Hydrocele Repair

What are hydroceles?

A hydrocele is when there is fluid that collects in the scrotum. This will often cause the scrotum to look big or swollen. A hydrocele can be on either one side or on both sides of the scrotum.

What causes a hydrocele?

During development in the womb, all babies normally form a short tunnel through the abdominal wall. In boys, this connects the abdominal cavity with the scrotum. In girls, this connects the abdominal cavity with the labia. This tunnel has thin lining called the "processus vaginalis." This lining is the extension of the same layer that lines the inside of the abdominal cavity. 

The tunnel between the abdominal cavity (the belly) and the scrotum serves a purpose in boys. During development in the womb, the testicles initially grow inside the boy's tummy, and descend through this tunnel to end up in his scrotum. In both boys and girls, this tunnel and its lining are supposed to seal off prior to the baby being born. 

Sometimes when it seals off, some fluid is trapped around the testicles in the scrotum. This trapped fluid is called a non-communicating hydrocele. Sometimes the tunnel closes down but does not close completely. As a result, at times the fluid can drip down and accumulate in the scrotum to cause it to look bigger while at other times it can drain back into the abdominal cavity and thus make the scrotum look normal in size. This is called a communicating hydrocele because there is still a tunnel "communicating" between the belly and the scrotum.

Distinguishing between a communicating hydrocele and a non-communicating hydrocele is important since it may influence the treatment recommended by the pediatric surgeon.

What is the treatment for a non-communicating hydrocele?

For most patients less than a year of age, surgeons will often recommend observing (just watching) non-communicating hydroceles. This is because many of these hydroceles will go away on their own. However, if the hydrocele fails to disappear by the time the child reaches his or her first birthday, then it is unlikely to do so. In this situation, the child will probably need an operation.

What is the treatment for a communicating hydrocele?

The recommended treatment for a communicating hydrocele is an operation since the communication between the abdominal cavity and the scrotum will not close or seal on its own. 

How can you tell if a patient has a communicating hydrocele or a non-communicating hydrocele?

A non-communicating hydrocele will not change in size. If you try to squeeze the scrotum, it will not deflate. On the other hand, a communicating hydrocele can get bigger and smaller throughout the day, and it is often possible to gently squeeze the scrotum and cause the fluid to flow back into the abdominal cavity.

What else can cause scrotal swelling besides hydroceles?

There are many reasons that your child's scrotum might look enlarged. Some conditions can cause the testicles themselves to enlarge. In addition, the testicles can move up and down in the scrotum and give the impression that the scrotum is getting bigger or smaller. Inguinal hernias can also cause scrotal enlargement. In fact, a hernia is very much like a communicating hydrocele except that in a hernia it is a loop of intestine or some other abdominal tissue that slides down into the scrotum instead of just fluid.

How are hydroceles diagnosed?

Most hydroceles are discovered by noticing the unusual size of the scrotum. Parents or caregivers might be the first to notice although many times it is the pediatrician or other primary care provider who will find the hydrocele. In older children, the patient may be the first person to know that something is not quite right. When a hydrocele is suspected, the patient is referred to a surgeon to confirm the diagnosis and to discuss management plans with the family. 

Are there tests that can be done to diagnose pediatric hydroceles?

Despite all the high-tech advances in healthcare, the diagnosis of a hydrocele is best made by a careful examination of the patient. While ultrasounds and various x-ray tests can be used to help determine if a hydrocele exists, they are rarely necessary and often add additional risks, stress, and costs to the child's care that can avoided by simply having the child examined by an experienced surgeon.

How are hydroceles repaired?

During the initial meeting with the surgeon, he or she will review the child's health, confirm the presence of a hydrocele, and determine if any additional testing is necessary prior to the repair. During your visit, the surgeon will review the risks, benefits, alternatives, outcomes and complications of the various treatment options.

If your child has a hydrocele that needs to be fixed, an operation will be scheduled. These operations are generally done as an outpatient procedure, meaning the patient comes in and goes home on the same day. In the pediatric age group, this procedure is performed under general anesthesia. 

What happens during the operation?

The repair involves making an incision just below the belt line and dissecting down to the hole in the muscle layer. The hydrocele lining is removed from the scrotum and any communication with the belly cavity is closed with stitches. The deeper tissues and skin are then sewn together with dissolvable sutures that are hidden under the skin so that there are no stitches to be removed. 

What can a patient expect after the procedure?

After a hernia operation, the patient will have some pain. Many times this is controlled with over-the-counter pain medicines, but it may be necessary to take prescription pain medicine as directed by your surgeon. The child may need to rest at home before returning to school for up to a week, and will likely have to refrain from full strenuous activities for a month.

Pediatric Care at Johns Hopkins Medicine

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