Does a hydrocele need surgery? Swollen scrotum in men and boys

What a hydrocele is

Each testicle sits in a thin sac. When fluid collects in that sac, the scrotum swells, usually on one side. The swelling is smooth, soft and usually painless, and can grow slowly over months or years until it is very large. A doctor can often shine a light through it to show it is fluid.

In adults, hydroceles can follow an injury or infection, and in parts of Nigeria and other tropical countries, lymphatic filariasis is a known cause of large hydroceles. Often no cause is found.

Get it checked first

Any new swelling of the scrotum should be examined by a doctor. Usually an ultrasound scan is done to look at the testicle behind the fluid, because occasionally a hydrocele in a young man is caused by a problem in the testicle itself, including a tumour. The scan also tells a hydrocele apart from a hernia, which needs a different operation.

When an adult hydrocele needs surgery

Watching is reasonable for a small hydrocele that does not bother you. Surgery is usually advised when:

• It is large, heavy or uncomfortable
• It makes walking, sitting at work, wearing trousers or sex difficult
• It keeps growing
• It causes embarrassment you would rather not live with
• The testicle cannot be examined properly because of the fluid

Why the needle is not the answer

Draining the fluid with a needle gives quick relief but the fluid usually comes back, sometimes within weeks, and repeated draining carries a risk of infection. It is sometimes used for men who are too unwell for an operation. For most men, hydrocele repair is the treatment that lasts.

Repair is done through a small cut in the scrotum, under a general or spinal anaesthetic, usually as a day case. The sac is opened, the fluid drained and the lining folded or partly removed so fluid cannot collect again. Expect swelling and bruising for a few weeks; supportive underwear and rest help. Most men return to desk work in about one to two weeks, and your surgeon will advise on heavier work.

Hydrocele in babies and boys

Many baby boys are born with a hydrocele. Most go away on their own by around one to two years old. A hydrocele that gets bigger during the day and smaller at night, or with crying, means there is still an open channel to the tummy, which can let a hernia through. That type, and any hydrocele still present after about two years, usually needs a small operation in the groin, similar to a hernia repair.

Swellings that are an emergency

Sudden, severe pain in the testicle, with or without swelling, especially in a boy or young man, can be torsion, a twisted testicle. Go to an emergency department immediately: the testicle can be lost within hours. Also see a doctor quickly for a hard lump in the testicle itself, or a swelling in the groin that is painful and will not go back.

Common questions