Genitourinary and Kidney Disorders

Hydrocele

What is a hydrocele?

A hydrocele occurs from an accumulation of fluid in the tunica vaginalis (a thin pouch that holds the testes within the scrotum). In the fetus, the tunica vaginalis is formed in the abdomen and then migrates into the scrotum with the testes. After the pouch is in the testes, it seals off from the abdomen. Hydroceles can be communicating or non-communicating.

• communicating hydrocele
  A communicating hydrocele occurs from the incomplete closure of the tunica vaginalis, so that a small amount of abdominal fluid may flow in and out of the thin pouch. It is distinctive because the fluid fluctuates throughout the day and night, altering the size of the mass.
  
  
• non-communicating hydrocele
  A non-communicating hydrocele may be present at birth and usually resolves on its own spontaneously within one year. A non-communicating hydrocele in an older child may indicate other problems, such as infection, torsion (twisting of the testes), or a tumor. Always consult your child's physician for a diagnosis.

A hydrocele is present in as many as half of all full-term male live births; however, in most cases, it disappears without treatment within the first year.

What are the symptoms of a hydrocele?

The following are the most common symptoms of hydrocele. However, each child may experience symptoms differently. Symptoms may include the following:

• A mass that is usually smooth and not tender.
  
  
• A communicating hydrocele will fluctuate in size, getting smaller at night while lying flat, and increasing in size during more active periods.
  
  
• If the hydrocele is large and tense, it may require more immediate attention.

The symptoms of a hydrocele may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is a hydrocele diagnosed?

Diagnosis of a hydrocele is usually made by a physical examination and a complete medical history. Your child's physician may need to determine if the mass is a hydrocele or an inguinal hernia (a weakened area in the lower abdominal wall or inguinal canal where intestines may protrude).

Transillumination (the passage of a strong light through a body structure to permit inspection on the opposite side) of the scrotum can differentiate a hernia from a hydrocele.

Treatment for a hydrocele:

A non-communicating hydrocele usually resolves spontaneously by the time the child reaches his first birthday. Resolution occurs as the fluid is reabsorbed from around the testes.

A hydrocele that persists longer than 12 to 18 months usually has a persistent communication allowing fluid to accumulate around the testes. A communicating hydrocele usually requires surgical repair to prevent continuing accumulation of fluid around the testes and a possible inguinal hernia from occurring. The surgery involves making a small incision in the groin or inguinal area and then draining the fluid and closing off the opening to the tunica vaginalis with internal stitches, if the surgery is done as an outpatient procedure.