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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Hydrocele

What is it?

A hydrocele is a fluid-filled swelling around one or both testicles. Each testicle is surrounded by a two-layered sheath or sac (not to be confused with the scrotum, the pouch of skin in which the testicles hang). The small amount of lubricating fluid that is normally present between the layers of the sheath allows the testicles to move freely. If too much fluid is produced, or too little is absorbed, an excess amount may accumulate between the two sheath layers, forming a hydrocele. (A hydrocele is thus not an enlargement of the testicle itself.)

This disorder is more common among men of middle age or older. However, some young boys may have a hydrocele associated with an inguinal hernia, a localized protrusion of a portion of the abdominal lining, located in the channel where the testicles descended from the abdomen. In these cases the channel did not close properly after descent of the testicles, and excess fluid may leak into the hydrocele sac from the abdominal lining. In rare cases hydroceles are associated with testicular cancer. Hydroceles seldom cause pain, and, in adult men, require treatment only when the swelling causes discomfort.

What Causes It?

  • In most cases the cause of a hydrocele is unknown, but over production or decreased absorption of the normal cushioning fluid appears to be involved.
  • Injury to the testicles may lead to a hydrocele.
  • An inguinal hernia may produce a hydrocele in young boys.

Prevention

  • There is no known way to prevent hydrocele.
  • Regular self-examination of the testes aids in early diagnosis and treatment of any abnormalities (see Testicular Cancer for more information on performing a self-examination).

Diagnosis

  • The doctor will gently palpate the testicles to determine the size and consistency of any lumps.
  • The doctor may shine a bright light on the scrotum to determine the nature of the swelling. Because hydroceles are composed of watery fluid, they are relatively transparent and allow the light to shine through. (A tumor or other mass would appear opaque.)
  • An ultrasound examination may confirm the diagnosis.

How to Treat It

  • In young boys, surgery (through a small incision in the abdomen) to close the inguinal hernia eliminates the cause of the hydrocele.
  • Excess fluid may be removed with a needle and syringe (needle aspiration) under local anesthesia; however, with this method the hydrocele tends to recur. Needle aspiration also carries the risk of infection.
  • In adult men, surgery (through a small incision in the scrotum) may be used to tighten or remove the testicle sheaths and permanently eliminate a hydrocele.

When to Call a Doctor

  • Call a doctor if you notice an unusual growth or swelling in the testicles. While a hydrocele is not a health risk, an examination by a doctor is warranted to rule out more serious disorders.