Hydrocele

A hydrocele is a fluid-filled sac along the spermatic cord in the scrotum. These are common in the newborn infant, and they may be on one side or both sides. Fluid drains from the abdomen into the scrotum, causing enlargement of the scrotum. These can also be caused by trauma to the testes or epididymis or by fluid or blood obstruction within the spermatic cord.

These normally resolve a few months after birth, but their appearance may worry new parents. Sometimes these children also have an inguinal hernia. It’s easy to diagnose one by shining a flashlight through the enlarged portion of the scrotum. If the scrotum is full of clear liquid, the scrotum will light up.

Parents will notice a painless, swollen testicle, on one or both sides, which feels like it’s filled with water. An ultrasound may be done to confirm the diagnosis. Hydroceles usually are not dangerous and frequently are treated only when they are an embarrassment or are uncomfortable. Treatment options include either aspiration or surgery.

In aspiration, a needle is inserted into the testicle sac, and the fluid is removed, decreasing the size of the hydrocele. With aspiration, it is common for the condition to come back, and there is always the risk of infection.

If the condition doesn’t fix itself by the time the child is a few months old, surgery may be necessary. The surgery is called hydrocelectomy. This is a minor surgical procedure performed on an outpatient basis using general or spinal anesthesia. An incision is made in the scrotum or lower abdomen, and the area is drained. The open communication between the peritoneum and the scrotum is repaired. The incision is then closed. In some cases, this can be done laparoscopically, using small incisions and a camera to guide the surgeon.

The child will have a bandage over the area and be required to wear a scrotal support (an athletic supporter) for a few weeks. The child should be encouraged not to overdo activity and can resume normal activities in four to seven days. Complete correction usually occurs after surgery, and the prognosis is good. As with any surgery, there is a possibility of problems with anesthesia and a risk of bleeding or infection.

Pediatric urologic surgeons who treat hydroceles:

Paul F. Austin, M.D.

Douglas E. Coplen, M.D.

For an appointment with a Washington University pediatric urologic surgeon, call (314) 454-6034.