Causes of scrotal swelling in children

Scrotal swellings can occur at any age, even during childhood. Miss Marie-Klaire Farrugia, a leading paediatric urologist, clarifies the causes of scrotal swelling and explains when medical advice could be urgent, as well as providing treatment information.

What is scrotal swelling in children?

Scrotal swelling is when the scrotal sack, which houses a male’s testes, becomes swollen, discoloured or painful. It can happen at any age and has various potential causes.

The "scrotum" houses the testes and its structures. Any swelling of the scrotum may be related to any of these following structures.

• The testes themselves
• The epididymis, which is attached to the testes and will store sperm in the future.
• Arteries and veins.
• The "tunica". This is a membrane in which the testes sit.
• In young boys, there may also be a "patent processus vaginalis" (PPV), which is like a "channel” through which the testes descend into the scrotum during development.

What are the possible causes of scrotal swelling in kids?

Common causes are:

• hernias (bowel entering the scrotum through the PPV)
• hydrocoeles (a fluid collection
• varicocele (swelling of the veins around the testis)

Less commonly:

• twisting (clinically referred to torsion) of a testis or a small cyst related to the testis (clinically called a torted hydatid)
• infection
• an epididymal cyst (a sac of fluid that grows in the epididymis, which is the structure that will store sperm after puberty)

Very rarely:

• a tumour
• any lesion from an injury, such as a haematoma (collection of blood)

Is there a difference between painless and painful scrotal swelling, such as different causes?

Yes. Painful swelling may be an emergency and ought to be seen by a doctor as soon as it arises. Painful causes that need urgent management are a testicular torsion or a hernia which has become "stuck".

Painless causes, such as a hydrocoele, varicocele or cyst are less urgent but still ought to be assessed.

What additional symptoms should I watch out for?

You should watch for redness and tenderness over the area. These are a sign of an urgent problem

How is scrotal swelling treated in children?

This will depend on the cause.

• Hydrocoeles often resolve spontaneously by the time the child is 3 years of age. If it hasn't resolved, it can be fixed by a straight-forward surgical procedure after that age.
• Hernias do not resolve spontaneously and will require surgery at any age. Large or painful hernias ought to be fixed as soon as possible.
• Testicular torsion is an emergency. Studies have shown that surgery should be performed within 6 hours of the onset of symptoms, in order to salvage the twisted testis.
• The remainder of the causes will need a consultation as they may require observation rather than immediate surgery.

Are there any complications of scrotal swelling if it goes untreated?

The main learning point here is never to leave suddenly painful and/or red and swollen scrotal swellings untreated. This is because the cause may be a twisted testis, which could be lost if not operated on within 6 hours; or a stuck hernia, which could result in the bowel being damaged if not treated within a few hours.

Miss Marie-Klaire Farrugia specialises in all areas of kidney, bladder and genital anomalies that babies are born with or that develop later in childhood. Visit her profile to learn how she can help your child.