A hydrocele is a common condition defined by a collection of fluid in the sac surrounding the testicle, causing swelling in the scrotum. In infants, hydroceles are often communicating, caused by an incomplete closure of the channel connecting the abdomen to the scrotum. Adult hydroceles are usually non-communicating, meaning the fluid is trapped, and may arise from injury, infection, or inflammation. While surgery is the definitive treatment, non-surgical approaches depend heavily on the type of hydrocele and the patient’s age. A medical evaluation is necessary for any scrotal swelling to correctly diagnose the condition and rule out serious issues, such as a hernia or a testicular tumor.
When Hydroceles Resolve Naturally
The most frequent non-surgical approach is watchful waiting, particularly for infants. Approximately 89% of hydroceles in newborns resolve spontaneously or show significant improvement within the first year of life. This occurs because the body reabsorbs the fluid as the channel between the abdomen and scrotum closes. If a non-communicating hydrocele persists beyond 12 to 24 months in a child, intervention may be required.
In adults, small, non-symptomatic hydroceles can also be monitored, especially if a clear cause, like a recent infection or injury, is identified and treated. Adult non-communicating hydroceles may resolve on their own, but they do not disappear as reliably as they do in infants. Any hydrocele should be properly evaluated to ensure the swelling is not due to an underlying condition that requires immediate treatment.
Professional Minimally Invasive Treatments
For adult hydroceles that are symptomatic or do not resolve naturally, a professional, minimally invasive option is aspiration followed by sclerotherapy. Aspiration involves using a fine needle to drain the fluid from the hydrocele sac. Aspiration alone is not considered a permanent solution because the fluid reaccumulates in nearly all cases.
Sclerotherapy is performed immediately after the fluid is drained. This procedure involves injecting a sterile solution, known as a sclerosing agent, into the empty sac to cause a controlled inflammatory reaction. The goal is to scar the inner lining of the sac, which prevents the reaccumulation of fluid. Common sclerosing agents include sodium tetradecyl sulphate (STD) or polidocanol.
Success rates for a single treatment can be as high as 84% for simple hydroceles, comparable to reported surgical success rates. For patients whose hydrocele recurs, a second round of aspiration and sclerotherapy can increase the resolution rate to over 73%. This method is often preferred for older patients or those with health issues who may not be suitable candidates for traditional surgery involving general anesthesia.
Evaluating Home Management Methods
Many people search for ways to remove a hydrocele at home, but no established clinical evidence suggests that dietary changes, supplements, or herbal remedies can eliminate the condition. Methods like applying ice packs or wearing a scrotal support only alleviate discomfort and swelling. Cold compresses can help reduce local inflammation and provide temporary relief.
Supportive undergarments or scrotal wraps can help manage the sensation of heaviness caused by the fluid-filled sac. An Epsom salt bath is sometimes suggested to reduce swelling, but this acts as a palliative measure and does not address the underlying cause. Relying solely on unproven home remedies can delay a proper medical diagnosis, which is hazardous if the swelling is caused by a testicular tumor or an inguinal hernia.
When Surgical Intervention Becomes Necessary
Surgical removal, known as a hydrocelectomy, remains the standard treatment for a persistent hydrocele. A surgical consultation becomes necessary if the hydrocele causes significant pain, discomfort, or interferes with daily activities like walking. A rapid increase in the size of the swelling or failure to resolve naturally after observation are also indicators for surgery.
Surgery is required if the hydrocele is suspected to be a symptom of a more serious underlying issue, such as a testicular mass, or if it is associated with an inguinal hernia. For infants, communicating hydroceles that persist past one to two years of age typically require surgery to prevent future complications. If minimally invasive treatments like sclerotherapy fail due to recurrence, a hydrocelectomy provides a long-term solution by surgically removing the fluid sac.