Most hydroceles are treated with a straightforward surgical procedure called a hydrocelectomy, which has a high success rate and a recovery period of roughly one to two weeks. However, not every hydrocele needs treatment right away. Small, painless hydroceles in adults are often monitored over time, and in infants, most resolve on their own within the first year of life. The right approach depends on your symptoms, the type of hydrocele, and whether an underlying condition is causing it.
When a Hydrocele Needs Treatment
A hydrocele is a buildup of fluid around the testicle that causes swelling in the scrotum. Many hydroceles cause no pain and pose no health risk. If yours is small and not bothering you, your doctor will likely recommend a wait-and-watch approach with periodic checkups to track any changes in size.
Treatment becomes necessary when the hydrocele grows large enough to cause discomfort, heaviness, or embarrassment, or when it becomes complicated by infection or bleeding. A hydrocele that keeps getting bigger over time is also a reason to consider intervention, since the fluid won’t drain on its own in most adult cases.
Treatment in Infants and Children
Babies are commonly born with hydroceles, and the standard approach is patience. In many cases, the fluid reabsorbs and the hydrocele disappears by the child’s first birthday as the tissue channel connecting the abdomen to the scrotum closes naturally. If the hydrocele persists past age one, surgical repair is typically recommended. For a specific type called a communicating hydrocele, where fluid moves back and forth between the abdomen and scrotum, the channel hasn’t closed properly and surgery is needed to seal it. If a congenital hydrocele of any type persists beyond age two, referral to a surgeon is standard practice.
Hydrocelectomy: The Standard Surgery
Surgery is the primary treatment for hydroceles in adults and older children. The procedure is usually done as outpatient surgery, meaning you go home the same day. A surgeon makes a small incision in the scrotum or lower abdomen, drains the fluid, and then modifies or removes the sac that was holding it to prevent the fluid from accumulating again.
There are a few different surgical techniques, and they all have similar success rates. In a large comparative study, the overall recurrence rate after open hydrocele surgery was about 6%, regardless of which technique was used. Where the techniques differ is in complication rates. One approach called Lord’s repair, which involves plicating (gathering) the sac tissue rather than cutting it away, had a significantly lower rate of overall complications and postoperative blood collection (hematoma) compared to other methods. Your surgeon will choose a technique based on the size and type of your hydrocele.
Aspiration and Sclerotherapy
For people who can’t undergo surgery or prefer to avoid it, a less invasive option involves draining the fluid with a needle (aspiration) and then injecting a chemical that irritates the sac lining so it sticks together and stops refilling. This is called sclerotherapy. One well-studied agent, polidocanol, achieved an overall success rate of 89% in a prospective, placebo-controlled trial. However, the recurrence rate after a single treatment was 44%, meaning nearly half of patients needed a second round. Even after retreatment, about one in four patients saw the hydrocele return.
Aspiration alone, without sclerotherapy, almost always leads to the fluid coming back. It’s sometimes used as a temporary measure to relieve discomfort while a more permanent solution is planned. Because of the higher recurrence rates, aspiration with sclerotherapy is generally reserved for older adults or people with significant surgical risks.
Treating the Underlying Cause
Some hydroceles develop as a reaction to another problem, such as an infection of the epididymis (the tube behind the testicle), testicular injury, or inflammation. These are called reactive or secondary hydroceles. In these cases, treating the underlying condition is the priority. An infection, for instance, is treated with antibiotics, and the hydrocele often shrinks as the inflammation resolves. If it doesn’t, surgery can be considered once the original condition has been managed.
What Recovery Looks Like
After a hydrocelectomy, plan to take five to seven days off work. If your job involves physical labor, you may need up to two weeks before you’re ready to return. Heavy lifting should be avoided for two to four weeks after surgery, since straining can worsen swelling and slow healing.
Wearing supportive underwear or a jockstrap for up to a week after the procedure, including while sleeping, helps reduce swelling and keeps the surgical area stable. Some swelling and bruising around the scrotum is normal and can take several weeks to fully resolve. Ice packs and over-the-counter pain relief are typically enough to manage discomfort in the first few days.
Possible Complications
Hydrocelectomy is considered safe, but like any surgery, it carries risks. A large retrospective study of 866 hydrocele operations found that hematoma (a collection of blood at the surgical site) occurred in about 17% of cases, and infection developed in roughly 12.5%. Most of these complications were mild and resolved with conservative treatment or a short course of antibiotics. Severe complications requiring reoperation were rare.
The risk of the hydrocele coming back after surgery sits around 6%. Choosing an experienced surgeon and following post-operative instructions closely, particularly the restrictions on lifting and physical activity, helps minimize the chance of complications. Some temporary discomfort and swelling at the surgical site is expected and doesn’t indicate a problem on its own.