A hydrocele in children is a medical condition wherein there is a fluid collection in the scrotum, that surrounds the testicle. This can occur on one side or both sides. The fluid accumulation can make the scrotum look swollen. It can be identified with a physical examination as when it looks flat in the supine position and bulgy when doing other activities in standing posture.
How are Hydroceles Formed?
When baby boys are developing in the womb, there is a sac/pouch that is formed in the abdomen. This descends into the scrotum with the testes. It then seals itself from the abdomen once the pouch is in the testes. When it does not seal fully, it causes a hydrocele. The different types of hydrocele are:
- Communicating hydrocele: This is the case when the pouch does not close fully and abdominal fluid can flow into and outside the pouch.
- Non-communicating hydrocele: This is a by-birth condition that can heal itself within a year. In this case, the sac is closed but the body does not absorb the fluid by itself.
- Reactive hydrocele: It is also a non-communicating type that occurs due to inflammation in the scrotum as a result of injury, infection or testicular torsion.
- Hydrocele of the chord: It is a condition when the sac is closed but the fluid is trapped within the spermatic cord.
The most common symptom that is easy to observe is the swelling of the scrotum that is least painful.
Hydrocele can be identified with
- Physical examination of the scrotum
- Ultrasound imaging
- Transillumination of the scrotum to identify whether the lump is a hernia or a hydrocele
The treatment procedure of hydrocele is as follows:
- Non-communicating hydrocele generally resolves by itself within a year of birth. The surgeon suggests parents wait for a year and observe the hydrocele. In case if it does not heal, surgery becomes necessary.
- Communicating hydrocele needs corrective surgery to repair the hydrocele.
- A reactive hydrocele is a result of infection or inflammation. Hence, it requires antibiotics or anti-inflammatory medications over the course of time.
- Hydrocele of the chord will not resolve on its own. It requires corrective treatment as well.
The surgical procedure that is required to repair a non-communicating hydrocele and hydrocele of the chord is known as hydrocelectomy. This procedure involves incising the groin to drain the fluid and remove a portion of the sac. The incision is stitched using dissolvable sutures and a waterproof dressing is performed over the wound. This is a one-day procedure. For babies who are premature, they might require an overnight stay as the surgery will be performed with general anesthesia and the babies need monitoring for their breath (post-anesthetic apnea).
For communicating hydrocele along with the fluid drainage and sac removal, the hernia defect is also closed and the incision is stitched back with dissolvable sutures with an appropriate waterproof dressing.
One can call the doctor as a precaution step when:
- Upon pressing the belly of the child, if the scrotum changes in size
- Scrotum seems enlarged but looks smooth from outside
- When the hydrocele identified is firm
- Fever accompanied by swelling of the scrotum or pain
Even though hydrocele causes swelling, do not worry because this condition is painless. Moreover, hydrocele can be identified with a simple physical examination.