Hydrocele is a common condition that causes fluid to build up around a testicle, leading to swelling in the scrotum. It affects males of all ages, and while it is often painless, it can be uncomfortable and concerning when it appears. Jeff Morrison, MD, urologist at CU Medicine, explains the causes, symptoms and treatment options for this condition.

What is Hydrocele?

"The take-home message about hydrocele is that it's a benign, not dangerous condition," said Dr. Morrison. "Hydrocele refers to accumulation of fluid around testicle, which can range from barely noticeable to quite large,” said Dr. Morrison. 

A hydrocele forms when fluid collects between the layers of tissue that surround a testicle. It can occur on one or both sides and can range from barely noticeable to quite large.

There are two main types of hydrocele:

Congenital hydrocele, present at birth and common in newborn boys.

Acquired hydrocele, which develops later in life, often linked to inflammation, injury or infection of the scrotum.

“Anytime a man has new-onset scrotal swelling, we want them to come see a urologist,” explained Dr. Morrison. “We want to rule out anything dangerous and take care the issue promptly.”

What Are the Symptoms of Hydrocele?

Recognizing the signs of hydrocele early can help patients seek timely evaluation and avoid unnecessary worry.

Common signs and symptoms of hydrocele are:

• Painless swelling in one or both sides of the scrotum
• A feeling of heaviness or fullness in the scrotum
• Swelling that changes size throughout the day, often larger in the evening
• Swelling that may shrink when lying down
• Discomfort or mild aching in more advanced cases

What are the Causes and Risk Factors of Hydrocele?

Several factors can contribute to the development of a hydrocele:

• Age: Newborns are commonly affected due to incomplete closure of the processus vaginalis before birth. Adult hydroceles become more common with age.
• Injury: Trauma to the scrotum can trigger fluid buildup.
• Infection or inflammation: Conditions like epididymitis can lead to a hydrocele.
• Prior surgery: Procedures in the groin or scrotal area, including hernia repair, can sometimes result in a hydrocele.
• Underlying conditions: In rare cases, a hydrocele can develop alongside other testicular issues, which is part of why evaluation matters.

"I've seen hydroceles develop because of scrotal trauma, infection, inflammation and even viral infections," Dr. Morrison said. “Rarely, it’s a sign of a testicular tumor.” 

What are the Treatment Options for Hydrocele?

Diagnosing a hydrocele typically starts with a physical exam and often includes an ultrasound to confirm the diagnosis and rule out other causes of scrotal swelling, such as a hernia or testicular mass.

“Treatment of hydrocele depends on the cause, size and if it’s bothering the man,” said Dr. Morrison.

Common treatments of hydrocele include:

• Watchful waiting – many small hydroceles can go away on their own
• Conservative management – wearing supportive underwear to ease heaviness and discomfort
• Addressing any underlying inflammation or infection
• Surgical options – a hydrocelectomy is the most definitive treatment for hydrocele

"Surgery is usually straightforward with a quick recovery," Dr. Morrison said. “Most patients do very well and go home the same day.”

When Should I See a Urologist About a Hydrocele?

Consult with a urologist if you experience:

• New or sudden swelling in the scrotum
• Swelling accompanied by pain, redness or fever
• A hydrocele that continues to grow
• Any lump or firmness you notice within the scrotum
• Swelling that interferes with daily activities

Sudden, painful scrotal swelling should be evaluated right away, as it can sometimes signal a more urgent condition that needs prompt care.

CU Medicine's team of urology providers offers comprehensive evaluation and individualized treatment plans for patients with hydrocele and other scrotal conditions. To learn more about Jeff Morrison, MD, or CU Medicine Urology – South Denver at Highlands Ranch Pavilion 1, call 303-265-3940.