What is a hydrocele?
A hydrocele is an abnormal collection of fluid between the two layers of the membrane that surrounds the testis (tunica vaginalis). The fluid usually causes a painless, soft swelling in the scrotum. In Turkish it is popularly called a “water hernia” (su fıtığı), but it is not a true hernia. It can be on one or both sides.
Hydroceles arise for different reasons in babies and in adults, and the treatment approach differs between the two age groups.
Hydrocele in children
Before birth, the testes develop inside the abdomen and descend into the scrotum through the inguinal canal. During this descent, an extension of the lining of the abdomen (the processus vaginalis) travels down into the scrotum with the testis, and it normally closes after birth. If this channel stays open, fluid from the abdomen can pass into the scrotum; this is called a communicating hydrocele.
- Hydroceles are common in newborns, and most disappear by themselves within the first 1–2 years of life. Observation is usually sufficient during this period.
- A swelling that gets bigger and smaller during the day indicates that the channel is open.
- Surgery is planned for hydroceles that persist beyond 1–2 years of age, grow or occur together with a hernia.
- In children, the operation involves tying off the open channel through a small incision in the groin.
For information on other scrotal problems in children, see the pediatric urology page.
Hydrocele in adults
In adults, a hydrocele usually develops because the balance between fluid production and absorption by the membranes is disturbed, and in many cases no clear cause is found. It may, however, be associated with:
- Inflammation of the testis or epididymis (orchitis, epididymitis)
- An injury to the scrotum (trauma)
- Previous inguinal hernia or varicocele surgery
- Rarely, a testicular tumour
For this reason, a new hydrocele in an adult should not be regarded as a simple fluid collection until an underlying testicular condition has been ruled out.
Symptoms
- Painless swelling on one or both sides of the scrotum
- A feeling of heaviness and tightness in the scrotum
- With large hydroceles, discomfort when walking, sitting or getting dressed
- In children, a swelling that gets bigger and smaller during the day
Sudden, severe pain in the scrotum is not a typical symptom of a hydrocele. Especially in children and young people, sudden pain suggests a condition requiring urgent treatment, such as testicular torsion, and medical help should be sought without delay.
When should you see a doctor?
Every new swelling noticed in the scrotum should be assessed by examination, even if it is painless. Do not delay seeking advice in the following situations:
- Sudden, severe pain in the scrotum, nausea or vomiting
- In a baby or child, a swelling in the groin that becomes hard, red and cannot be pushed back
- Fever, redness or tenderness together with the swelling
- A hard area or lump in the testis itself
- A swelling that grows markedly within a short time
Apart from a hydrocele, these symptoms may indicate conditions requiring different treatment, such as testicular torsion, a trapped hernia, inflammation or a testicular tumour.
How is it diagnosed?
- Physical examination: The location and consistency of the swelling and its relationship to the inguinal canal are assessed. When a light is shone through it, a fluid-filled hydrocele lets the light through (transillumination).
- Scrotal ultrasound: Confirms the diagnosis, makes the testis itself visible and is important for ruling out a testicular condition that may be hidden behind the hydrocele. It also distinguishes a hydrocele from other conditions such as a hernia, spermatocele and varicocele.
How it differs from similar conditions
Inguinal hernia
In an inguinal hernia, bowel or fatty tissue from inside the abdomen comes down through the inguinal canal towards the scrotum. The swelling becomes more obvious when coughing or straining and can often be pushed back by hand. In a hydrocele, there is only fluid. In children, the two conditions can occur together because they arise from the same open channel.
Spermatocele (epididymal cyst)
A spermatocele is a fluid-filled cyst that develops in the epididymis at the upper back of the testis. It can be felt separately from the testis, whereas a hydrocele surrounds the testis. Small spermatoceles usually do not need treatment.
Varicocele
A varicocele is an enlargement of the veins of the testis; it feels like a soft “bag of worms” that becomes more obvious when standing. For details, see the varicocele page.
Treatment options
Small hydroceles that cause no discomfort may not need treatment; regular check-ups may be sufficient. The treatment decision is made individually after examination, taking into account the size of the hydrocele, the symptoms it causes and the patient’s age.
When is surgery needed?
- Large hydroceles that cause discomfort or keep growing
- Hydroceles in children that persist beyond 1–2 years of age
- Hydroceles that occur together with a hernia
- Hydroceles that bother the person because of their appearance
Hydrocele surgery (hydrocelectomy)
In adults, the operation is usually performed under general or spinal anaesthesia through a small incision in the skin of the scrotum. The fluid is drained, and the membrane that produces it is turned inside out, folded or partly removed to try to prevent the fluid from collecting again. The technique is chosen according to the size of the hydrocele and the thickness of the membrane. Most patients are discharged the same day or the next day.
Needle drainage
Draining the fluid with a needle and, if necessary, injecting a medication that makes the membrane layers stick together may be considered in selected adults with a high surgical risk. With this method, the likelihood of the fluid collecting again is higher.
Preparation before surgery
In adults, blood tests and an anaesthetic assessment are carried out before surgery. For patients taking blood thinners, whether to pause these medications before surgery is planned together with the doctor who prescribes them; this is important for reducing the risk of blood collecting in the scrotum. In very large hydroceles where the testis cannot be assessed on ultrasound, the testis is examined separately during surgery.
In children, the operation is performed under general anaesthesia. Fasting times before surgery and care after discharge are explained to families in detail. Most children go home the same day and can resume their daily activities within a few days; the time to return to activities such as cycling and playground play is decided at the check-up.
Recovery
- Swelling and bruising in the scrotum are expected in the first days; supportive underwear and cold compresses help.
- Pain is usually controlled with simple painkillers.
- Most adults can return to work within a few days to 1–2 weeks.
- Heavy lifting, cycling and strenuous sport should be avoided for a few weeks.
- It may take a few weeks for the swelling in the scrotum to disappear completely.
Risks
Hydrocele surgery is generally a safe procedure. Possible risks include a blood collection in the scrotum (haematoma), wound infection, prolonged swelling and recurrence of the hydrocele. Very rarely, the sperm duct or the blood vessels of the testis may be damaged. In groin operations in children, particular care is taken to protect the sperm duct and the testicular blood vessels.
Follow-up
The first check-up after surgery is usually within 1–2 weeks. If fever, increasing redness, a swelling that keeps growing or severe pain occurs, seek advice without waiting for the check-up. In patients who are being monitored without surgery, a new examination is recommended if a change in the size of the swelling is noticed.
Hydrocele treatment in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He has scientific studies on scrotal conditions such as testicular torsion and varicocele published in international peer-reviewed journals. In Bursa (Nilüfer), he sees children and adults with scrotal swelling at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00).
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book your consultation in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). You can share any previous ultrasound reports via WhatsApp (+90 541 622 54 82) beforehand. More information is available on the international patients page and the contact page.
