Hydroceles in children: Causes, types and diagnosis

A hydrocele is an accumulation of fluid that forms around the testes. While hydroceles can develop at any age, they are more common in newborns and children.

Here to provide an expert insight into hydroceles in children is Mr Simon Clarke, leading consultant paediatric surgeon. The London-based specialist discusses what are the different types of hydroceles, when should parents seek medical help for their child’s hydrocele, and what happens if hydroceles are left untreated.

What is a hydrocele?

Hydro means water and cele means sac, so a hydrocele is a sac of water.

In this particular context, a hydrocele refers to a sac that surrounds a male testicle. This is a potential space, meaning that it generally is empty of fluid, but when it does have an abnormally large collection of fluid, it is more visible and it looks asymmetrical compared to the other side of the testicle. Thus, essentially, a hydrocele is a collection of water around one side of the testicle.

Are there different types of hydroceles?

There are three main types of hydroceles.

In children, the most important one is a communicating hydrocele. There is a type of hydrocele that presents in three out of five babies who, at the time of their birth, are born with fluid around their testicles. This usually disappears very soon after. A communicating hydrocele, however, is a hydrocele that persists beyond this newborn period. It is often more present at the end of the day when a boy has been upright, and less so overnight when the boy has been sleeping in bed. A communicating hydrocele is the most common type of non-newborn hydrocele.

The second type is called a non-communicating hydrocele. It occurs when the sac itself produces fluid, and it is more commonly seen beyond childhood.

Lastly, the third type is called a hydrocele of the cord, which occurs when a cyst of fluid develops in the canal (the groin). This cyst of fluid is the same kind of mechanism (the same material) that the sac around the testicle is made from. A hydrocele of the cord is often confused for a lump in the groin, but this hydrocele tends to be painless, which is is the key to identifying all these swellings in the testicles or the groin - if it is painless, then it is more likely to be a hydrocele in nature.

Is a hydrocele serious?

In children, no. Often, it causes a lot of alarm in parents because they suddenly see a large bulge in their child’s body, which of course needs to be differentiated from that of a hernia that is more urgent to treat. This difference is important, because a hernia does not get better by itself, whereas a hydrocele can.

Most hydroceles disappear after the newborn period, so if a hydrocele has not disappeared by the age of 18 months to two years of age, then it is probably not going to. This is common, and about one per cent in all boys will end up having a consultation for a hydrocele.

When is it necessary to see a doctor about a hydrocele?

After the newborn period, it is usually worthwhile waiting to see if the initial hydrocele has decreased in size. However, parents who are concerned about their child’s hydrocele can comfortably go see a doctor at any time, because sometimes it is reassurance that is most important and most needed.

On the other hand, if a child has a hydrocele and the child is aged between 18 months to two years, then I think a consultation is really important. This is not only to reassure that the swelling is decreasing in its trend (because a longer waiting period might then be considered), but also to reassure if the swelling is very large.

Certainly, if the swelling is very large at any age, I think it is important to see a paediatric surgeon, because although sometimes the very, very large hydro diseases are quite rare, they can cause more problems than the average hydrocele.

How is a hydrocele diagnosed?

It is a fairly straightforward clinical diagnosis, based on a hydrocele’s painless symptoms and the fact that it can increase and decrease in size. Scans are normally not needed.

Sometimes, a pen torch with a light on the end of it is used to shine behind the fluid. If the fluid lights up brilliantly, it is called a transillumination. This is a common method of detecting hydroceles in very young infants, as well as any possible hernias.

Clinically, it is important to differentiate between a hydrocele and a hernia, and often, at a primary care level that will be possible.

What happens if a hydrocele is left untreated?

A hydrocele develops when fluid from the abdomen and the intestines drips down through the hole that joins the groin to the scrotum, which is a small, open channel that should have closed off at birth but did not quite do so. Eventually, a person grows the hole (making it bigger) and so, there is always a potential for an inguinal hernia, which occurs when the intestines push through the now larger hole.

In terms of damage to the testicle, that is pretty unlikely. However, if a hydrocele is left untreated into adulthood, particularly if it is on both sides, then there is a risk that the testicle will undergo a ‘warming’ effect that could possibly affect the function and the formation of one’s sperm. Certainly, I believe that about 10 per cent of adult males in infertility clinics have a hydrocele or have had hydroceles in the past.

In adults, very large hydroceles are also at risk of suffering injury, trauma, and bleeding within them. However, this is rarely seen in children.

Mr Simon Clarke is a leading London consultant paediatric surgeon with over 25 years’ experience.

If you are worried about your child’s hydrocele and you would like to seek expert assistance, do not hesitate to book an appointment with Mr Clarke via his Top Doctors profile today.