A hydrocele occurs from a buildup 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: 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 unique because the fluid fluctuates throughout the day and night, changing the size of the mass.
- Non-communicating hydrocele: may be present at birth and often resolves on its own spontaneously within one year. A non-communicating hydrocele in an older child may rarely indicate other problems, such as infection, torsion (twisting of the testes), or a tumor.
A hydrocele is present in as many as 10 percent of all full-term male live births; however, in most cases, it disappears without treatment within the first year.
Most hydroceles cause few if any symptoms.
What Are the Physical Findings of a Hydrocele?
The most common physical findings of a hydrocele may include:
- A mass that is usually smooth and not tender.
- A communicating hydrocele will vary in size, getting smaller at night while lying down, and increasing in size during more active times.
- If the hydrocele is large and tense and/or painful, it may require more immediate attention.
The symptoms of a hydrocele may resemble other conditions or medical problems.
How Is a Hydrocele Diagnosed?
Diagnosis of a hydrocele is usually made by a physical examination and a complete medical history. The pediatric urologist 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 distinguish a hernia from a hydrocele.
Treatment for a Hydrocele
A non-communicating hydrocele in a newborn often resolves on its own by the time the child reaches his first birthday. Resolution occurs as the fluid is reabsorbed from the pouch.
A hydrocele that persists longer than 12 to 18 months may be a communicating hydrocele. A very large or symptomatic hydrocele may require surgical repair. A communicating hydrocele usually requires surgical repair to prevent an 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.
Georgia Pediatric Urology’s expertise includes prenatal and newborn evaluation for diagnosis and treatment of a hydrocele.