Hydrocele and varicocele

Reviewed by Mr John Macfarlane, consultant urological surgeon

What is a hydrocele?

A hydrocele is a build-up of liquid in a fold of mucous membrane situated in the scrotum (testicle sac).

A number of boys develop minor cases of hydrocele during the first few months of their lives. Most of these disappear by themselves, but the more severe cases need to be removed through a simple operation.

How does a hydrocele develop?

When a male baby is in the womb or immediately after birth, his testicles move from the abdominal cavity to the scrotum. Sometimes, the passage which allows this to happen does not close up afterwards. This causes hydrocele in infants.

In adults the cause is unknown but there is a similar accumulation of fluid around the testis.

Is a hydrocele dangerous?

Children rarely experience any discomfort from hydrocele and it doesn't normally cause problems later in life. For this reason, doctors usually recommend waiting to see if the hydrocele disappears without treatment.

Your child will only need an operation if his hydrocele grows to a size which is uncomfortable.

Most hydroceles in adults are persistent. Small hydroceles do not require treatment. Large hydroceles cause some discomfort but are not dangerous.

What to do if you suspect you have a hydrocele

If you notice anything strange about the shape or size of your scrotum, contact your doctor immediately.

The doctor can usually diagnose the condition by shining a light underneath the scrotum which illuminates the fluid-containing sac. If in doubt, an ultrasound scan will confirm the diagnosis.

How is hydrocele treated?

Hydrocele in infants is usually left alone as most will disappear spontaneously. Only if it persists after the first year is an operation carried out.

In adults, hydrocele is managed by draining the fluid under local anaesthetic using a syringe (tapping). This gives an instant cure, but is usually temporary as the fluid re-fills again. For this reason a sclerosing agent is sometimes introduced following the tapping procedure, which causes the hydrocele to stick to itself and prevents re-filling.

Alternatively, the hydrocele can be removed surgically with a small operation.

What is varicocele?

A swelling in the scrotum can also be due to a varicocele. This occurs when the veins at the top of the scrotum get bigger. Varicocele is most common on the left-hand side of the scrotum, due to the arrangement of the veins on that side.

How does a varicocele develop?

A varicocele often develops for no apparent reason. It is usually discovered by accident during a routine examination. If the varicocele grows too large, you will notice an uncomfortable heaviness or pain in one side of your scrotum.

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