Hydrocele In Babies: Causes, Signs, Diagnosis And Treatment

Nonclosure of the canal can cause smooth and painless swelling in the scrotum.

Medically reviewed by Dr. Richa A Kaushal, MD Dr. Richa A Kaushal Dr. Richa A KaushalMD facebook_icon Specialty: PediatricsExperience: 12 years
Written by Dr Bisny T. Joseph
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Hydrocele In Newborns Causes, Symptoms, And Treatment

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Hydroceles in babies is common and often diagnosed at birth or during routine checkups in infancy. Approximately one in ten newborn baby boys are affected by this condition. Boys born prematurely are at a higher risk of developing hydrocele than term babies.

Although it is often self-resolving, some may require surgical correction. Fortunately, hydrocele surgeries have a good prognosis.

Read this post to know the causes, symptoms, diagnosis, and treatment for hydrocele in babies.

What Is A Hydrocele?

A hydrocele is the accumulation of fluid within the thin sac or pouch surrounding a testicle within the scrotum (1). The condition may affect one or both the testicles. The sac is made of a thin membrane. The collection of fluid causes the sac to balloon, leading to enlargement of the testicle, indicated by a swollen scrotum.

Hydroceles are congenital (present at birth) and could occur in full-term baby boys with no history of prenatal issues. The condition tends to be most common among premature babies (2).

Causes Of A Hydrocele In Babies

A hydrocele occurs due to developmental defects in the descent of testicles into the scrotum (3).

The testicles originally develop in the abdominal cavity of the fetus. The tissue that lines the abdominal cavity forms the sac that covers the testicles. During the seventh month, the testicles gradually descend through a canal to the scrotum along with the sac made from abdominal tissue, which also lines the canal.

Once the testicles reach their normal position, the canal gradually closes, and there is no connection between the sac and the abdominal cavity. However, in some cases, the tunnel does not close correctly or closes abnormally, leading to the formation of hydrocele.

The type of developmental defect during the closure of the canal determines the type of hydrocele.

Types Of Hydroceles

There are two types of hydroceles (4).

  • Communicating hydrocele: The canal does not close entirely, leading to a connection between the testicular sac and abdominal cavity. It permits fluids from the abdominal cavity to flow into the scrotum and vice-versa, leading to the formation of hydrocele.
  • Non-communicating hydrocele: Some abdominal fluid flows into the sac before the closure of the canal, causing the fluid to become trapped inside the scrotum. Since there is no connection between the testicular sac and abdominal cavity, it is called a non-communicating hydrocele. It tends to be less severe since the baby’s testicles and abdominal cavity have normal physiology.

Note: Some babies may develop non-communicating hydrocele due to injury to the testicles. It has different symptoms and prognosis than congenital non-communicating hydrocele.

Signs And Symptoms Of Hydroceles

The prominent sign of hydrocele is a swollen scrotum. If one testicle is affected, the scrotum will appear swollen on one side. Congenital hydrocele neither causes pain nor other symptoms in the baby (5). If the swelling is painful and the baby has other symptoms, such as vomiting, it is likely to be a hernia.

Communicating hydrocele may cause an increase in the size of the swollen scrotum during certain activities that lead to strain, such as crying. The scrotum may reduce in size when the baby lies down or is asleep (6). It happens due to the constant transfer of fluid between the testicular sac and abdominal cavity and vice-versa. It does not cause any discomfort to the baby.

Diagnosis Of Hydroceles

A doctor can diagnose hydrocele during routine postnatal examination by observing the swollen scrotum (7). The healthcare provider may shine a bright light through the scrotum to check if it is filled with fluid. A fluid-filled scrotum would light up and have a smooth appearance.

An ultrasound scan may be recommended to check the type of hydrocele and diagnose other possible conditions, such as an inguinal hernia. An X-ray may also be recommended to diagnose or rule out other problems.

Treatment For Hydroceles In Babies

The treatment depends on the type of hydrocele (8) (9).

Treatment for a communicating hydrocele

  • The doctor may recommend wait-and-watch for some months. If the hydrocele does not close by 18 to 24 months, it is certainly a communicating hydrocele.
  • Surgery is the only treatment since the canal between the scrotum and abdominal cavity will not close on its own.
  • The surgery is performed under general anesthesia. An incision is made in the testicular sac to drain the fluid. The sac is closed and disconnected from the abdominal cavity.
  • The muscles around the scrotum and lower abdomen may be stitched to make them stronger. The doctor may likely use dissolvable stitches during the procedure.
  • The baby may have to stay in the hospital for a few days. Once discharged, parents would be guided about appropriate care. You may have to give a sponge bath to the baby and avoid straddling them until the surgical wound heals.
  • You may have to visit the doctor each week for an examination. The wound would heal, and the testicles become normal within a few weeks.

Treatment for a non-communicating hydrocele

  • There is no treatment required for non-communicating hydrocele.
  • The body will gradually absorb the fluid present within the sac.
  • The hydrocele goes away on its own by the baby’s first birthday.

The baby may require other procedures if they have other conditions, such as an inguinal hernia or umbilical hernia. If a non-communicating hernia does not go away by 12 months, consult a doctor since it may be communicating hernia, or the baby may have other underlying problems.

Complications Of A Hydrocele

The prognosis of both types of hydroceles is very good, and they seldom lead to complications (10). Most babies have normal development of testicles once the condition goes away. In rare cases, the baby may develop a hydrocele again. Complications tend to be more common among premature infants and in scenarios where the hydrocele is accompanied by a hernia or other birth defects.

Frequently Asked Questions

1. What care is needed after hydrocele surgery?

After hydrocele surgery, you may do the following to help your baby recover fast (11).

  • Resume their regular diet. If your baby has vomiting or nausea, give them water, and let them lie down or sit for some time.
  • Give them enough fluids to prevent dehydration.
  • If your baby has pain, you may give them medicines or apply ice packs.
  • Minor swelling or discharge at the site of surgery is normal. However, if it is bleeding, take your child to the doctor.
  • Use baby wipes or moist cloth for diaper changes.
  • You may notice changes in your baby’s eating and sleeping patterns. These may last for a few days or weeks.
  • Your baby may have a mild fever after surgery. If the fever increases, call your doctor.
  • Keep an eye on breathing difficulties, shortness of breath, or chest pain. If you are not sure of the symptoms, contact your doctor.

2. What happens if the hydrocele is not treated?

If communicating hydrocele does not heal and is left untreated, it may cause an inguinal hernia, where a part of the intestine or the intestinal fat is pushed into the groin area (12).

3. Can a hydrocele burst?

Yes, if the hydrocele becomes significantly large, it may burst due to the increased pressure (13).

Hydrocele is a prevalent condition in newborn boys that is more likely to occur in preterm than full-term babies. The most visible manifestation of hydrocele is a swollen rectum, which is sometimes accompanied by pain. There are two varieties of hydrocele: non-communicative hydrocele, which does not require treatment, and communicating hydrocele, which requires surgery. Although hydroceles in babies cannot be prevented, they can be diagnosed through standard postnatal examinations shortly after birth or during infancy. Once resolved, it has a favorable long-term prognosis.

Key Pointers

  • Hydrocele may occur due to a developmental defect or injury to the testicles.
  • Diagnostic modalities such as ultrasound and X-ray are required to detect hydrocele and rule out possibilities of hernias.
  • This condition is usually self-resolving, but a doctor may suggest surgical intervention if it doesn’t resolve within 18 to 24 months.

References

1. Hydrocele in Children; Cedars-Sinai
2. What are Hydroceles and Inguinal Hernias?; Urology Care Foundation
3. Hydrocele; Children’s Hospital of Philadelphia
4. Hydrocele; Boston Children’s Hospital
5. Congenital Hydrocele; University of Michigan
6. Communicating Hydrocele; American Academy of Pediatrics
7. Hydrocele in Children; University of Rochester
8. Hydrocele Repair; John Hopkins Medicine
9. Hydrocele repair; U.S. National Library of Medicine
10. Hydrocele in the Newborn; UC San Diego Health
11. How to Care for Your Child at Home After a Hydrocele Repair; Massachusetts General Hospital
12. Communicating Hydrocele; Cleveland Clinic
13. Viktor X. Flores et al.; Deflate-gate: Conservative Management of a Large Ruptured Hydrocele; NCBI
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Dr. Richa A Kaushal
Dr. Richa A KaushalMD
Dr. Richa Kaushal works as an Assistant Professor in the Department of Pediatrics at UCSF Fresno, California. She is also a physician at Community Regional Medical Center, Fresno, California, and Clovis Community Hospital, Clovis, California.

Read full bio of Dr. Richa A Kaushal
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