The hydrocele is a fluid accumulation in the scrotum. Read all about the causes, signs and treatment of hydrocele here!


At a hydrocele (Hydrocele testis, Wasserbruch) is a fluid accumulation in the scrotum. It can be innate or acquired. The patients notice a painless swelling of the affected testicle. If the hydrocele does not regress by itself, an operation is necessary. Read all about hydrocele here.

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in doctor's letters or on incapacity certificates. N43

Product Overview


  • description

  • symptoms

  • Causes and risk factors

  • Examinations and diagnosis

  • treatment

  • Disease course and prognosis

Hydrocele: description

As Hydrozele doctors refer to an accumulation of water in the testes, spermatic cord or epididymis. She is either innate or acquired. It is most common in boys born prematurely. About six percent of all mature newborn boys have hydrocele (hydrocele, hydrocele testis).

Hydrozeles: Different diseases

As a rule, the fluid is located between two skins that surround the testicles (collectively called tunica vaginalis testis). Should fluid accumulate in the spermatic cord, it is called a hydrocele funiculi spermatici. An accumulation of fluid in the epididymis is called spermatocele.

When a fluid in the groin occurs in girls, it is called a Nuck cyst. This disease is rare.

Hydrocele: symptoms

A hydrocele is characterized by a one-sided or bilateral swelling of the scrotum. As a rule, it develops slowly and is not painful. She feels bulging-elastic. If the water break is very large, it can restrict the mobility of the patient, such as walking.

A congenital testcene usually fills up standing, because the fluid from the abdominal cavity follows the force of gravity. As she lies down, she empties herself again.

Should it bleed into a hydrocele, such as by force or by a disturbed blood coagulation, doctors speak of a hematocele.

Hydrocele: causes and risk factors

A hydrocele can be either innate or acquired. Depending on the form of the hydrocele, there are corresponding causes and risk factors.

Hydrocele: Congenital water break

If the hydrocele is innate, doctors also speak of a primary hydrocele. So this form of water break affects baby and toddler. It is rare for congenital hydrocele to be noticeable in older children.

Preterm infants in particular have an increased risk of a primary hydrocele. The reason lies in the development of the testicle: While the child grows up in the mother's abdomen, the testes form in the abdominal cavity, enveloped by the peritoneum lining the abdominal cavity. In the course of pregnancy, it descends through the inguinal canal into the scrotum, forming an outgrowth of the peritoneum ("processus vaginalis peritonei"). Normally she closes herself during pregnancy. If this does not happen, fluid from the abdominal cavity can enter the scrotum, creating a hydrocele.

Hydrocele: Acquired water break

An acquired hydrocele is also called a secondary hydrocele. It can have different causes like:

  • Inflammation of testicles or epididymis
  • Acts of violence (blows, kicks)
  • Testicular torsion (testicular torsion)
  • Inguinal hernia
  • Tumor (tumor)

Hydrocele: examinations and diagnosis

A hydrocele, when it is innate, is first treated by the pediatrician. The specialist for the treatment of hydrocele is the urologist or a surgeon. To diagnose a hydrocele, your doctor will first ask you in detail about the history of the disease (anamnesis). He will ask you the following questions:

  • Is your child born too soon?
  • When did you first notice the swelling of the testicle?
  • Does the swelling change when standing or lying down?
  • Was there any violence on the testicles?

Hydrocele: physical examination

This is followed by the physical examination. The doctor scans the swelling on the scrotum and pay attention to whether it is plump-elastic or if any hardening can be felt. He then illuminates the scrotum with a flashlight. If there is a hydrocele, the light shines through the fluid.

Furthermore, an ultrasound examination (sonography) of the testicle is usually made. In this case, the fluid accumulation can also be displayed. This is also possible with magnetic resonance imaging (MRI). However, it is more expensive than an ultrasound examination.

Hydrozele: differentiation against other diseases

From a possible water break the doctor must differentiate other diseases. Similar symptoms may occur, for example:

  • hernia
  • Varicocele (testicular vein)
  • tumor

If the examination does not allow a clear diagnosis, the testicle is exposed in an operation. This ensures that potentially serious diseases of the testicle are not overlooked.

Hydrocele: treatment

If an innate hydrocele testis is present, no treatment is initiated initially. Instead, the water break is observed until the end of the second year of life. In most cases, it returns on its own, because the connection between the abdominal cavity and the testicles closes over time.

If this is not the case or the hydrocele is very large, surgery is performed. In the water break surgery, a small incision is usually made in the groin and the location of the open connection is visited. This is closed by the surgeon afterwards.

If the patient suffers from a secondary (acquired) testicular hydrocele, it is often operated on immediately. This hydrocele surgery usually takes place via a skin incision in the scrotum (scrotum), through which the fluid is removed.

Hydrocele: Outdated treatment options

Previously, a hydrocele testis was punctured with a needle or syringe to release the fluid. Nowadays, this is not done because of an increased risk of infection. Even a so-called sclerotherapy ("hardening") with chemical substances is no longer performed. Because this causes increased peritonitis, and there is a higher risk that the hydrocele returns (recurrence).

Hydrocele: Disease course and prognosis

The prognosis of a hydrocele is good. The causal connection between the abdominal cavity and the testicles usually closes on the baby between the third and fourth month of life. Also beyond about until the beginning of the third year of life, a closure can take place. Therefore, the therapy of a congenital hydrocele usually begins only with the completed second year of life.

The surgical therapy has a high cure rate, but the water break can recur (recurrence). In addition, bruising or infection may occur during surgery.

Hydrocele: possible complications

If the water break is not operated, complications can occur. These include:
  • Indirect inguinal hernia: A bowel loop can pass through the inguinal canal and be trapped.
  • Inability to procreate: A large accumulation of fluid in the scrotum can squeeze the circulation of the testicle.
  • Testicular torsion: The risk that the testicle turns on itself and thus disturbs the own blood circulation, is at one hydrocele elevated.

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