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DocSpot: Hydrocele

Dear Dr Margaret
My husband has a swollen testicle. It doesn’t hurt, but it is really big, almost the size of a big orange, and I am afraid that it is growing bigger.

Regular visitors to this site will know my advice about this problem, which is that anyone who notices a lump or swelling of the testicle should see his doctor straight away, because there is always a possibility that it could be cancerous. The good news is that testicular cancer can be successfully treated if it is found early. That is why all men should examine their testicles regularly. If you are not sure how, look at our section on how to examine your testicles.
So you must urge your husband to get this problem checked by a doctor. The most common cause of a painless swelling in the scrotum is a ‘hydrocele’, which is an accumulation of fluid around the actual testicle. Normally, the testicle is surrounded by only a few millilitres of fluid, but sometimes the fluid accumulates and makes the scrotum swell up. It may feel soft, doughy or firm, depending on how much fluid is there. Hydrocele may be on one side only, or there may be one on each side. It is most common in men over the age of 40 years.
A hydrocele can reach quite a large size (500 ml of fluid) without causing any pain. In some cases a man with a hydrocele may feel that he has to pass urine frequently, or urinating may be uncomfortable.
The reason for a hydrocele is a mystery in most cases – they just occur for no obvious reason. Sometimes they follow infection or trauma. In tropical countries, infection with a filarial worm can result in hydrocele. In a few cases, a hydrocele occurs because there is cancer of the testicle, which is why your husband needs a check-up. The doctor may possibly arrange an ultrasound scan to check that the testicle is normal. Tell your husband not to be surprised if the doctor shines a torch into the swollen scrotum – because of the fluid, this often makes a hydrocele glow like a lantern.
Sometimes hydroceles go away on their own. If not, there are various possible treatments. The simplest is removal of the fluid through a needle, but the hydrocele is likely to recur over the following few months. To cure the problem once and for all, a surgical operation is necessary.

Sources of information

Rubenstein RA, Dogra VS, Seftel AD, Resnick MI. Benign intrascrotal lesions. Journal of Urology 2004;171:1765–72.
Micallef M, Torreggiani WC, Hurley M et al. The ultrasound investigation of scrotal swelling. International Journal of STD and AIDS (London) 2000;11:297–302.

Last updated; Sunday, August 30th 2020

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