J INU JANET VARGHESE
TBILISI STATE MEDICAL UNIVERSITY
Hydrocele is an abnormal fluid collection in the
scrotum between the visceral and parietal areas of
the tunica vaginalis.
in infants is usually the result of incomplete closure
of the processus vaginalis. It may or may not be
associated with inguinal hernia. In older boys and
men it may be idiopathic but more likely to be
secondary to another pathologic process in the
scrotum or adjacent structures
For baby boys, a hydrocele can develop in the womb. Normally, the testicles
descend from the developing baby's abdominal cavity into the scrotum. A
sac (processus vaginalis) accompanies each testicle, allowing fluid to
surround the testicles.
In most cases, each sac closes and the fluid is absorbed. However, if the
fluid remains after the sac closes, the condition is known as a
NONCOMMUNICATING HYDROCELE. Because the sac is closed, fluid
can't flow back into the abdomen. Usually the fluid gets absorbed within a
In some cases, however, the sac remains open. With this condition, known
as COMMUNICATING HYDROCELE, the sac can change size or, if the
scrotal sac is compressed, fluid can flow back into the abdomen.
In older males, a hydrocele can develop as a result of inflammation or
injury within the scrotum. Inflammation may be the result of infection of
the small coiled tube at the back of each testicle (epididymitis) or of the
Most hydroceles are present at birth (congenital),
and babies who are born prematurely have a higher
risk of having a hydrocele.
Risk factors for developing a hydrocele later in life
Infection, including sexually transmitted infections
Hernias are 6 times more common in boys than in girls.
Bowel incarceration is more common in females than in
In females, an ovary or fallopian tube incarcerates more
frequently than bowel. Therefore, the overall incidence of
bowel strangulation is lower in females than in males.
The incidence of PPV decreases with age. In newborns,
80%-94% have a PPV. Hernias are 20 times more
common in premature infants who weigh less than 1500
g than in babies born at term.
SIGNS & SYMPTOMS
A bulge in the groin or scrotal enlargement is the classic
presentation of hernia or communicating hydrocele.
Pain is generally not a prominent feature but may occur
if a hydrocele expands quickly; tension in the wall may
cause milder pain. Severe pain raises concern about a
strangulated hernia. Very rarely, a hydrocele may
become infected and cause pain.
Frequently, parents report an intermittent bulge. The
bulge may reduce at night in the supine position. A
history of vomiting, colicky abdominal pain, or
constipation suggests bowel obstruction, which may
occur with an incarcerated or strangulated hernia.
The exam may reveal an enlarged scrotum that isn't tender
to the touch. Pressure to the abdomen or scrotum may
enlarge or shrink the fluid-filled sac, which may indicate an
associated inguinal hernia.
Because the fluid in a hydrocele usually is clear, your doctor
may shine a light through the scrotum (transillumination).
With a hydrocele, the light will outline the testicle,
indicating that clear fluid surrounds it.
If the hydrocele is caused by inflammation, blood
and urine tests may help determine whether there is
an infection, such as epididymitis.
The fluid surrounding the testicle may keep the
testicle from being felt. In that case, ultrasound
imaging test is done. This test can rule out a hernia,
testicular tumor or other cause of scrotal swelling.
Laboratory evaluation is generally not essential to
the evaluation of hydroceles and hernias.
Leukocytosis may be a sign of a strangulated hernia.
Leukocytosis with a higher percentage of neutrophils
suggests an infectious and/or inflammatory process
Simple hydroceles do not require radiographic
studies. Findings from radiographic or
ultrasonographic studies can help evaluate for an
underlying process, such as a tumor or torsion.
As with ultrasonography, duplex studies are not
warranted in simple hydroceles. However, duplex
studies may provide substantial information
regarding testicular blood flow when a hydrocele
may be associated with chronic torsion.
Hydroceles usually improve without any treatment within the
first year of life. An operation is usually only advised if the
hydrocele persists after 12-18 months of age.
The operation for a hydrocele involves making a very small cut
in the lower tummy (abdomen) or the scrotum. The fluid is
then drained from around the testicle (testis). The passage
between the abdomen and the scrotum will also be sealed off
so the fluid cannot reform in the future. This is a minor
operation and is performed as a day case, so does not usually
involve an overnight stay in the hospital.
There are no long-term effects of having a hydrocele. Having a
hydrocele does not affect the testicles (testes) or a boy's
fertility in the future.
Potential Complications from Surgery
Complications from surgery are very rare, but are
more likely if the child has previous groin surgery.
Possible risks include infection, bleeding recurrence,
pulling up of the testicle, and injury to the testicle or