Pediatric Hydrocele

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 two 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.  It often goes away on its own with no treatment within one year. Sometimes noncommunicating hydrocele remains large which makes it difficult to feel the testis. When this occurs, surgery is offered to remove the hydrocele. When scrotal swelling occurs in an older child, it may be a noncommunicating hydrocele associated with trauma, infection tumor or twisting of the testes (torsion).

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). Communicating hydroceles/hernias are usually approached by an incision in the groin, while noncommunicating hydroceles can be approached by incisions in the scrotum.

Talk with your child’s healthcare provider about the risks, benefits and possible side effects of all treatments.

After the hydrocele goes away or is treated, long-term problems are rare.

Call the healthcare provider if your child has:

• A large hydrocele that is firm
• Painful scrotum
• Other symptoms that don’t get better, or get worse
• New symptoms