Hydrocele (Pediatric)

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What is a hydrocele?

A hydrocele occurs when fluid accumulates between the testis and the tunica vaginalis, a thin pouch that holds the testes within the scrotum. In the fetus, the tunica vaginalis is formed in the abdomen and then migrates into the scrotum with the testes. After the pouch is in the testes, it seals off from the abdomen. There are two types of hydrocele:

Communicating hydrocele

Communicating hydrocele occurs from the incomplete closure of the tunica vaginalis, and a small amount of abdominal fluid may flow in and out of the thin pouch. This type is distinct because fluid fluctuates throughout the day and night, altering the size of the mass.

Noncommunicating hydrocele

Noncommunicating hydrocele may be present at birth and usually resolves on its own within one year. A noncommunicating hydrocele in an older child may indicate other problems, such as an infection, torsion (twisting of the testes), or a tumor. Always consult your child's doctor for a diagnosis.

A hydrocele is present in as many as 10 percent of all full-term male live births. However, in most cases, the hydrocele disappears without treatment in the first year.

What are the symptoms of a hydrocele?

Common symptoms of a hydrocele are:

• A mass that is usually smooth and not tender.
• A communicating hydrocele fluctuates in size, getting smaller at night while lying flat and increasing in size during active periods in the day or during coughing or straining.
• A large, tense mass that requires immediate evaluation.

Each child may experience symptoms differently. The symptoms of a hydrocele may also resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.

How is a hydrocele diagnosed?

Diagnosis of a hydrocele is usually made by a physical examination and review of a complete medical history. Your child's doctor may need to determine if the mass is a hydrocele or an inguinal hernia.  An inguinal hernia in children allows intestine to enter the scrotum through a large patency in the tunica vaginalis Transillumination may help to differentiate a hernia from a hydrocele by passing a strong light through a body structure and permitting inspection of the scrotum's opposite side.  Transillumination should be confirmed by physical examination or ultrasound.

What is the treatment for a hydrocele?

A noncommunicating hydrocele usually resolves spontaneously by the time children reach their first birthday. Resolution occurs as fluid is reabsorbed from the pouch.

A hydrocele that persists longer than 12 to 18 months is usually a communicating hydrocele, which requires surgical repair to prevent an inguinal hernia. Surgery involves making a small incision in the groin or inguinal area and then draining fluid and closing the opening to the tunica vaginalis.

What happens if urologic abnormalities are detected in utero?

Doctors sometimes detect fetal abnormalities when women have routine sonograms during pregnancy. Many of these abnormalities are in the baby's developing kidneys, ureters, or bladder. We work closely with other specialists in obstetrics, neonatology, and pediatric anesthesiology, as well as surgeons in all pediatric sub-specialties, to detect urologic problems and ensure a seamless transition from pregnancy to delivery to treatment of your baby after birth. We are known for our advanced treatment of the following conditions:

Hydronephrosis

Hydronephrosis, sometimes called "large kidneys" or "swollen kidneys," is a term for extra fluid in the kidneys or ureters and a symptom of many of the conditions listed here. When hydronephrosis or pyelectasis is found during pregnancy, it usually resolves within the first few years of the child's life. Our experienced pediatric urologists can determine the cause of the condition and whether it's a serious problem.

Ureteropelvic junction (UPJ)

Ureteropelvic junction (UPJ) obstruction is a blockage that develops where the ureter and kidney meet at the ureteropelvic junction. This obstruction is usually caused by poor peristalsis, the rhythmic propulsion of urine toward the bladder. Obstructions also develop if the ureter is narrow, kinked, or compressed by a blood vessel. Surgeons can remove a section of the ureter to reestablish normal flow between the healthy sections.

Vesicoureteral reflux (VUR)

Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder into the ureter and kidney. Most low-grade reflux resolves itself during the first few years of a child's life. Doctors often use daily antibiotics to prevent urinary tract infections (UTIs), as children with UTIs and reflux can go on to develop kidney infections (pyelonephritis) and sometimes kidney damage. In some cases, reflux requires surgical treatment.

Ureterovesical junction obstruction (UVJ)

Ureterovesical junction obstruction (UVJ) is a blockage at the point where the ureter enters the bladder. UVJ obstructions usually develop because a section of the ureter near the bladder is narrowed and has poor peristalsis. Surgeons may remove the obstructed segment and taper or narrow the ureter so it fits properly into the bladder.

Ureterocele

Ureterocele is a cyst-like enlargement of the ureter in the bladder. It is typically found in children who develop two ureters instead of one draining the kidney. Treatment of the ureterocele depends on the size and how well the kidney functions. Surgeons may puncture and/or remove ureteroceles that obstruct drainage of the kidney.  If reflux occurs, further operations may be indicated for repair.

Ectopic ureter

Ectopic ureter is a condition in which one or both ureters drain somewhere other than the bladder. Like ureteroceles, ectopic ureters usually develop in children with two instead of one ureter and can be quite dilated. In females, ectopic ureters may cause continuous incontinence. Doctors usually correct this problem through surgery.

Posterior urethral valves (PUV)

Posterior urethral valves (PUV) are abnormal leaflets (valves) in the male urethra that partially or completely block the flow of urine out of the bladder. PUV can cause mild to severe hydronephrosis in one or both kidneys, but in many cases the kidneys function reasonably well. Bladder development is also affected by the obstruction of urinary flow.  The bladder is evaluated with urodynamic testing to determine if medication or catheterization is needed.  Children with PUV should be delivered and cared for in a medical center with doctors from all pediatric specialties (anesthesia, neonatology/ICU, pediatric urology, and pediatric nephrology).  The bladder will be drained with a catheter after birth.  The PUV will be incised to allow urine drainage.  Future procedures may be needed if your child has reflux, poor kidney function, and/or poor bladder function.

Prune belly syndrome (PBS)

Prune belly syndrome (PBS) is a rare condition in which a male child has insufficient abdominal wall muscles, a wrinkled abdominal wall, testes in the abdomen, and abnormalities of the urinary tract. Many other abnormalities are associated with PBS and require the attention of specialists in anesthesia, neonatology/ICU, pediatric urology, pediatric nephrology, cardiology, and pulmonology. Treatment generally includes surgery to bring the testes into the scrotum, correct the ureteral reflux, and reconstruct the abdominal wall.

Multicystic dysplastic kidney (MCDK)

Multicystic dysplastic kidney (MCDK) is a kidney that has been replaced by nonfunctioning cysts. The other kidney usually functions well in children with MCDK and they are able to lead a normal life. Studies show many MCDKs eventually shrink and rarely do they need to be removed in newborns.