Could my intermittent, excruciating testicular pain be caused by a hydrocele?

Possibly: Hydroceles are generally asymptomatic. However, when they become very large or are under tension from the increased fluid volume, it may cause discomfort and pressure but is typically not excrutiating. If there is excrutiating pain, further testing is warranted to determine the etiolgy of the pain.

Not usually: What can , however cause that pain ( depending on you age) is intermittent testicular torsion. This is where the testicle spins and cuts off it's own blood supply. That is a surgical emergency.

See MD immediately: Hydroceles are generally asymptomatic. If you have unilateral intermittent, excruciating testicular pain, you very likely have intermittent testicular torsion which can become a surgical emergency and result in testicular necrosis. Get to your you urologist asap.

Need to ...: If the described pain is highly variable in its onset, degree, duration, and interval, one has to think the possibility of testicular torsion even though at age 44. If suspecting such, hydrocelectomy will confirm the diagnosis and correct hydroele; so, it is a deal of a stone hitting two birds.