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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

David Perlstein, MD, MBA, FAAP

David Perlstein, MD, MBA, FAAP

Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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In this Article

• What is a hydrocele?
• What causes hydroceles?
• What are the physical features and types of hydroceles?
• Communicating hydroceles
• Non-communicating hydroceles
• How are hydroceles diagnosed?
• What is the treatment for hydroceles?
• What are other non-tender scrotal swelling conditions?
• Hydrocele At A Glance
• Patient Comments: Hydrocele - Types and Features
• Patient Comments: Hydrocele - Treatment
• Patient Comments: Hydrocele - Other Swelling Conditions
• Find a local Urologist in your town
• Hydrocele (Pediatric, Testicular) Index

A hydrocele is characterized as a non-painful, soft swelling of the scrotum (one or both sides). The overlying skin is not tender or inflamed. There are two types of hydroceles:

1. communicating, and
   
   
2. non-communicating.

Communicating hydroceles are present at birth and occur as a consequence of the failure of the "tail" end of the process vaginalis to completely close off. Peritoneal fluid (free fluid in the abdominal cavity) is thus free to pass into the scrotum in which the process vaginalis surrounds the testicle.

A characteristic feature of communicating hydroceles is their tendency to be relatively small in the morning (having been horizontal during sleep) and increase in size during the day (peritoneal fluid drainage assisted by gravity). Actions which increase intra-abdominal pressure (for example, crying, severe coughing, etc.) will also tend to increase the size of the hydrocele.

Non-communicating hydroceles may also be present at birth or develop as a boy matures. In a non-communicating hydrocele the tail end of the process vaginalis has closed appropriately. The fluid surrounding the testicle is created by the lining cells of the process vaginalis and is unable to either drain or be reabsorbed efficiently and thus accumulates. Since this fluid is walled off, the size of the hydrocele is generally stable and does not reflect intra abdominal pressure.

The diagnosis of a hydrocele is generally made clinically. An apt description of a hydrocele surrounding a palpable (something that can be felt) testis would be that of a small water balloon containing a peanut. The differences between communicating and non-communicating hydroceles described above help to support the suspected diagnosis.

A bedside test, transillumination, provides confirmation of the condition. Transillumination involves placing a small light source (commonly an otoscope - the medical device used to examine the ear) against the swollen scrotum. The fluid filled nature of the hydrocele side is distinctly different from the non-involved side of the scrotum. In rare cases either ultrasound or X-ray study of the region may be indicated. In unusual cases where a hydrocele may be a secondary phenomenon to pathologic cause (caused by disease), surgical exploration may be necessary to establish the diagnosis.