A hydrocele is a collection of fluid around the testicle. In children, this fluid comes down from the normal fluid that is present in the abdomen into a balloon-like structure around the testicle (called the "tunica vaginalis"). The neck of this balloon runs along the spermatic cord and opens into the abdomen. Normally, this neck closes off by itself within the first year of life. If it does not close off, it continues to let fluid come through and it may enlarge. If the opening becomes large enough a piece of the bowel may slip into it. This is called a "hernia." If the bowel in a hernia becomes trapped it might swell and choke off its blood supply, which can be life-threatening.
How do I know if my child has a hydrocele or hernia?
A parent usually notices a hydrocele or hernia by detecting a bulge or swelling in the scrotum or above this in the groin. If this bulge gets bigger and smaller, it suggests that the opening is big enough to permit free flow of the fluid in and out of the tunica vaginalis. Girls can also get hernias and the bulge or swelling will be noted along the outside of the vagina in the labia.
Is surgery necessary?
Most infants with a hydrocele will have it go away as the opening closes off within the first year of life and require no surgery. If the hydrocele persists, it is unlikely to go away by itself and should be surgically corrected. If the hydrocele has a big enough opening to let fluid flow freely in and out (as noted by the swelling-getting bigger and smaller), it is unlikely to close on its own and surgery is indicated. A hernia (when a piece of bowel extends through the opening) can be very dangerous and should always be surgically corrected.
What is the surgery like?
The operation is performed by a small incision made in the groin. The abnormal opening is found and closed off and the fluid in the sac is drained. Almost all children will go home on the same day of surgery. There are no drains or stiches to be removed.
What can I expect following surgery?
Your child will go home on the day of surgery. The diet should start with liquids and then advance to soft food and solid food over the next 12 to 24 hours. Most children only require pain medication for 1 to 2 days after the operation. It is not unusual to see some swelling in the scrotum after surgery which will also go away over the next several weeks.
What are some of the specific complications associated with hydrocele/hernia surgery?
Wound infection or bleeding may occur with any operation, but are uncommon. Injury to the testicular blood vessels or vas deferens (the tube that carries sperm) may occur during a hydrocele or hernia operation. These structures are delicate and avoidance of injury requires delicacy and precision while performing the surgery. Rarely, a child may develop another hernia or hydrocele requiring a second operation.
Christopher S. Cooper, MD, Pediatric Urologist
Department of Urology