What is a hydrocele?

A hydrocele is a collection of fluid in the scrotum, surrounding the testicle, which can occur on one or both sides. The fluid will make your son’s scrotum look swollen or enlarged, but hydroceles are usually painless. Hydroceles occur more commonly in infants, especially premature infants, but can occur at any age.

Causes

During fetal development, all babies have a canal that goes from their abdomen to their genitals. In boys, this canal allows the testicles (which develop in the abdomen) to travel to the scrotum. The lining of the canal creates a sac, or pouch, which travels with the testicles. The canal and the sac usually close completely but if this does not happen a hydrocele can form.

There are several different types of hydroceles:

Non-communicating hydrocele

A non-communicating hydrocele forms as a result of fluid being trapped in the scrotum after the canal and sac close. Since there is no connection with the abdomen, the fluid is not able to move back through the canal into the abdomen.

Reactive hydroceles

A reactive hydrocele is a type of non-communicating hydrocele that results from inflammation in the scrotum caused by trauma, infection or testicular torsion.

Communicating hydrocele

A communicating hydrocele forms when the canal fails to completely close during fetal development, leaving an opening for fluid to move into the scrotum. Due to the canal being open, the fluid is able to travel back and forth through the canal.

For this reason, you may notice that the size of your child’s scrotum may change. When the fluid is in your son’s scrotum, the scrotum will look enlarged; but when the fluid moves back through the canal, your son’s scrotum will look smaller. The opening also allows abdominal contents (such as intestine) to move into the scrotum, resulting in an inguinal hernia.

Hydrocele of the cord

A hydrocele of the cord occurs when the sac closes but fluid is trapped within the spermatic cord. The spermatic cord is connected to the testicle. It contains blood vessels, nerves and a tube that carries sperm called the vas deferens.

Testing and diagnosis

Hydroceles are diagnosed by a thorough health history and physical examination.

Treatment

The treatment approach for your child’s hydrocele will depend on the type of hydrocele.

• Non-communicating hydrocele: In many cases, non-communicating hydroceles will resolve over the first year of life. If your child is less than 1 year of age, the surgeon will often recommend observation of the hydrocele. If the hydrocele persists past the age of 1, surgical repair will be necessary.
• Reactive hydroceles: If your son’s hydrocele is caused by infection or inflammation, antibiotics or anti-inflammatory medications will be used for treatment.
• Communicating hydrocele: Communicating hydroceles will not resolve on their own and will require a surgical procedure to repair the hydrocele.
• Hydrocele of the cord: Hydroceles of the cord will not resolve on their own and will require a surgical procedure.

Surgical repair of a hydrocele

The surgery to repair a hydrocele is usually a day surgery, meaning your child will go home the same day as the procedure. Premature babies who are less than 60 weeks post-conception age may require an overnight stay for post-anesthetic apnea (breath holding) monitoring. The procedure will be done under general anesthesia.

Surgery for non-communicating hydroceles and hydrocele of the cord

The surgical procedure to repair a hydrocele is called a hydrocelectomy. A small incision is made in the groin (along a skin crease), the fluid is drained, and a portion of the sac is removed. Dissolvable sutures are used to close the skin incision and DERMABOND, a sterile, liquid adhesive, is placed over the incision to help hold the edges of your child’s wound together and act as a waterproof dressing.

Surgery for communicating hydroceles

The surgical procedure to repair a communicating hydrocele is similar to the procedure to repair an inguinal hernia. A small incision is made in the groin (along a skin crease), the fluid is drained, and a portion of the hydrocele sac is removed. The hernia defect is then closed with dissolvable sutures. The overlying skin is also closed with dissolvable sutures and sealed with DERMABOND to hold the edges of your child’s wound together and act as a waterproof dressing.

DERMABOND usually stays in place for 5 to 10 days before it starts to fall off. You should not pick, peel, or rub the DERMABOND, as this could cause your child’s wound to open before it is healed.

Once it sets, the adhesive can get wet (as in a shower) the same day as the procedure, but should not routinely be submerged under water (as in swimming) for seven days. Do not apply any ointments such as Vaseline or Neosporin to the incision while the DERMABOND is in place until seven days after surgery.

Visit our Guide to Your Child’s Surgery to learn more about what to expect when your child has surgery at The Children’s Hospital of Philadelphia.

Follow-up care

After surgery, your child’s incision may appear to be slightly swollen. In boys, the scrotum may also appear swollen. This will go away over the next few weeks. Your child will not be able to participate in physical education or sports for 2 to 3 weeks after surgery.

We will schedule your child for a follow-up appointment in our surgery clinic 2 to 4 weeks after the procedure, at which time we will evaluate the repair and your child’s recovery.

When to call the doctor

Please call the Division of Pediatric General, Thoracic and Fetal Surgery at 215-590-2730 if your child has any of the following symptoms after an inguinal hernia repair:

• Fever (a temperature of 101.5 degrees or higher)
• Any signs of infection, including redness, swelling or pain
• Any drainage from the incision
• Any pain that is not controlled with the prescribed pain medicine
• Any further questions or concerns

Why choose CHOP for hydrocele repair

The world-class, board-certified pediatric general surgeons at The Children’s Hospital of Philadelphia (CHOP) perform surgery to repair a hydrocele on patients ranging from tiny premature babies up to young adults.

Hydrocele surgery is performed at the Main Hospital in Philadelphia, and also at CHOP’s three Ambulatory Surgery Centers in Voorhees, NJ, Exton, PA and Bucks County (Chalfont), PA. Surgery at all locations is performed in conjunction with CHOP’s board-certified pediatric anesthesiologists and our compassionate, skilled surgical nurses.