One in every 10 baby boys has hydrocele at birth. In many cases, it gets better on its own by two years of age. Hydrocele is one of the most common conditions in newborns. As a baby grows inside the mother’s uterus, the testicles descend from the abdomen through a tube into the scrotum. Hydrocele occurs when this tube does not close. Fluid drains from the abdomen through the open tube and gets trapped in the scrotum. This causes the scrotum to swell. The other causes may include
- The baby’s abdominal wall wasn’t fully developed at birth.
- Buildup of the normal fluid around the testicle. This may occur because the body makes too much of the fluid or it does not drain properly.
- Swelling or injury of the testicle or epididymis.
There are two types of hydroceles:
- Present at birth, generally found in infants and young children.
- It occurs during fetal development.
- Testicles develop in the abdomen. They eventually move into the scrotum through a small channel. This channel should close after the testicles pass through it. When the channel does not close, fluid can pass from the abdomen into the membrane covering the testicle
- Acquired, occurs at any age.
- A noncommunicating hydrocele is more common in adults.
- It may be caused by an injury or infection that causes fluid buildup.
- It can also be a complication of surgery. In some cases, the cause is unknown.
Factors that may increase the chances of a hydrocele are
- Premature birth
- Injuries to the testicles or scrotum
- Infections, including sexually transmitted infections
What is a hydrocele?
A hydrocele is a collection of fluid around one or both testicles. It can cause the scrotum or groin to swell. This is more likely to occur in premature babies, but about five percent of all male infants will be born with a hydrocele. It is not considered dangerous and is usually not painful. The other signs and symptoms may include
- The main symptom is a painless, round, oval-shaped swollen scrotum, which feels like a water balloon. A hydrocele may occur on one or both sides. However, the right side is more commonly involved.
- Feeling of heaviness or soreness in the scrotum.
- Swelling with activity or standing, especially with a communicating hydrocele.
- A scrotum that gets smaller at night while lying flat and bigger while doing activities.
- The doctor may ask about the child’s symptoms and health history. They will give the child a physical exam.
- The doctor may need to check if the mass is a hydrocele or an inguinal hernia. An inguinal hernia is a weak area in the lower abdominal wall (inguinal canal) where the intestines may bulge.
- To check for this problem, the child may have an ultrasound study. This is a painless imaging test. It uses sound waves to look at tissues in the body.
- The doctor 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.
If observing any of the following signs, call the baby’s doctor right away.
- The hydrocele gets bigger or red.
- The baby cries more than normal and can’t be soothed.
- The baby cries or fusses when the hydrocele is touched.
What are the treatment options for hydrocele?
Treatment may depend on the 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 their 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 requires surgery to prevent an inguinal hernia.
- The surgery is done by making a small incision in the groin.
- The doctor drains the fluid and closes the opening to the pouch.
- Usually, a hernia is present. It is treated at the same time as well.
- Surgery is performed under anesthesia and the patient is discharged within a couple of hours.
- A large-sized dressing is applied afterward along with support for the scrotum. The patient may need fluid drainage tubes for about a week. There are no major risks associated with the surgery.
- It's rare for the hydrocele to come back.
Typically, a hydrocele goes away without intervention. In infants, they may persist for up to a year, but they go away eventually. An operation is usually advised if the hydrocele persists after 12 to 24 months of age.
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Michigan Medicine: "Congenital Hydrocele." https://www.uofmhealth.org/health-library/ug1044
UpToDate: "Causes of Painless Scrotal Swelling in Children and Adolescents." https://www.uptodate.com/contents/causes-of-painless-scrotal-swelling-in-children-and-adolescents