Does your water break hurt?

Hydrocele and spermatocele

Hydrocele (Water break): Watery accumulation of fluid in the scrotum, more precisely within the inner testicle cover. A hydrocele can be congenital or acquired later in life. It often occurs in infants - often together with an inguinal hernia - and usually resolves during the first year of life. In adults, hydroceles develop spontaneously, as a result of inflammation and rarely also accompanying a tumor.

Spermatocele (Broken semen): Cyst (cavity) in the area of ​​the epididymis filled with fluid that is rich in protein and containing sperm. It is usually located at the upper end of the testicle and can be felt from the outside as a small nodule or a large, soft swelling. The spermatocele is usually the result of trauma or epididymitis, but it can also be congenital.

If they cause discomfort, hydroceles and spermatoceles are treated surgically.

Leading complaints

  • Tightly elastic, mostly painless enlargement of the scrotum in the hydrocele
  • Enlargement of the scrotum, sometimes with a palpably small structure at the upper testicular pole in spermatocele
  • Rarely discomfort after long periods of standing.

When to the doctor

In the next few days to

  • other more serious causes of testicular enlargement such as: B. exclude a testicular tumor.

The illness


Normally there is a balance of fluid production and drainage in the scrotum. If this balance is disturbed, water accumulates and a hydrocele forms. Acquired causes for this are for example

  • Inflammation and injury
  • Testicular torsion
  • Tumors of the testes or epididymis
  • Postoperative disorders of the lymphatic or blood flow.
  • The congenital is a special form juvenile hydrocele, in which the connection between the scrotum and the abdomen is not closed during prenatal development. Risk factors for juvenile hydrocele are undescended testes and cleft bladder, but also prematurity and congenital connective tissue defects. The juvenile hydrocele often resolves on its own.


  • Spermatoceles are benign cysts that are either congenital or caused by inflammation or injury. They are often very small, but sometimes they can be as large as a hydrocele. Because of a connection to the seminal ducts, they mostly contain sperm. In old age, up to 30% of all men have a spermatocele, but in the vast majority of cases it is clinically completely normal. The spermatocele is only treated if it causes pain or if the person concerned finds its size disturbing.

Diagnostic assurance

The doctor can recognize both the hydrocele and the spermatocele well in the ultrasound and can thus rule out other causes of the enlargement of the scrotum such as tumors.

Differential diagnoses: Other also mostly painless enlargements of the scrotum are the testicular hernia, the varicocele and the testicular cancer.


Acquired hydrocele. Treatment is only necessary for a hydrocele if it causes symptoms. During the operation, the doctor empties the testicular sheaths and then sutures them up so that no more fluid can collect in them. The previously common puncture (sucking off the liquid with a cannula) is only performed in exceptional cases (e.g. in very old patients) because of the risk of infection and the mostly only temporary improvement. Another alternative to surgery is sclerotherapy with 2.5% phenol. Here, however, the risk that a hydrocele will form again is greater than with surgical therapy. In addition, the scarring after sclerotherapy is problematic if another intervention is necessary, which is why this treatment is also rarely offered.

Juvenile hydrocele. The congenital hydrocele often regresses by the age of two. If this is not the case or if the hydrocele is very large, an operation is carried out. The open connection between the scrotum and the abdominal cavity is sought through an incision in the groin region and then closed.

Spermatocele. Spermatoceles are only operated on if they cause discomfort. The doctor stops the cysts and then carefully removes them from the epididymis. If the epididymis is completely interspersed with cysts, it must be completely removed.


An untreated hydrocele increases the risk of testicular torsion. In addition, the increased pressure in the testicles can cause the patient to be unable to reproduce.

The operation of a spermatocele usually leads to the fact that no fertile sperm can be found in the affected testicle.


Dr. med. Martina Sticker, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 17:18

Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.