마지막 업데이트: 2026년 4월 29일

A painless scrotal swelling is one of the most common presentations in my andrology clinic. The condition we must always be aware of is a Hydrocele — an abnormal accumulation of fluid within the scrotal sac surrounding the testicle.

To understand why hydrocele occurs, a brief review of scrotal anatomy is helpful. Between the scrotal skin and the testicle lies a space covered by a layer called the Tunica vaginalis, which contains a small amount of fluid that allows the testicle to move freely. This space has a balanced system of fluid production and absorption. When this equilibrium is disrupted — either through overproduction or reduced absorption — fluid accumulates, creating a hydrocele.

Hydrocele scrotal swelling
Scrotal hydrocele — a balloon-like fluid accumulation within the scrotal sac surrounding the testicle.

2 major causes of 하이드로셀 in adult men

  1. Overproduction of fluid:
    • Inflammatory processes — infection of the testis (orchitis) or epididymis (epididymitis), or syphilis
    • Trauma — scrotal injury, or as a complication after inguinal hernia repair
    • Malignancy — tumor in or around the genital area
  2. Abnormal fluid absorption — failure of the Tunica vaginalis to reabsorb fluid at the normal rate
Urologist history taking hydrocele
A thorough history and physical examination is performed at the urology office to rule out serious diagnoses.

When a patient presents with a scrotal swelling, a full history is taken and a careful physical examination performed to exclude other important diagnoses that may appear similar:

Scrotal ultrasonography is the gold standard imaging tool for confirming hydrocele. It measures the fluid size and characteristics, and — critically — it can confirm whether any suspicious testicular tumor is hidden within the sac.

Scrotal ultrasound hydrocele
Scrotal ultrasonography is the most important imaging tool for confirming hydrocele and excluding testicular tumor.

Once hydrocele is confirmed, treatment targets the underlying cause. If the hydrocele does not resolve after treating the cause, surgical intervention is offered. Two surgical techniques are available:

  1. Open scrotal surgery — performed in the operating room under anesthesia; lowest postoperative complication and recurrence rate; the preferred definitive treatment
  2. Needle aspiration — an in-office option for patients who decline surgery; however, carries higher risk of intra-scrotal bleeding and a higher recurrence rate compared to surgery
Hydrocele surgery
Open scrotal surgery is considered when hydrocele does not resolve with conservative management.

The key message is that hydrocele is a benign condition — it is never life-threatening, but it can significantly affect quality of life. Surgery is the most effective treatment, though some recurrence remains possible with any approach.

Frequently Asked Questions About Hydrocele

What is a hydrocele and is it dangerous?

A hydrocele is an abnormal accumulation of fluid in the space between the testicle and the inner scrotal wall (Tunica vaginalis), causing painless scrotal swelling. It is a benign condition — it is never life-threatening and does not become cancerous. However, a large hydrocele can cause discomfort, heaviness, and reduced quality of life. The most important first step is scrotal ultrasound to confirm the diagnosis and exclude hidden testicular tumor, which can occasionally present similarly.

What causes hydrocele in adult men?

In adult men, hydrocele is caused by either overproduction of scrotal fluid or impaired fluid absorption. Overproduction occurs secondary to inflammation (testicular or epididymal infection, syphilis), scrotal trauma, hernia repair complications, or nearby malignancy. Impaired absorption occurs when the Tunica vaginalis lining loses its ability to reabsorb fluid at the normal rate. Many adult hydroceles develop gradually without a clearly identifiable trigger and are classified as idiopathic. A thorough evaluation is essential to exclude treatable secondary causes.

When is surgery needed for hydrocele and what are the options?

Surgery is indicated when the hydrocele does not resolve after addressing the underlying cause, or when it causes significant discomfort. Open scrotal surgery (hydrocelectomy) performed under anesthesia in the operating room offers the lowest complication and recurrence rates and is the gold standard approach. Needle aspiration is an in-office alternative for patients who prefer to avoid surgery, but carries higher rates of intra-scrotal bleeding and recurrence. After surgery, regular follow-up is recommended to monitor for recurrence.

If you have a scrotal swelling and would like specialist evaluation, Dr. Soarawee Weerasopone offers specialist consultations at Bangkok Hospital Headquarters. 상담 예약.

면책 조항: 본 내용은 방콕 병원 본사의 전문의인 Soarawee Weerasopone 박사가 작성하고 검토한 것입니다. 교육 목적으로만 제공되며 의학적 조언을 구성하지 않습니다. 모든 의학적 치료를 시작하기 전에 항상 자격을 갖춘 의료 전문가와 상담하십시오.

의학적으로 작성 및 검토됨: 소아라위 위라소폰 박사(폼 박사) — 방콕 병원 본원 비뇨의학과 전문의. 국제 펠로우: 베일러 의과대학(미국) · 준텐도 대학(일본) · 창궁 기념 병원(대만).

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