What is a hydrocoele?

A hydrocoele is a collection of fluid around the testicle (testis), in the tunica vaginalis (the space surrounding the testis).

Hydrocoeles only occur in males.

Typically presents as a painless swelling of the scrotum.

Most hydrocoeles are congenital (ie. present at birth) - these are usually seen in boys aged 1-2 years of age. Most congenital hydrocoeles resolve by the end of the first year of life. Persistent congenital hydrocoele is readily corrected surgically.

Secondary hydrocoeles can affect males of any age, but usually occur in men older than 40 years.

May affect one side of the scrotum or both sides.

Causes of hydrocoeles in adults:

In many cases, no cause is found. Possible causes include:

  • Trauma - traumatic hydrocoeles are common.
  • Infection (eg. epididymo-orchitis)
  • Testicular Tumour
  • Torsion of the testes - reactive hydocoeles occur in up to 20% of cases of testicular torsion.

    Symptoms of a hydrocoele:

    Painless, enlarged scrotum.

    There may be a sensation of heaviness or dragging.

    Hydrocoele is not usually painful (pain may be an indication of an accompanying infection).


    A light shined through the scrotum will cause the hydrocoele to illuminate (transillumination).

    Investigation is not usually required in children.

    For adults, an ultrasound of the testis may be required.

    Since testicular lumps could potentially be missed on physical examination (due to the collection of fluid preventing full examination of the testis), an ultrasound is often advised. An ultrasound of the scrotum will confirm the diagnosis of hydrocoele & also identify any abnormal testicular lumps.

    Treatment of hydrocoeles:

    If the hydrocoele is small, no treatment is usually required.

    For larger hydrocoeles, drawing off of the fluid using a needle & syringe may be indicated. However, such needle aspiration is not therapeutic because the fluid generally reaccumulates quickly & is associated with a risk of infection.

    For larger hydrocoeles, or where there is a suspected underlying tumour, surgery may be required.

    Hydrocoeles can usually be cured with a relatively simple surgical operation.

    Note: Most hydrocoeles occur with normal testes. However, always see your doctor if you notice any change in the size and/or shape of your scrotum or testes.

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