Hydrocele in adults: is excess fluid in the scrotum dangerous?

Written by: Professor Francis Chinegwundoh MBE
Published:
Edited by: Laura Burgess

A hydrocele presents as a swelling in the scrotum. They are fairly common. It is excess fluid in the sack that surrounds the testis. The testis sits in a sack called ‘tunica vaginalis’. There is always a small amount of fluid in this sack, which acts as a shock absorber. A hydrocele happens when the lining of the sack produces too much fluid.

Here, renowned urologist Professor Francis Chinegwundoh MBE explains the signs of hydrocele in men, whether it might be a cause for concern and when it needs to be treated.

What causes hydrocele?

Why the excess fluid should happen is unclear, in the majority of cases. Some hydroceles, however, develop due to a problem with the testes. For example, inflammation of the testes, injury or occasionally a tumour. Such a hydrocele is termed a secondary hydrocele.
 

How can men check for a hydrocele from home?

Generally, the swelling is painless, but can cause discomfort if the hydrocele becomes large. Any swelling in the scrotum that the man notices on self-examination, should be checked out by a doctor. There are several causes of scrotal swelling, some more serious than others. After physical examination an ultrasound is required to make the diagnosis.
 

How is it treated in adults?

Hydroceles are not dangerous. They only need treating if causing discomfort or it reaches such a size that it is unsightly.

Just draining the hydrocele with a needle is not done as the fluid soon re-accumulates. The treatment of choice is surgery to remove the fluid and stitch the sack in such a way that the fluid does not re-accumulate. It is not a major operation. Generally, it is done as a day case under anaesthesia.
 

Why does the fluid re-accumulate in a hydrocele after being drained?

The fluid reaccumulates after drainage alone because nothing has been done to address the underlying problem of overproduction of the ‘shock-absorbing’ fluid produced by the inner layer of the tunica vaginalis or its continued dissemination. During surgery the sac is turned inside out and sutured to itself behind the testis. Fluid produced by the sac is absorbed by veins lining the the inside of the scrotum.
 

After treatment, how likely is it that the hydrocele will return?

Once treated it is unlikely to recur.


If you are concerned about any lumps or swelling with your testis, do not hesitate to book an appointment to see Professor Chingewundoh via his Top Doctor's profile here

By Professor Francis Chinegwundoh MBE
Urology

Professor Francis Chinegwundoh MBE is a renowned consultant urologist based in London, who specialises in treating prostate cancer, benign prostate enlargement, erectile dysfunction, and a wide variety of other urological conditions. In addition to treating patients, he is a widely published researcher, lecturer, and professor, actively involved in teaching and also involved in charity work as Chairman of the charity Cancer Black Care and a trustee of Tackle prostate cancer. He was recognised with an MBE in 2013 for services to the NHS.

Since qualifying in medicine in 1984 from the University of London, Professor Chinegwundoh has accrued a wealth of experience and expertise. He obtained a Master of Surgery degree in 1994 and more recently a Master of Medical Law in 2010. He is a Fellow of the Royal College of Surgeons of England and Edinburgh as well as a Fellow of the European Board of Urology. He established and runs the regional prostate low dose brachytherapy service at Barts Health NHS Trust. He has performed over 100 transurethral needle ablation of the prostate for benign prostate enlargement and over 1500 transperineal template prostate biopsies. He is also a medical legal expert.

Professor Chinegwundoh is currently urology lead at Newham University Hospital, Barts Health NHS Trust and past chairman of the Prostate Cancer Advisory Group. He serves as an honorary clinical senior lecturer at Queen Mary’s College, University of London and has been an honorary visiting Professor in the School of Health Sciences, City University, London since December 2014.

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