What Is a Hydrocele?

A hydrocele (fluid around the testicle) is a collection of clear fluid inside the tunica vaginalis (the thin sac that surrounds the testicle). The fluid makes the scrotum swell on one or both sides. Most hydroceles are soft and painless, and they are very common — in adults they often develop slowly over months to years.

Non-communicating hydrocele

The sac is closed off, so fluid simply builds up around the testicle. This is the usual type in adults. The size may stay steady or slowly grow.

Communicating hydrocele

A small channel stays open to the abdomen, so fluid moves in and out. The swelling often changes size during the day — larger when standing or active, smaller after lying down. This type is more common in infants but can occur in adults.

Common symptoms

  • Painless scrotal swelling — the most common sign, on one or both sides
  • A feeling of heaviness or fullness in the scrotum
  • Size changes — some hydroceles grow larger over time or fluctuate through the day
  • Discomfort or a dragging sensation when the hydrocele becomes large; usually there is little or no sharp pain

How a hydrocele is diagnosed

Your urologist can usually diagnose a hydrocele with a simple physical exam. A quick test called transillumination (shining a light through the scrotum) makes fluid glow, which helps tell a hydrocele apart from a solid lump. A scrotal ultrasound (a painless imaging test) is often used to confirm the diagnosis and make sure the testicle underneath is healthy.

Is Surgery Right for You?

Not every hydrocele needs surgery. Many small, comfortable hydroceles can simply be watched. Surgery becomes worthwhile when the hydrocele is causing symptoms or continuing to grow.

Surgery Is Often Considered When

  • The hydrocele is large, heavy, or uncomfortable
  • It keeps growing or interferes with daily activity
  • It causes cosmetic or functional concerns (fit of clothing, sitting, intimacy)
  • The skin is stretched or the size makes hygiene difficult
  • Simple observation has not helped and the hydrocele is bothersome

Watchful Waiting May Be Fine When

  • The hydrocele is small and painless
  • It is not growing and doesn't bother you
  • It causes no functional or cosmetic problems
  • You'd prefer to avoid surgery and your urologist agrees it's safe to monitor

Adults vs. children

In infants, many hydroceles are present at birth and resolve on their own by about age one, so surgery is usually delayed. In adults, hydroceles rarely go away on their own — so when one is large or symptomatic, hydrocelectomy is the standard, definitive fix. Your care team will tailor the timing to your situation.

What Happens During Hydrocelectomy

Hydrocelectomy is a well-established, same-day operation. Through a small incision, your surgeon drains the trapped fluid and then repairs the sac so fluid cannot collect again. Most men go home a few hours after the procedure.

The Steps

  • Anesthesia: you receive general or spinal anesthesia so you feel nothing during surgery
  • Small incision: most hydrocelectomies are done through a small scrotal incision; an inguinal (groin) incision is sometimes used, especially for a communicating hydrocele
  • Drain the fluid: the surgeon opens the sac and removes the trapped fluid
  • Repair the sac: the sac is either removed (excision) or folded and stitched behind the testicle (plication) so fluid can no longer build up
  • Close & support: dissolvable stitches close the incision; a dressing and scrotal support are applied

At-a-Glance

  • Setting: outpatient (day surgery)
  • Anesthesia: general or spinal
  • Duration: about 30–60 minutes
  • Incision: small scrotal (sometimes inguinal)
  • Hospital stay: none — home the same day
  • Recovery: back to light activity within days; full activity in about 2–4 weeks

Hydrocelectomy vs. Other Options

There are a few ways to manage a hydrocele. Surgery is the only option that reliably fixes it for good, but not everyone needs surgery right away.

Option What It Involves Recurrence & Notes
Observation Simply monitoring a small, painless hydrocele over time Reasonable when there are no symptoms; won't make the hydrocele go away, but avoids any procedure
Needle aspiration ± sclerotherapy Draining the fluid with a needle, sometimes injecting a medicine (sclerotherapy) to help the sac scar closed Quick and office-based, but the fluid commonly comes back; may be offered when surgery isn't a good option
Hydrocelectomy (surgery) Definitive repair — drains the fluid and fixes the sac Lowest recurrence; the standard long-term solution for a bothersome hydrocele

In short: observation is fine while a hydrocele is small and silent, aspiration offers temporary relief, and hydrocelectomy is the definitive fix with the lowest chance of the fluid returning.

Recovery

Most men recover from hydrocelectomy quickly and comfortably. Some swelling and bruising are normal at first and settle over a few weeks.

First few days

  • Wear a scrotal support (athletic supporter) to reduce swelling and add comfort
  • Use ice packs (20 minutes on, 20 off) over the dressing for the first day or two
  • Control soreness with the pain medicine your care team recommends
  • Rest and keep the area clean and dry per your instructions

Weeks 1–2

  • Most men return to desk or light work within a few days to a week
  • Keep wearing scrotal support; expect swelling and bruising to steadily improve
  • Avoid heavy lifting and strenuous activity

Weeks 2–4 and beyond

  • Gradually resume exercise, heavy lifting, and sexual activity — usually around 2–4 weeks, guided by your surgeon
  • Residual swelling can take several weeks to fully resolve, which is normal

When to call your care team

Contact your urologist for fever, worsening pain or swelling, redness or drainage from the incision, or a rapidly enlarging scrotum. These can be signs of bleeding or infection that should be checked promptly.

Risks & Potential Complications

Hydrocelectomy is very safe, but as with any surgery there are some risks to be aware of. Serious problems are uncommon.

  • Swelling and bruising — expected and temporary; the scrotum may look larger before it gets smaller
  • Hematoma (a collection of blood) — the most common complication; usually resolves on its own, occasionally needs drainage
  • Infection — uncommon; treated with antibiotics and, rarely, wound care
  • Fluid reaccumulation or recurrence — the hydrocele can occasionally return, though this is uncommon after surgery
  • Rare injury to nearby structures — the testicle's blood supply, the epididymis (the tube behind the testicle), or the vas deferens (the tube that carries sperm); injury is unusual
  • Anesthesia-related risks — as with any procedure requiring anesthesia

Frequently Asked Questions

Is hydrocelectomy painful?

You won't feel anything during surgery because of anesthesia. Afterward, most men have mild to moderate soreness for a few days that's well controlled with ice, a scrotal support, and pain medicine.

Will it affect my fertility or testosterone?

A standard hydrocelectomy is not expected to affect testosterone or fertility. The testicle and its blood supply are protected during the operation, and serious injury to the sperm-carrying structures is rare.

Will the hydrocele come back?

Recurrence after surgery is uncommon. Because the sac itself is repaired, hydrocelectomy has a much lower chance of the fluid returning than draining it with a needle.

How long is recovery?

Many men return to light activity or desk work within a few days to a week and to full activity in about 2–4 weeks. Some swelling can linger for several weeks and is normal.

When can I resume sex and exercise?

Most men resume exercise, heavy lifting, and sexual activity around 2–4 weeks after surgery, once soreness and swelling have settled. Your surgeon will give you specific timing based on how you're healing.

Get Answers About Your Hydrocele

If scrotal swelling is bothering you, a quick evaluation can tell you whether it's a hydrocele and whether surgery is the right choice. Our team will walk you through your options and what to expect.

  • ✅ A clear diagnosis with exam and, when needed, scrotal ultrasound
  • ✅ Honest guidance on observation vs. surgery
  • ✅ Outpatient hydrocelectomy — usually home the same day
  • ✅ Coordinated recovery support from your care team
Schedule Your Consultation

Call 678-344-8900 to speak with our team