Hydrocele & Hydrocelectomy

Causes

• In babies: fluid passes down through an opening that normally closes before birth (communicating hydrocele). Most resolve by 12–24 months.
• In adults: imbalance between fluid production and absorption in the sac around the testis, sometimes after injury, infection (epididymo-orchitis), hernia surgery or, in some regions, filarial infection.
• Rarely, a hydrocele may be secondary to a testicular tumour – which is why an ultrasound scan is important.

Symptoms

A smooth, painless swelling of one or both sides of the scrotum, which may grow slowly. Large hydroceles feel heavy, cause discomfort when walking or sitting, and can interfere with clothing and intimacy.

Diagnosis

Examination often shows the swelling lights up when a torch is shone through it (transillumination). A scrotal ultrasound confirms fluid, checks the testis and rules out a hernia or tumour.

Treatment

Small, painless hydroceles in adults can be observed. Surgery (hydrocelectomy) is recommended when the hydrocele is large, uncomfortable, growing, or causes cosmetic concern.

• Jaboulay procedure: the sac is opened, excess wall trimmed and the edges everted behind the testis.
• Lord's plication: the sac is folded with stitches, with less dissection – suitable for thin-walled hydroceles.
• Excision of the sac for thick-walled or large hydroceles.
• Children: a small groin operation closes the open channel (similar to hernia repair).

Needle aspiration provides only temporary relief, with high recurrence and infection risk, and is reserved for patients unfit for surgery.

Recovery

• Usually done as day-care under spinal or general anaesthesia, in 30–45 minutes.
• Wear scrotal support and apply cold packs for 2–3 days to reduce swelling.
• Return to desk work in 5–7 days; avoid heavy exercise, cycling and intercourse for 2–3 weeks.
• Some swelling can take several weeks to settle completely.

Last reviewed: October 2026. This page is general information and does not replace advice from your own doctor.