What are the treatment options for a large hydrocele?

Dear Nilesh Kumar Ji

A hydrocele is a collection of fluid around the testicle that causes swelling in the scrotum. Since your left-sided hydrocele has gradually increased in size and is now causing heaviness and discomfort, you should consult a urologist for an examination rather than continuing to monitor it at home. An ultrasound is commonly used to confirm the hydrocele and rule out other causes of scrotal swelling, such as a hernia, infection or a testicular mass.

What Can Cause a Hydrocele?

In adults, a hydrocele may develop because of

• Previous injury to the scrotum

• Infection or inflammation around the testicle

• Previous surgery or other scrotal conditions

• An associated inguinal hernia

• Sometimes, no specific cause can be identified

The fluid gradually accumulates around the testicle, causing the scrotum to become enlarged and heavy. 

What Symptoms Can Occur?

A large hydrocele can cause

• Gradually increasing scrotal swelling

• Heaviness or a dragging sensation

• Discomfort while walking or sitting

• Tightness or difficulty wearing certain clothes

• Discomfort during physical activity

• Sometimes pain when the swelling becomes very large

Because other conditions can also cause scrotal swelling, it is important to confirm the diagnosis rather than assuming every swelling is a hydrocele.

Which Tests Are Usually Required?

A urologist will first examine the scrotum. Depending on the findings, the doctor recommend

1. Scrotal ultrasound: This can confirm fluid around the testicle and help rule out a hernia, tumour or other causes.

2. Urine or blood tests: These may be advised if infection or inflammation is suspected.

3. Additional investigations: These are considered depending on the examination and ultrasound findings. 

Take any previous ultrasound reports, prescriptions and medical records to your consultation.

Can a Large Hydrocele Be Treated Without Surgery?

Small hydroceles that are not causing symptoms may sometimes simply be monitored. However, when an adult hydrocele is large, progressively increasing or causing discomfort, a urologist may recommend surgical treatment.

Medicines generally do not remove the accumulated fluid permanently.

Hydrocele Surgery: What Happens?

The standard definitive treatment is hydrocelectomy.

During the procedure

• Anaesthesia is given so you do not feel the operation.

• The surgeon makes an incision to access the hydrocele.

• The accumulated fluid is drained.

• The hydrocele sac is treated or removed/closed in a way that reduces the chance of fluid collecting again.

• The area is closed and dressed.

Depending on the individual case and hospital protocol, it may be performed as a day-care procedure or may require a short hospital stay. A temporary drain may sometimes be used. 

What About Needle Drainage?

Simply draining the fluid with a needle can provide temporary relief, but the hydrocele can fill again. Therefore, it is generally not considered a definitive treatment for a persistent symptomatic hydrocele. Do not attempt to drain it yourself.

Precautions Until You See the Urologist

While waiting for your consultation

• Avoid activities that significantly increase scrotal discomfort.

• Avoid heavy lifting if it makes the swelling or pain worse.

• Wear comfortable, supportive underwear if it reduces discomfort.

• Keep the area clean and dry.

• Do not massage, squeeze or puncture the swelling.

• Do not take antibiotics or other medicines without medical advice.

• Arrange the ultrasound and urology consultation rather than delaying evaluation.

When Should You Seek Urgent Care?

Seek urgent medical attention if you develop sudden severe testicular/scrotal pain, rapidly increasing swelling, fever, redness, vomiting, or severe tenderness. Sudden severe pain can indicate conditions such as testicular torsion, which requires prompt treatment. 

How HexaHealth Can Assist You

We can assist you with

• Finding a suitable partner hospital for hydrocele treatment.

• Connecting you with an experienced urologist.

• Coordinating the urology consultation and scrotal ultrasound.

• Helping you understand the recommended treatment and surgery.

• Assisting with hospital admission and surgery coordination.

• Guiding you regarding insurance or applicable government health schemes, if you have coverage.

Please share your city and state, and we can help connect you with an experienced urologist at a suitable partner hospital for examination, ultrasound and further treatment.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth