Hydrocele is the swelling of the scrotum caused by an accumulation of excessive fluid in the membranes surrounding the testicles. It is a common condition in male children and is also known as “water hernia” in the public. It occurs in approximately 1-2% of newborns. Usually, it is congenital and may resolve spontaneously in some cases. However, if it does not heal on its own, treatment is required. The treatment approach is generally the same as for inguinal hernia (see inguinal hernia).

Symptoms

The most noticeable symptom of hydrocele is a painless swelling around the testicles or in the scrotum (testicular sac). The size of the swelling may fluctuate over time. This fluctuation is related to the presence of an open inguinal canal on the affected side, meaning hydrocele often accompanies inguinal hernia.

If untreated, hydrocele may cause several problems. The fluid collected around the testicles raises the temperature of the area above the level needed for healthy testicular development, reducing sperm production capacity. The swelling may grow over time and cause discomfort for the child. A large hydrocele can cause cosmetic concerns and affect the child’s social life. The fluid around the testicle can also become infected.

Treatment

It has been observed that in nearly half of children up to about 1 year of age, hydrocele resolves spontaneously and disappears completely. Therefore, suspected hydrocele cases should be evaluated by a pediatric surgeon and regularly monitored. If the hydrocele persists after the child turns 1 year old or if complications such as infection, rapid growth, or pain develop, surgery should be considered.

There are two surgical methods. Laparoscopic (minimally invasive) surgery has become more commonly preferred in recent years. The scrotal fluid is drained by closing the inguinal canal. In rare cases where the inguinal canal is already closed, open surgery is performed.

Most children recover quickly after surgery with minimal pain. The surgery is done on an outpatient basis, meaning the child goes home the same day.

Although complications such as bleeding, damage to the testicles or surrounding structures, and recurrence have been reported, these risks are less than 1% in experienced centers and are more rare in laparoscopic surgery.

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