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A testicular hydrocele is a buildup of fluid around one or both testes, a common condition in newborn males that usually goes away within a few months. Adults can also experience abnormal scrotal swelling with a direct injury, a severe infection, or a tumor. When a testicular hydrocele causes pain or does not improve on its own, a surgeon can drain excess fluid with a needle or manually excise the membranous sac containing the fluid. Surgery is very effective in most cases, and individuals do not typically experience recurring problems.
The testes are covered and protected by a membrane called the tunica vaginalis. During embryonic development, the membrane normally descends with the testes and fills with a small amount of serous fluid for cushioning and lubrication. If a congenital defect or prenatal injury inhibits the descent of the tunica vaginalis, fluid buildup can cause a testicular hydrocele to develop. In most cases, congenital hydroceles resolve themselves within the first year of life as the testes and tunica vaginalis continue their development.
A testicular hydrocele can arise in adulthood if an infection or injury damages the tunica vaginalis. Direct trauma to the scrotum, testicular torsion, hernias, and benign or cancerous tumors can all contribute to serous fluid buildup. The condition itself is usually painless, but an especially swollen scrotum may make it difficult to sit or walk comfortably. Underlying causes, especially trauma or infection, can cause additional symptoms of discoloration, nausea, and fatigue.
Medical care should be sought whenever an excessive scrotal swelling persists for more than a few hours. A doctor can conduct a physical examination and perform a series of diagnostic tests to look for an underlying cause. Blood samples may confirm an infection and ultrasounds might indicate physical abnormalities such as tumors or hernias. After confirming a diagnosis, the doctor can discuss different treatment options.
When swelling and pain are minimal and an immediate cause cannot be determined, a patient may simply be instructed to schedule checkups and wait for the condition to resolve. Infections are typically treated with antibiotics or antiviral drugs, and tumors may require radiation or chemotherapy treatments. When a testicular hydrocele persists or worsens, surgery may be necessary.
A surgeon may take one of several different approaches to relieve a testicular hydrocele, depending on the cause and the severity of symptoms. In some cases, fluid can be removed through needle aspiration. Draining the fluid provides immediate relief, but it is possible for a hydrocele to return in time. A surgeon usually chooses to remove part or all of the tunica vaginalis membrane instead to ensure that the condition permanently resolves. Following surgery, a patient can expect a full recovery within a few months.