What is testicular hydrocele? Causes, symptoms and treatments

• Testicular hydrocele is an inflammation of the scrotum with fluid accumulation in the spermatic cord.
• Testicular hydroceles do not usually present symptoms other than the characteristic swelling, although they can sometimes be very uncomfortable.
• The only way to resolve an acquired testicular hydrocele in adults is by surgical intervention.

Testicular hydrocele is the accumulation of serous fluid around one of the testicles, more specifically in the spermatic cord, between the two layers of the tunica vaginalis covering the testicle and the inner surface of the scrotum.

Testicular hydrocele is the most common type of hydrocele, as hydrocele in general terms refers to the accumulation of serous fluid in a human body cavity.

Testicular hydrocele is the accumulation of serous fluid inside the scrotal sac, causing swelling of one or both testicles.

Types of testicular hydrocele

• Congenital testicular hydrocele. This type of hydrocele appears from birth and is called communicating testicular hydrocele as it is due to a problem in the closure of the duct that connects the inside of the abdomen with the scrotum. It is sometimes associated with an inguinal hernia.
• Acquired or chronic testicular hydrocele. This is the type of hydrocele that occurs in adult men throughout their lives due, as we have already mentioned, to the accumulation of fluid around the testicle. If this type of hydrocele forms in both testicles, it is called a bilateral testicular hydrocele and is mainly solved by surgical intervention.

Now that we know what this type of male condition is, it is important to know what causes this problem to develop. We invite you to read on to learn about the most common causes of testicular hydrocele.

The causes of testicular hydrocele vary according to the type, being due to incomplete closure of the peritoneal cavity in congenital hydroceles, as mentioned above, while the causes of acquired testicular hydrocele may be due to several reasons, among which the following stand out:

• Injury to the testicle or epididymis leads to dysfunction of the tunica vaginalis which secretes and reabsorbs the serous fluid responsible for lubricating the testicles inside the scrotal sac. This can cause testicular hydrocele, unilaterally or bilaterally. This occurs more frequently in adult men than in boys.
• Infectious or inflammatory problems leading to destructuring of the testicular layers that block the normal flow of serous fluid.
• As a result of previous surgery for another reason. Examples are hydroceles acquired after varicocele surgery or inguinal hernia repair surgery.

However, these cases usually comprise a very small percentage of testicular hydrocele cases and are repaired in the same way as hydroceles of non-surgical origin.

In addition to the causes that can lead to the appearance of testicular hydrocele, it is important to know the symptoms of this condition, and we offer you this information in the following section.

In principle, testicular hydrocele does not usually present symptoms other than swelling of the scrotum. However, there are cases in which other symptoms may be noticeable:

• The increase in size is such that the patient may feel a sensation of heaviness or discomfort.
• Pain: It usually appears when the presence of fluid inside the scrotal sac is very high. This symptom is more common in hydroceles larger than 600cc and is related to the weight of the scrotal ball and each of its layers, especially when standing.
• Infection. This is not usually a very common symptom in cases of testicular hydrocele; on the contrary, cases of hydrocele are generally related to patients who have undergone a previous infectious and inflammatory process that has led to the hydrocele, as we mentioned above.
• As a result of another condition. It is possible to develop hydrocele as a result of other pathologies that camouflage its appearance. Among the most common conditions are: epididymitis, orchiepidididymitis, testicular torsion, among others.

One of the most common symptoms of testicular hydrocele is enlargement of the testicle compared to the opposite testicle.

As we have been telling you, testicular hydrocele presents quite diffuse symptoms, which rarely appear except for swelling of one or both testicles. 

Therefore, in order to know specifically what is happening to you, a diagnosis by a specialist in urology or by your family doctor will be necessary to know what the next step is to treat it correctly, either by means of pharmacological treatment or, if necessary, by undergoing a surgical procedure.

It is important to see a doctor when an increase in the size of the scrotal sac or any kind of lump is noticed in order to determine what it is and to rule out more serious medical problems such as a testicular tumour or testicular torsion, which can lead to the loss of the testicle if action is not taken in time.

To diagnose a testicular hydrocele, the doctor can perform two types of tests in addition to a proper anamnesis (medical interview). 

These diagnostic tests are:

• Palpation of the scrotum to see if there is a cystic mass inside, with a rounded feel and no sensation of tenderness, unless there is inflammation in the area.
• Ultrasound if there is any pain, an imaging test will be necessary to confirm that it is a testicular hydrocele.

In addition to the tests, the specialist will also be concerned about your lifestyle, other testicular conditions you may have had, as well as your general state of health and how the development of this problem is affecting you.

After the tests and the interview, your doctor will determine the treatment you should follow to solve the problems caused by the testicular hydrocele, either by resorting to non-surgical treatment with drugs or by indicating the need for an operation.

If you have any of the symptoms listed above and you are looking for a concrete diagnosis of what is happening to you, as soon as possible, you can click on the following link and request a private consultation with our urology specialists.

In case you need more information about this medical appointment you can contact our patient service department by filling out the contact form or by calling at +34 91 141 33 56.

After diagnosis, the decision whether or not to treat a testicular hydrocele depends mainly on whether or not it causes bothersome symptoms and on the type of hydrocele in question.

In the case of congenital testicular hydrocele, it is recommended to wait until the baby is a year or a year and a half old before carrying out any type of operation, as this type of testicular hydrocele usually resolves spontaneously. This is not the case if it is a hydrocele associated with an inguinal hernia, in which case it will probably be necessary to intervene and carry out surgery to remove it instead of simply draining it.

Hydroceles are usually not harmful and are only treated when they cause discomfort or infection or for cosmetic reasons.

In cases where surgical treatment of the hydrocele is chosen, an outpatient procedure is performed in the vast majority of cases, which we explain step by step below.

If you have already been diagnosed and have a testicular hydrocele that requires surgical treatment, you can click on the image below to request an appointment with our Urology Specialists to start managing the whole process as soon as possible:

As we mentioned earlier, after consultation with a specialist and having determined the need for an operation to solve the testicular hydrocele, the surgical treatment, called hydrocelectomy, will be carried out as follows.

On the day of the operation, at home, one hour before the operation, you should apply a cream to the area of the groyne near the scrotum (previously shaved), which the surgeon or the medical team will indicate to you in the previous consultations.

Testicular hydrocele surgery usually has a very good outcome and is usually uncomplicated.

Then, once at the hospital, after the relevant administrative formalities, you will be taken to a room where you will be asked to change into your operating clothes. You will then enter the operating theatre where the urological surgeon, the anaesthetist and a member of the nursing team will be waiting for you. 

You will be given antibiotics beforehand to reduce the chance of infection. 

The next steps are:

1. First, anaesthesia will be administered to avoid any pain during the operation. Usually local anaesthesia is administered and sometimes local anaesthesia plus sedation to eliminate anxiety.
2. The next step is to make a scrotal incision of between 3 and 4 centimetres that allows access to the area where the hydrocele is located. In the case of a bilateral testicular hydrocele (remember that this means that there is a hydrocele in both testicles), the incision is made first on one side and then on the contralateral side. Alternatively, a longitudinal incision is made over the median raphe, which allows a bilateral approach from a single access.
3. The surgeon dissects the different scrotal layers until reaching the tunica vaginalis where the testicular hydrocele is located.
4. Once the testicular hydrocele has been located, the doctor will aspirate some of the fluid accumulated in the hydrocele and then dissect and remove the sac in order to extract the remaining fluid and suture the operated area.

Once the surgery is over, you will be taken to the resuscitation room where you will stay for about 1 hour until you recover from the effects of the anaesthesia and the medical staff checks that everything has gone well.

The total duration of testicular hydrocele surgery is approximately 20 to 60 minutes, depending largely on the size of the sac and whether it is a bilateral or unilateral testicular hydrocele.

As for discharge from hospital, the patient can usually leave the hospital on their own a few hours after the operation, and may spend the night if the surgery was performed in the afternoon or if the surgeon so indicates.

Before you are discharged from hospital, the medical team will explain to you how the surgical wound is cared for and tell you what post-operative care to follow.

This post-operative care is very simple:

• Pain control with mild oral analgesic medication every 6 to 8 hours, depending on the specialist's instructions.
• Use of a scrotal jockstrap to prevent free movement of the scrotal sac for the first few weeks.
• Cleaning the wound regularly to avoid possible infection or problems with the surgical incision.

In addition to care, you will need to have postoperative follow-up visits after the testicular hydrocele surgery. These visits are usually the following day and the subsequent controls indicated by the specialist's criteria.

If you have testicular hydrocele problems and you are looking for a solution as soon as possible, you can contact the patient care department at Operarme.es to make an appointment with our urology specialists in your city by calling at +34 91 141 33 56, or by filling in this contact form.

You can also request an appointment through our website in a few simple steps by clicking on the following image: