Hydrocele in children

A hydrocele is fluid buildup in the thin pouch that holds the testes in the scrotum. Up to 1 in 10 baby boys have a hydrocele at birth. In most cases, it goes away without treatment in the first year.

In a baby growing in the womb, the pouch is formed in the baby’s belly (abdomen). It then moves into the scrotum with the testes. After the pouch is in the testes, it seals off from the abdomen. But in some cases this doesn’t happen normally. It can then cause a hydrocele.

There are 2 types of hydrocele:

• Communicating hydrocele. This type is caused when the pouch that holds the testes does not fully close. A small amount of abdominal fluid can flow in and out of the thin pouch. The amount of fluid changes all day and night. This changes the size of the hydrocele.

• Noncommunicating hydrocele. This type may be present at birth. It often goes away on its own with no treatment within 1 year. But this type of hydrocele in an older child may be a sign of other problems. These include infection, twisting of the testes (torsion), or a tumor.

Symptoms can be a bit different in each child. They can include:

• A lump or swelling that is smooth and not painful

• A scrotum that gets smaller at night while lying flat, and bigger during activity

The symptoms of a hydrocele can seem like other health conditions. Have your child see his healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam.

The healthcare provider may need to check if the mass is a hydrocele or an inguinal hernia. An inguinal hernia is a weak area in the lower belly wall (inguinal canal) where intestines may bulge. To check for this problem, your child may have an ultrasound study. This is a painless imaging test. It uses sound waves to look at tissues in the body.

The healthcare provider may also shine a strong light through one side of the scrotum, and look at the scrotum from the other side. This is called transillumination. This will help show if the problem is a hydrocele or a hernia

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

A noncommunicating hydrocele often goes away on its own by the time a child reaches his first birthday. The fluid is reabsorbed into the body from the pouch.

A hydrocele that lasts longer than 12 to 18 months is often a communicating hydrocele. This often needs surgery to prevent an inguinal hernia. The surgery is done by making a small cut (incision) in the groin. The provider drains the fluid and closes off the opening to the pouch

References

1Guidelines on Paediatric Urology; European Association of Urology (2015)

2 Verma S, Agrawal V, Acharya H, et al; Laparoscopic suture-less herniotomy using tissue-sealing device for paediatric hydrocele. J Minim Access Surg. 2019

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