Identifying scrotal swellings: Hydroceles in babies

In baby boys, testicles descend down into the scrotum before birth. It is in this moment that a hydrocele, a fluid build-up that swells, may form within the baby’s scrotum.

Here, Mr Nav Johal, leading consultant paediatric urologist, provides an expert insight into hydroceles in babies, explaining how scrotal swellings are formed, how they can be identified, what is their treatment and more.

How can parents identify a scrotal swelling in their baby?

Swellings in the scrotum are a common problem in baby boys where typically, one half of the scrotum is larger than the other side. This is most frequently caused by a hydrocele (which is a collection of fluid around one or both testicles) or a hernia (a bulge of bowel through a defect in the tummy muscle).

The swelling may be identified immediately after birth; before the baby is discharged from the baby ward; or later in infancy or early childhood, for example, following a chest infection. It can fluctuate throughout the day.

What are the most common causes of hydrocele?

As the baby is developing, there is a connection between the abdomen and the scrotum, which allows the testicles to move from the tummy into the scrotum. This connection or tube closes in most baby boys, but in some, it remains patent (open), allowing the passage of fluid into the scrotum. This is what causes a hydrocele.

A hydrocele can be completely patent (called a communicating hydrocele) or partially patent (called a non-communicating hydrocele). If the hydrocele tube enlarges, the bowel can find its way through and a hernia can develop as a result.

Is a hydrocele serious? When should parents seek medical attention?

It is not serious. If a scrotal swelling is found, one should see a GP or attend the local emergency department if the swelling is associated with acute symptoms.

Is treatment always necessary? Can a hydrocele go away on its own?

In the majority of babies identified with a hydrocele, the tube closes off completely and resolves spontaneously. If it persists beyond the age of two, the hydrocele is unlikely to resolve and surgery will be required.

How is a hydrocele treated?

Hydroceles are treated with an operation which involves a small incision or cut in the groin. The muscle is divided and the tube (the pouch of peritoneum, also known as the processus vaginalis) is separated from the fine vessels that supply the testicles with blood. The tube is isolated, closed and divided whilst the fluid from the testicles is drained at the same time. This procedure is most commonly performed as a day case procedure.

If you have identified a scrotal swelling in your baby and wish to seek the utmost expert paediatric urology care, don’t hesitate to visit Mr Johal’s Top Doctors profile today.