Congenital Hydrocele

Topic Overview

What is a hydrocele?

A hydrocele (say “HY-druh-seel”) is a buildup of watery fluid around one or both testicles. It causes the scrotum or groin area to swell.

A congenital hydrocele is one that a baby is born with. Hydroceles can also occur later in life for a number of reasons. This topic is about congenital hydroceles, which are found in about 1 or 2 out of 100 male newborns.¹

The swelling from a hydrocele may look scary, but it is usually not a problem. It will probably go away by the time your baby is 2 years old.

What causes a congenital hydrocele?

A month or so before birth, a baby’s testicles move from the belly area down into the scrotum, along with a bit of the lining of the belly area. The lining shrivels up, leaving a small empty space around the testicles. This space normally closes up by the time a baby is 2 years old.

Sometimes fluid leaks into the space, filling it like a small water balloon. This is a hydrocele. When the space closes up and traps the fluid inside, it’s called a noncommunicating hydrocele. Usually, the body absorbs the fluid over time.

If the space doesn't close up the way it should, the fluid moves back and forth between the scrotum and the belly area. This is called a communicating hydrocele. The swelling comes and goes. This problem is usually fixed with surgery to help prevent a hernia in the groin.

Another type of hydrocele is a hydrocele of the spermatic cord. It is located higher up in the scrotum. The fluid is usually absorbed within a few months and at the latest by age 1 or 2. A hydrocele of the cord may be mistaken for an inguinal hernia.

What are the symptoms?

The usual symptom is a swollen scrotum. The swelling does not hurt. If your child seems to be in pain, call the doctor. Pain may mean that your child has a hernia or other problem.

How is a congenital hydrocele diagnosed?

Doctors diagnose a congenital hydrocele during a physical exam that includes questions about the child’s health. The swelling is often easy to see, so it’s usually not hard to identify.

How is it treated?

Most of the time, all you need to do is watch for any changes in the swelling. If the swelling gets bigger or if it comes and goes, tell your doctor.

Your child may need surgery if:

He still has the hydrocele at age 2.
The swelling comes and goes.
The swelling causes pain.
The swelling gets worse.

Frequently Asked Questions

Learning about congenital hydrocele:	What is a congenital hydrocele? What are the symptoms?
Being diagnosed:	How is a congenital hydrocele diagnosed?
Getting treatment:	How is it treated? What home treatment may be needed?

Symptoms

The obvious symptom of a congenital hydrocele is a swollen scrotum or groin area. The scrotum may have a bluish tinge. The swelling:

Is painless.
May be soft or slightly firm.
Cannot be reduced by changing its position or gently pushing it up.
May be small in the morning and gradually increase in size throughout the day.
May be translucent (light will shine through it).

If pain is present, it may point to an inguinal hernia, injury to the testicles, or other problem. Contact your child's doctor.

Exams and Tests

Congenital hydroceles are diagnosed through a physical exam and a medical history. Because the swelling often is obvious, it is not difficult to diagnose. But care should be taken to ensure it is a hydrocele and not an inguinal hernia. The doctor will examine the scrotum and groin area to:

Check for pain. Pain may indicate a hernia or an injury to the testicles.
See if the swelling can be pushed back into the abdomen. If it can be, it may be a hernia.
Try to feel above the swelling. If this is not possible, it may be a hernia.
Shine a light at the scrotum. If the light does not shine through the swelling, it may be a hernia.

If your child has a hydrocele that varies in size (a communicating hydrocele), it may not be apparent during the visit. The doctor may ask if the swelling is less in the morning and then increases as the day goes on.

If an inguinal hernia or an abdominal-scrotal hydrocele (a rare hydrocele that extends from the scrotum into the belly area) is suspected, the doctor may order more tests, including an ultrasound.

Treatment Overview

For a congenital hydrocele that remains the same size or gets smaller (a noncommunicating hydrocele), aggressive treatment is not recommended. A noncommunicating hydrocele generally will go away by age 2. The focus will be on watching the hydrocele for any changes.

Surgery may be needed if a noncommunicating hydrocele:

Does not go away by age 2.
Comes and goes.
Causes painful swelling.

If your child has a hydrocele that varies in size (a communicating hydrocele), surgery generally is needed.

For surgery, your child first receives general anesthesia. A small incision is made in the groin area, and the sac containing the hydrocele is identified. The surgeon empties the fluid from the sac and ties off the sac to close it. Stitches are then used to strengthen the area and prevent another hydrocele from forming.

One of the major decisions in surgery for hydrocele is whether to explore the opposite groin area for an inguinal hernia or another hydrocele during the surgery. At this time, there is no agreement as to the age at which this should be considered.² But the older your child is, the less likely it is that the other side will be explored.

Removal of the fluid with a needle (aspiration) is not performed on children because of the high risk that the hydrocele will return or become infected.

Home Treatment

If no surgery has been done, home treatment for a congenital hydrocele consists of watching it for any changes. If its size increases, or if its size varies, contact your child's doctor. Also watch your child for nausea and vomiting. This may mean he has an incarcerated hernia.

If surgery has been done, home treatment focuses on caring for the groin incision. Watch for signs and symptoms of infection, such as fever, swelling, redness, or increasing pain.

Other Places To Get Help

Organization

UrologyHealth.org, American Urological Association
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Web Address:	www.urologyhealth.org

UrologyHealth.org is a Web site written by urologists for patients. Visitors can find specific topics by using the "search" option. The Web site provides information about adult and pediatric urologic topics, including kidney, bladder, and prostate conditions. You can find a urologist, sign up for a free quarterly newsletter, or click on the Urology Resource Center to find materials about urologic problems.

Related Information

References

Citations

Elder JS (2007). Hydrocele section of Disorders and anomalies of the scrotal contents. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 18th ed., p. 2264. Philadelphia: Saunders Elsevier.

Schneck FX, Bellinger MF (2007). Hernias and hydroceles section of Abnormalities of the testes and scrotum and their surgical management. In A J Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 4, pp. 3787–3789. Philadelphia: Saunders Elsevier.

Other Works Consulted

Zderic SA (2005). Hydrocele section of Developmental abnormalities of the genitourinary system. In HW Taeush et al., eds., Avery's Diseases of the Newborn, 8th ed., chap. 83, pp. 1282–1297. Philadelphia: Saunders.

Credits

Author	Debby Golonka, MPH
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Peter Anderson, MD, FRCS(C) - Pediatric Urology
Last Updated	January 23, 2009

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