Hydrocele: symptoms, causes, treatment and when to see a doctor

The NHS says treatment for a testicular lump or swelling depends on the cause. You might not need treatment if it does not cause any problems and is not getting worse. If the lump or swelling is painful or very big, the GP may refer you to a specialist for an operation to drain, shrink or remove it.

NICE Clinical Knowledge Summaries says that for a suspected idiopathic hydrocele in an adolescent or adult, the person is reassured and advised on scrotal support, such as supportive underwear. If the person has a large, symptomatic hydrocele, they are referred to a urologist or paediatric surgeon. CKS notes that surgery (hydrocelectomy) may be considered, and that aspiration and sclerotherapy is an alternative for people who are unfit for or choose not to have surgery, but has a lower success rate.

In children, Great Ormond Street Hospital describes an operation under general anaesthetic, using keyhole or open surgery, lasting about an hour. The fluid is drained away from the scrotum and the passageway is closed with a stitch. Risks include a small risk of damage to the testicular cord and blood vessel, a small risk of infection and the usual risks of a general anaesthetic.

NHS inform describes hydroceles as swellings in the scrotum caused by a build-up of fluid. The NHS says to see a GP if you have a lump in your testicles, swollen testicles, a change in the shape or feel of your testicles, one testicle that has become bigger than the other, or aching or discomfort in your testicles that does not go away.

Great Ormond Street Hospital says that in a child the doctor may shine a torch through the scrotum, and if the swelling is a hydrocele filled with clear fluid, the outline of the testicles will show up and the rest of the scrotum will show the light.

Great Ormond Street Hospital explains that, as a baby develops, each testicle creates a passage as it travels into the scrotum. If this passage is quite narrow, only fluid from the abdomen can flow through it into the scrotum, causing a fluid-filled sac, called a hydrocele. It says there is no known way of preventing hydroceles and they are not due to anything a mother did during pregnancy.

NICE CKS lists possible causes of a late-onset hydrocele in adolescents and adults as minor trauma, infection and epididymitis, testicular torsion, varicocele surgery and testicular cancer. This is why a new scrotal swelling needs to be checked.

Great Ormond Street Hospital says most hydroceles in babies go down within a few months of birth, but occasionally they last longer. If a hydrocele is still present after two to three years or is causing any problems, an operation might be suggested. NICE CKS says most congenital hydroceles resolve spontaneously by 12 months of age, and watchful waiting is an acceptable approach in a child under 12 months.

NICE CKS says a child should be referred to a paediatric surgeon if a simple hydrocele is not decreasing in size or is still present after 12 months of age, or if a concomitant inguinal hernia or underlying testicular problem is suspected, because an incarcerated hernia may be difficult to distinguish from a hydrocele.

Great Ormond Street Hospital says that if a child has an inguinal hernia, it needs to be corrected with an operation, because trapped bowel can be damaged by pressure on its blood supply, so the operation is arranged within a few weeks.

NHS inform says there is no single test for testicular lumps and swellings. The doctor will discuss your situation and carry out a physical examination, and may look at and feel your testicles, shine a torch through the scrotum to check for a build-up of fluid, refer you for an ultrasound scan, and take a urine sample if they suspect an infection.

NICE CKS says that if a person is 18 to 40 years of age, or the testis cannot be felt, an urgent ultrasound scan of the scrotum is arranged, because cancer usually presents in adolescents and adults.

The NHS says to go to A&E immediately or call 999 if you have sudden, severe pain in a testicle, testicle pain along with feeling sick, being sick or pain in your tummy, or testicle pain that has lasted more than an hour or continues when you are resting. These can be signs of a serious problem that needs to be treated in hospital as soon as possible. Do not drive to A&E.

NHS inform says to contact your GP practice urgently if you have a lump in your testicles, swollen testicles, a change in the shape or feel of your testicles, one testicle bigger than the other, or aching or discomfort that does not go away.

On the NHS, a GP can examine a scrotal swelling, arrange an ultrasound and refer you to a urologist, or a paediatric surgeon for a child. Surgery for a hydrocele is usually done as a planned procedure.

Private urology clinics can offer assessment, ultrasound and surgery. The NHS advice on warning signs, particularly sudden severe testicle pain, applies whichever route you use, and these symptoms need emergency care rather than a private appointment.