HYDROCELE IN CHILD

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Accumulation of fluid around the testicle, usually visible as an increase in scrotum volume. It can be congenital or acquired, and it is important to distinguish its origin and evolution to decide between monitoring and surgical treatment.

One of the sides of the scrotal sac seems larger?

It's a fluid accumulation around the testicle. It can appear on one or both sides.

Two types, two paths

The location of the fluid and the existence - or not - of communication with the abdomen determine the evaluation and treatment.

PRIMARY
Communicating form

ABDOMEN

OPEN CHANNEL

The fluid from the abdomen can descend and envelop the testicle. The volume can vary throughout the day and increase when the child is standing, crying or making an effort

SECONDARY
Generally non-communicating

ABDOMEN

CLOSED CHANNEL

The fluid accumulates locally, as a response to trauma, inflammation or infection. More rarely, it can be associated with an injury or a testicular tumor.

In secondary hydrocele, the cause is first identified and treated.

When the exam is enough — and when to ask for an ultrasound

The medical exam evaluates the volume, the consistency, the variation and, above all, the testicle itself.

CLINICAL EXAM

Many times it is enough
In a typical hydrocele of the baby, when:

  • ●
    The increase is smooth, painless and without rapid growth
  • ●
    The testicle can be palpated and examined
  • ●
    There are no doubts about the diagnosis
DOPPLER ULTRASOUND

May be necessary if

  • ●
    It is not possible to palpate the testicle
  • ●
    Pain, hardness or rapid growth appear
  • ●
    The increase appears in an older child
  • ●
    There is trauma or suspicion of secondary cause
THE USEFUL RULE

The appearance, by itself, does not confirm the cause. If there is doubt between hydrocele and inguinal hernia, the evaluation should not be delayed

Observe, investigate or treat?

The age, evolution and cause are more important than the volume, by itself.

PRIMARY · IN THE BABY

Many times it is enough

Sample text. Click to select the Text element. In most babies, observation is safe during the first year. Many hydroceles decrease spontaneously.

WEIGH SURGERY IF

  • ●
    Persist beyond the expected period
  • ●
    Increase or cause discomfort
  • ●
    Exist suspicion of hernia or testicular alteration
SECONDARY · ACQUIRED

Treat the cause

Investigate and treat the cause: trauma, inflammation, infection or other identified situation.

HYDROCELE CAN

  • ●
    Decrease when the cause improves
  • ●
    Be accompanied for a few months, if it is safe
  • ●
    Be operated if it persists, increases or causes symptoms

A simple and painless hydrocele usually does not damage the testicle. The decision depends on the type and cause, not just the volume.

If surgery is necessary

The technique changes depending on whether there is communication with the abdomen or if it is a secondary hydrocele.

COMMUNICATING FORM

Close the channel through the groin

Under general anesthesia, a small incision is made, the communication is closed, and the fluid is drained.

SECONDARY HYDROCELE

Treat the cause first

If it is necessary to treat the hydrocele itself, the approach is usually scrotal and adapted to the case.

30–60 min
simple unilateral repair
Same day
usual discharge
​​5–7 days
usual return to school
​≈ 2 weeks
without physical education, bicycle, or swimming

WHAT THE TREATMENT SEEKS
​Close the communication or treat the cause, reducing the likelihood of new fluid accumulation.

​Approximate times for a simple repair; follow the team's instructions. In secondary hydrocele, the approach may vary. Some swelling or black and blue marks are usual in the first days. The time in the clinic is longer than the surgery.

Sudden pain requires urgent evaluation

A simple hydrocele is usually painless. Sudden pain or rapid change require urgent medical evaluation to exclude other causes.

SEEK URGENT EVALUATION IF APPEARING)
  • ●
    Sudden and intense pain in the scrotal sac or groin
  • ●
    Pain accompanied by nausea or vomiting
  • ●
    Rapid increase in volume, hard, red or very sensitive
  • ●
    Fever, malaise or significant increase after trauma

A testicular torsion is an emergency.

AFTER SURGERY

The appearance alone does not confirm the cause. If there is doubt between hydrocele and inguinal hernia, evaluation should not be delayed

If you notice a persistent increase in volume in the scrotal sac, schedule an evaluation

what is evaluated in the treatment

01.

pathological conditions:

If the patient has recurrent infections or other clinical conditions.

02.

Hygiene and comfort:

The doctor will assess the patient's level of comfort, taking into account their hygiene and potential complications of the scrotum.

03.

Aesthetic reasons:

The doctor will discuss the expectations and benefits of the procedure.

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