Pediatric Hydrocele

A hydrocele is a space filled with fluid occurring below or next to a testicle in the male scrotum. It is usually painless. A hydrocele is different from a hernia, but the two can often occur together. Hydroceles occur as the testicle descends from inside the abdomen and the opening into the scrotum through which it passes does not seal normally. This opening allows abdominal fluid to leak into and collect in the scrotum. 

There are two main types of hydroceles: communicating and non-communicating. With a communicating hydrocele, the opening from the abdomen remains open after birth. This type of hydrocele is more commonly associated with a hernia. With a non-communicating hydrocele, the channel closes by the time a baby is born. This leads to fluid within the scrotum but is not associated with a hernia. In most cases, the body will re-absorb the fluid over time. 

How Common Are Hydroceles?

Hydroceles are very common in infants, affecting 1–2 percent of infant boys. Premature infants have a higher incidence than full-term babies. Hydroceles can also occur later in life secondary to trauma or infection. 

What Causes a Hydrocele?

Some hydroceles may run in families, but true hereditary factors have not been identified.

What Are the Symptoms of a Hydrocele?

Communicating Hydrocele: Most children with this condition will have fluid around the testicle within the scrotum. Parents may see that there is no fluid present in the morning when the child wakes up, but throughout the day, the fluid accumulates. The amount of fluid present may also increase with straining, crying or coughing. In some cases, children can also have signs of a hernia associated with this. Parents should look out for the presence of a bulge in the groin. This could represent the intestine moving from the abdomen and into the groin or scrotum. If the intestine were to become stuck, children could present with signs of pain, redness to the area, poor feeding or vomiting. This would be in an indication to bring the child to the emergency department. 

Non-Communicating Hydrocele: children will present with a swollen appearance to the scrotum. The testicle may be more difficult to feel because there is fluid around the testicle. This is generally painless unless it were to become very large. The size of a non-communicating hydrocele generally does not change throughout the day. This could occur on one or both sides.

How Is a Hydrocele Diagnosed?

A hydrocele and the specific type of hydrocele is diagnosed based on the clinician’s physical exam and the history obtained from family. In the case of a communicating hydrocele, the fluid may be present in the scrotum and able to be drained back into the abdomen with squeezing the scrotum. In some cases, the fluid may not be present at the time of evaluation, making the history from family more important. Continued observation by family members and photography of the area can often be helpful in making a diagnosis.  Physical exam can often allow for detection of an inguinal hernia, and the clinician will determine if the hernia is able to be reduced (intestine pushed back into the abdomen) easily or with difficulty. 

For non-communicating hydroceles, the clinician will detect fluid within the scrotum on exam. The fluid will not be able to be squeezed out of the scrotum. In some cases, the clinician may be unable to feel the testicle due to the amount of fluid present. It is possible that your clinician will obtain ultrasound imaging to assist in the diagnosis and make sure there is a normal, healthy testicle present. Ultrasound is generally not used in the diagnosis of hydroceles otherwise. 

How Is a Hernia/Hydrocele Treated?

Communicating Hydroceles: In some cases, communicating hydroceles can resolve on their own over the first two years of life. Because of this, your clinician will generally not immediately surgically correct the problem. If the hydrocele does not resolve, surgical correction may be required to close the communication between the abdomen and scrotum and prevent further fluid passage. Surgery is generally performed to eliminate the risk of the intestines moving into the channel and becoming stuck.

Non-Communicating Hydroceles: This type of hydrocele almost always resolves on its own over the first year of life. Surgery would only be performed if the hydrocele does not resolve over time or if it leads to discomfort. In the case of a hydrocele that occurs in an older child secondary to trauma or infection, surgery may also be performed if the hydrocele is large, not resolving, or causing discomfort.