Hydrocele in infants and children symptoms causes and best treatment methods through follow-up and surgery

Many mothers notice swelling or a lump in the scrotum of their infant boys, which naturally raises concerns about the cause. The truth is, hydrocele is one of the most common conditions among male infants, and in most cases, it is simple and doesn’t require surgical intervention.In this Daleeli Medical article, we will explore the causes of hydrocele, the important signs to watch for, when it might resolve on its own without surgery, and the different treatment options if it persists.Keep reading until the end to ensure your peace of mind and your child’s health and safety.

What is Hydrocele in Children?

Hydrocele, medically known as "hydrocele," is the accumulation of fluid around the child’s testicle inside the scrotum. This condition is very common and occurs in about 5% of newborn boys.

Here’s what happens: the testes develop inside the abdomen during fetal life, and before birth, they gradually descend into the scrotum. Normally, the body closes the channel between the abdomen and the scrotum after the testes descend. But sometimes, this channel doesn’t close properly, allowing some fluid from the abdomen to flow into the area around the testicle, which is what we call a hydrocele.

Symptoms of Hydrocele in Children

The most noticeable sign for mothers is swelling in the scrotum, usually on one side but sometimes on both. The size of the swelling can vary from child to child and may be smaller in the morning and enlarge by the end of the day.

It’s important to know that this condition does not cause pain, so the child won’t cry or complain. You may notice it during diaper changes or bath time when you see that the testicle looks larger than usual or swollen.

Is Hydrocele Dangerous for the Child?

In most cases, hydrocele in infants resolves on its own within the first year of life without any treatment. However, if the swelling persists beyond one year or increases in size, you should consult a pediatrician or pediatric surgeon to evaluate the condition and decide if a minor surgical intervention is needed.

Is Hydrocele the Same as Inguinal Hernia in Children?

Many people confuse hydrocele with inguinal hernia because both appear in the same area—the scrotum—and cause swelling.

But they are completely different conditions:

Hydrocele is fluid accumulation around the testicle due to the open channel between the abdomen and scrotum.
Inguinal hernia occurs when part of the intestine or fat from the abdomen pushes through that same channel, causing larger swelling that can sometimes be painful.

That’s why it is very important for a doctor to accurately diagnose the condition, as the treatment for hernia differs from hydrocele treatment.

How Long Does Surgery Take to Treat Hydrocele?

If the hydrocele does not resolve on its own after the child turns one year old, the doctor may recommend a simple operation called "hydrocelectomy." This surgery:

Is done on an outpatient basis, so no long hospital stay is needed.
Usually takes about 30 minutes.
The child can usually go home the same day or the next day at the latest.
Requires 3 to 5 days of rest at home for full recovery.

Can Hydrocele Come Back After Surgery?

In most cases, hydrocele does not return after surgery. However, in very rare cases, it may recur, especially if the child has other issues with the inguinal canal or a specific type of hydrocele related to congenital defects.

If the hydrocele returns within a year after surgery, the doctor will usually re-evaluate and may recommend another surgery, but this is uncommon.

Steps of Hydrocele Surgery in Children

If the doctor decides surgery is needed, don’t worry! The operation is simple and very safe. Here is a simplified overview of the steps:

General Anesthesia
The child is put under full anesthesia to sleep throughout the surgery and feel no pain. The anesthesia team continuously monitors the child’s safety.
Small Surgical Incision
The surgeon makes a very small cut, usually in the groin area (above the scrotum) or directly on the scrotum, depending on the hydrocele’s location and type.
Closing the Open Channel
If the hydrocele is due to the open channel between the abdomen and scrotum, the surgeon carefully closes this channel to prevent fluid from returning.
Draining Fluid and Removing the Sac
The fluid accumulated around the testicle is drained. The surgeon may also remove or repair the sac to prevent recurrence.
Closing the Wound
Finally, the surgeon closes the incision with fine dissolvable stitches, so there’s no need to remove them later. The wound heals easily and safely.

Advantages of the Surgery:

Takes about 30 minutes only
The child usually goes home the same day or next day
Recovery is quick and requires only a few days of rest

When Does Hydrocele Disappear in Children?

In most cases, hydrocele in children resolves on its own without treatment within the first year of life. This happens because the channel between the abdomen and the scrotum (called the processus vaginalis) gradually closes on its own, and the fluid around the testicle is naturally absorbed over time.

However, in some children, the condition may:

Persist beyond the first year
Disappear and then reappear later
Increase noticeably in size over time

In these cases, it is important to follow up with a pediatrician or pediatric surgeon, as the child may require medical or surgical intervention if the hydrocele remains after two years of age.

When Should I See a Doctor Immediately?

Contact a doctor if you notice any of the following:

The hydrocele is still present after the child is one or two years old
The swelling increases in size over time
The swelling becomes painful or red
The child suddenly cries without an obvious reason
The hydrocele disappeared but then returned

Early follow-up helps prevent potential future health problems.

What Can Happen If Hydrocele Is Left Untreated?

Neglecting treatment of hydrocele can lead to serious complications, especially if it persists for a long time, including:

Infection
Fluid accumulation around the testicle for an extended period may cause infection, leading to inflammation, severe pain, and possible impact on sperm production later in life.
Fertility Problems
If the hydrocele affects testicular function, it may reduce sperm production as the child grows, potentially impacting fertility in the future.
Inguinal Hernia
In some cases, a hydrocele can develop into an inguinal hernia, which happens when part of the intestine pushes into the inguinal canal. This condition is dangerous and requires urgent surgical treatment.

Types of Hydrocele in Children

Hydrocele (or fluid around the testicle) is not just one type—it has several forms, each with different causes and symptoms. Here’s a simple overview of the main types:

Congenital Hydrocele
The most common type in infants.
Caused by an open channel between the abdomen and the scrotum (processus vaginalis), allowing fluid to collect around the testicle.
Present at birth and usually disappears within the first 1–2 years.
Acquired Hydrocele
Develops after birth due to infections or injury to the testicle or scrotum.
Fluid accumulates due to inflammation or disrupted fluid drainage.
Communicating Hydrocele
A special form of congenital hydrocele where the channel remains open, allowing fluid to move back and forth.
Swelling increases when the child cries or moves.
Non-communicating Hydrocele
The channel is closed, but fluid remains trapped around the testicle.
The swelling size is stable and does not change with movement or crying.
Epididymal Hydrocele
Fluid collects around the epididymis (the tube that carries sperm).
Less common in children, appears as a slight swelling.
Spermatic Cord Hydrocele
Fluid accumulates along the spermatic cord rather than directly around the testicle.
Causes swelling in the groin or upper scrotum.
Secondary Hydrocele
Occurs due to other problems such as:

Testicular infections
Direct injuries
Tumors
Blood vessel issues
Usually accompanied by pain, redness, or fever.

Giant Hydrocele
A rare but serious type with a large fluid collection causing significant swelling.
May press on the testicle or interfere with walking, requiring urgent treatment.
Inflammatory Hydrocele
Caused by inflammation of the testicle or epididymis.
Fluid accumulates as a response to inflammation.
Chronic Hydrocele
A long-lasting hydrocele that does not improve.
May cause testicular problems or reduced function if untreated.
Hydrocele with Inguinal Hernia
Occurs when an inguinal hernia is present along with fluid accumulation around the spermatic cord.
Usually requires surgical intervention.
Hematocele (Blood Hydrocele)
A rare type where the fluid contains blood, usually due to injury or trauma.
Needs prompt and accurate diagnosis and treatment.

What Are the Causes of Hydrocele (Fluid Around the Testicle) in Children?

Hydrocele is a collection of clear fluid around a child's testicle, appearing as swelling in the scrotum. The causes vary, but most are not serious and often resolve on their own over time. Here are the main causes explained simply:

Unclosed Channel After Birth
During pregnancy, the testicles descend from the abdomen into the scrotum through a small channel. Normally, this channel closes after birth, but if it remains open, fluid can pass through and form a hydrocele around the testicle.
Natural Fluid Accumulation
Sometimes the child’s body produces fluid around the testicle for no clear reason. This is very common and usually disappears on its own within the first year.
Infections or Injuries
If there is inflammation or injury to the testicle or scrotum (like a blow or trauma), the body may produce fluid as a reaction, causing a hydrocele.
Blocked Fluid Drainage Channels
In some cases, the channels responsible for draining fluid from the scrotum may be weak or blocked, leading to fluid buildup around the testicle.
Premature Birth
Premature babies (born before term) are more likely to develop hydrocele because the channel between the abdomen and scrotum takes longer to close.
Changes in Abdominal Pressure
When the child cries hard or strains, the abdominal pressure increases. If the channel is still open, fluid can flow from the abdomen into the scrotum and collect around the testicle.
Presence of Inguinal Hernia
Sometimes a child may have a small hernia near the testicle, which allows fluid or part of the intestine to enter the scrotum, appearing as swelling or hydrocele.
Weakness in the Lymphatic System
If there is a problem with the lymphatic vessels that drain fluid from the body, fluid can accumulate around the testicle.
Congenital Abnormalities
Some children are born with defects in their reproductive or urinary systems that affect fluid drainage, causing fluid to collect around the testicle.
Increased Fluid Production by the Testicular Membrane
The membrane surrounding the testicle sometimes produces more fluid than normal, leading to hydrocele even without other issues.
Chronic Infections
Repeated or chronic infections in the scrotal area can cause continuous fluid buildup.
Genetic or Metabolic Disorders
In very rare cases, certain genetic diseases or metabolic problems can affect the body’s fluid balance and lead to hydrocele formation.

When Does a Hydrocele Need Surgical Intervention?

If the hydrocele persists beyond the child’s first year of life, or if it starts causing problems such as pain or a significant increase in size, the doctor will likely recommend a simple surgical procedure to remove the fluid and fix the issue.

This surgery is very safe and usually resolves the problem permanently, helping the child return to normal quickly.

Main Treatment Options for Hydrocele in Children:

Hydrocelectomy (Surgical Removal of the Hydrocele)
This is a very simple surgical procedure where the surgeon makes a small incision in the scrotum or lower abdomen. Through this incision, the doctor drains the fluid collected around the testicle.
The surgeon also checks if there is a connection between the testicle and the channel that carries sperm and closes it to prevent fluid from accumulating again.
After the surgery, the child can usually go home the same day. Parents should keep the wound clean and dry.
A follow-up visit is necessary after a few days to ensure proper healing.
Needle Aspiration
In some cases, the doctor may use a small needle to drain the fluid from the scrotum.
Sometimes a special substance is injected afterward to prevent the fluid from reaccumulating.
This method is less common than surgery and may have a higher chance of the hydrocele coming back but can be an option in specific cases.

Steps of Hydrocelectomy Surgery in Children:

Anesthesia:
The child is given general anesthesia to prevent any pain during the operation.
Small Surgical Incision:
The surgeon makes a small cut in the scrotum or lower abdomen depending on the location and size of the hydrocele.
Draining the Fluid:
The surgeon drains the fluid collected around the testicle.
Closing the Open Channel:
If the hydrocele is caused by an open channel between the abdomen and the scrotum, the surgeon closes this channel to prevent fluid from returning.
Closing the Incision:
The incision is closed with dissolvable stitches that will disappear over time without needing to be removed.

Important Post-Operative Care Tips:

Rest:
Let the child rest well and avoid strenuous activities. They should resume daily activities gradually.
Gradual Walking:
For older children, gradual walking is encouraged to improve blood circulation and reduce complications.
Bathing:
The child can take a bath 24 hours after surgery, but the surgical site must be dried carefully. Avoid full baths for about a week unless the doctor permits.
Return to School:
Usually, the child can go back to school 4 to 7 days after surgery unless the doctor advises otherwise.
Avoid Strenuous Activities:
The child should avoid heavy physical activities such as cycling or intense sports for 2 to 4 weeks.
Hydration:
Make sure the child drinks plenty of fluids.
Light Diet:
If the child has stomach discomfort, offer light, easily digestible foods like plain rice, grilled chicken, toast, and yogurt.

Recovery Period After Hydrocele Surgery in Children:

The child needs rest to fully recover.
Avoid rough play or strenuous activities for 2 to 3 weeks.
Monitor the surgical wound regularly for redness, swelling, or discharge.
Clean the wound gently with mild soap and water.
Dress the child in loose, comfortable clothing to avoid irritation.
Follow up with the doctor to ensure proper healing.

Possible Risks After Hydrocele Surgery:

Infection:
Signs include redness, pain, or pus at the surgery site. If infection occurs, the doctor will prescribe antibiotics.
Bleeding:
Minor bleeding may happen but usually stops quickly without complications.
Recurrence of Hydrocele:
In rare cases, the hydrocele may come back after surgery, requiring further medical attention.

The Specialist Who Treats Hydrocele in Children:

The treating doctor is usually a Pediatric Surgeon, specialized in diagnosing and treating surgical conditions in children, especially those related to the reproductive system and scrotum like hydroceles and inguinal hernias.

In some cases, a Pediatric Urologist may also be involved, especially if there are broader issues with the testicles or urinary system.