The normal scrotum and testes

The scrotum is normally loose, soft and fleshy. It holds the two testes (testicles). Usually you can easily feel the testes in the scrotum. A tube (the vas deferens) takes sperm from each testis to the the penis. It is normal for one testis to hang lower than the other.

What is a hydrocele?

A hydrocele is a collection of fluid in a sac in the scrotum next to a testis. It usually occurs on one side, but sometimes a hydrocele forms over both testes.

What do hydroceles look and feel like?

A hydrocele feels like a small fluid-filled balloon inside the scrotum. It feels smooth, and is mainly in front of one of the testes.

Hydroceles vary greatly in size. Very large hydroceles are sometimes seen in elderly men who have never shown their swelling to a doctor. It might have been getting larger over a number of years.

Hydroceles are normally painless. Large hydroceles may cause discomfort because of their size. Walking or sexual activity may become uncomfortable if you have a very large hydrocele.

What causes hydroceles?

Most hydroceles occur in adults and are most common in men aged over 40 years.

• The cause is not known in most cases.
• A small number of hydroceles are caused when something is wrong with one of the testes. For example, infection, inflammation, injury or tumours of a testis may cause fluid to be formed which leads to a hydrocele forming.
• Sometimes hydroceles develop when there is generalised swelling of the lower half of the body due to fluid retention.

Do I need any tests?

A doctor will examine the testes. Your doctor may also shine a light through the scrotum which helps to diagnose a hydrocele.

If the hydrocele is large, and the doctor cannot feel the testis, the fluid may be drained with a needle and syringe. (This is helped by injecting local anaesthetic into the overlying skin to make the procedure painless.) Once the fluid is removed, the testes can then be examined more easily.

Sometimes an ultrasound scan of the testes will be advised. This can check the testes to make sure there is no underlying cause for the hydrocele.

What are the treatments for hydrocele?

Leaving it alone can be an option

In adults, if the hydrocele causes no symptoms, one option is simply to leave it alone. If it becomes larger or troublesome, you can always change your mind and have treatment.

Surgery

Surgery may be recommended if your hydrocele is large or uncomfortable. The operation for a hydrocele involves making a very small cut in the scrotum (or lower abdominal wall). The fluid is then drained from around the testicle. The passage between the abdomen and the scrotum will also be sealed off so the fluid cannot reform in the future. This is a minor operation and is performed as a day case so does not usually involve an overnight stay in the hospital.

Drainage

The fluid can be drained easily with a needle and syringe. However, following this procedure, it is common for the sac of the hydrocele to refill with fluid within a few months. Draining every now and then may be suitable though, if you are not fit for surgery or if you do not want an operation.