Hydrocele: when scrotal swelling is (almost) silent

Asymptomatic or mildly symptomatic scrotal swelling is a common clinical manifestation of a hydrocele — a collection of serous fluid within the vaginalis space surrounding the testicle.
In most cases, a hydrocele presents as a painless, slowly developing increase in scrotal volume, often noticed casually by the patient or during a routine medical examination.
Although generally benign, it may cause a sensation of heaviness or local discomfort, especially when the fluid collection becomes large.
Recognizing the condition and performing a differential diagnosis is essential to exclude other causes of scrotal swelling, such as hernias, infections, or tumors.

After observing scrotal swelling that is asymptomatic or only mildly bothersome, hydrocele is often the most likely diagnosis, especially in the absence of acute pain or inflammatory signs.
But what does this condition actually entail?

🔍 Hydrocele can be:

• Congenital — more common in newborns due to the patency of the processus vaginalis

• Acquired — typically in adults, secondary to trauma, infections, or, in many cases, idiopathic (without a recognizable cause)

🧪 Diagnosis

Diagnosis is clinical and can be confirmed with a simple scrotal ultrasound, which helps exclude other testicular conditions and assess the extent of the fluid collection.

💡 Management

Although a hydrocele is not a dangerous condition, it can lead to physical or psychological discomfort.
Treatment is not always necessary, but in cases of large volume or significant symptoms, hydrocelectomy — a straightforward and definitive surgical procedure — may be recommended.

📌 Conclusion

If you notice a change in scrotal volume, even without pain, a specialist evaluation is always advisable.
Prevention starts with awareness and periodic check-ups, even in the absence of obvious symptoms.