Hydrocele

Hydrocele is the accumulation of fluid in the scrotum. This condition is common in newborns and usually disappears without treatment by one year of age.

Hydrocele does not affect testicular function and is caused by the passage of fluid through an orifice that communicates the abdominal cavity with the inguinal region. Normally, the communication with the abdominal cavity eventually closes and the fluid is gradually reabsorbed, causing the hydrocele to disappear spontaneously during the first year of life.

When the hydrocele is not congenital but appears during adolescence or adulthood (acquired or "adult-type" hydrocele), it is due to a loss of balance between the production and absorption of fluid by the sheaths surrounding the testicle, resulting in fluid accumulation.

Hydrocele can be: communicating

• Communicating: when the communication with the abdomen remains open and allows the passage of fluid in both directions.
• Non-communicating or cord cyst: when the communication with the abdominal cavity is closed and a liquid cyst remains in the duct or in the scrotum.

Symptoms of hydrocele

Hydrocele is perceived as an accumulation of fluid in the scrotal sac or groin. It is not usually painful and does not usually become infected.

Symptoms may manifest differently depending on whether it is communicating or non-communicating. In the first case, it is usual for the parents to report a normal appearance of the scrotum in the morning and, throughout the day, the scrotum increases in size.

When parents consult for suspected hydrocele, they usually report that the child wakes up with a normal sized scrotum but it increases in size throughout the day. This is due to the fact that during rest, while the child remains lying down, the liquid returns to the abdominal cavity and, during the day, after hours of standing and moving, the liquid descends to the scrotal sac and the increase in size can be seen.

In non-communicating hydrocele, the scrotum remains swollen throughout the day with no change in size throughout the day.

Diagnosis of hydrocele

The diagnosis of hydrocele is based on clinical history and physical examination, reserving ultrasound for those patients who may be difficult to diagnose due to anatomical anomalies or previous interventions.

Classically, hydrocele was diagnosed by transillumination, which consists of illuminating the interior of the scrotum by projecting a light onto the scrotal skin and observing the presence of the displaced testicle due to the presence of fluid inside the scrotum. At present, careful physical examination by the specialist in pediatric surgical pathology is sufficient to confirm the diagnosis.

Hydrocele treatment

In a very high percentage of cases, the hydrocele resolves on its own because the communication with the abdominal cavity closes spontaneously and the fluid in the scrotum is reabsorbed. This usually occurs before one and a half years of life.

From 18-24 months of age, the chances of the hydrocele resolving on its own are reduced and in these cases surgical intervention is indicated.

The main reason for indicating surgery, according to the Spanish and European guidelines for pediatric surgery, is that the hydrocele can give way to an inguinal hernia, since the mechanism by which it is produced is the same.

Surgery is performed through a small incision in the inguinal crease. Communication with the abdominal cavity is sought, closed and the contents of the hydrocele are emptied. Recovery is usually good and complications are not frequent.

In the "adult type" hydrocele, the intervention is performed via the scrotal route and consists of resecting part of the lining to prevent the accumulation of fluid and empty the contents of the hydrocele.