocele is not due to infection and does not cause discomfort, surgery is not indicated as it is not considered necessary. The patient may also choose to undergo surgery for aesthetic reasons.

In terms of pain caused by a hydrocele, it is very rare for fluid accumulation in the testicle to hurt, unless, as mentioned above, the hydrocele is due to an infection inside the scrotum.

In any case, any man who notices the appearance of a small lump in the testicle or scrotal sac should see a specialist immediately to determine whether it is a hydrocele or whether it may be due to a testicular tumour or testicular torsion, which is substantially more serious.

Once the patient sees the primary care specialist or the urologist directly, he/she will ask the patient about the reasons and sensations caused by the lump in the scrotum.

After this, the doctor will carry out a physical examination consisting of palpation of the scrotum to determine whether there is a cystic mass inside the scrotum, whether it is rounded to the touch and whether the patient feels any pain to the touch. If this is the case, it is perceived to be a testicular hydrocele.

If fluid accumulation in the testicle is accompanied by swelling, ultrasound may be required to determine definitively whether it is a hydrocele testis.

Sometimes it does and sometimes it doesn't, depending on several factors which are explained below:

Treatment of congenital hydrocele

If the accumulation of fluid occurs in a newborn baby, the main recommendation is to wait until the baby is a year or a year and a half old, as in these cases the hydrocele usually reabsorbs on its own. If this does not happen, an attempt will be made to drain it and, as a last resort, an operation to remove it will be carried out.

On the other hand, if the hydrocele is associated with an inguinal hernia, intervention is most likely to be necessary to eliminate major problems.

Treatment of acquired hydrocele

This type of hydrocele does not resolve spontaneously and in order to eliminate it definitively it will be necessary to perform a testicular hydrocele surgery. 

It is also important to emphasise that hydroceles are only operated on when they cause discomfort due to size or pain, as well as for aesthetic reasons in some cases.

The conclusion is that the best option is to discuss with the urologist whether surgery is indicated in each patient's case, but if it does not cause discomfort of any kind, surgery is not necessary.