Congenital Hydrocele - Causes, Symptoms, and Management in Infants

What Is a Hydrocele?

A hydrocele is an accumulation of watery fluid that can occur around one or both of the testicles. It might lead to swelling in the genital area or the scrotum. A congenital hydrocele is one that is present at birth in the newborn.

How Is a Congenital Hydrocele Formed?

• A baby's testicles move from the area of the belly down into the scrotum about a month or two before birth, along with a bit of the lining of the belly area throughout this process. The lining becomes thinner, which results in the creation of a circumferential void around the testicles.

• Typically, by the time a baby is two years old, this area will have been filled in. Sometimes, fluid will leak into the area, which will eventually cause it to fill up like a miniature water balloon. A hydrocele is what one sees here. A non-communicating hydrocele is a term used to describe in medical language when the space cannot remain open, and the fluid becomes trapped inside. In most cases, the body will absorb the fluid over time. If the space does not seal up the way it should, fluid will travel freely between the scrotum and the area around the belly. A communicative hydrocele is the medical term for this condition. The swelling appears and disappears at random. Surgery is the typical treatment for this condition, as it helps to prevent a hernia in the groin area.

• A hydrocele of the spermatic cord is a subtype of the more general condition known as hydrocele. It can be found closer to the top of the scrotum. Typically, the fluid is absorbed within a few months and, at the very latest, between the ages of one and two.

What Are the Causes of Congenital Hydrocele?

Four primary causes can be responsible for the development of hydrocele. These are discussed in further detail below:

• Creating a link with the abdomen using a natural passage called the "processus vaginalis" present since birth.

• An abnormally high rate of fluid production (secondary hydrocele).

• Impairment in the body's ability to absorb fluid.

• Disruption with the lymphatic drainage of the scrotal tissues, such as in filarial hydroceles (fluid-filled swellings due to a parasitic infection).

What Are the Symptoms of a Congenital Hydrocele?

The primary symptom is a painless, enlarged scrotum that feels like a water-filled balloon on one or both sides of the scrotum. It is painless unless the swelling becomes significantly large, which might cause discomfort.

What Is the Frequency of Congenital Hydrocele?

Around 80 to 90 percent of term male newborns have a hydrocele at the time of birth. This number continues to fall until it stabilizes between 25 and 40 percent when the child is two years old. The data obtained from autopsies suggest that the hydrocele remains patentable until a later stage in adult life at a frequency of 20 percent. However, only six percent of these conditions show any signs of clinical manifestation after the newborn period.

What Are the Diagnostic Tests for Congenital Hydrocele?

1. Imaging Studies: These are useful in diagnosing and determining the severity of hydrocele. They can also determine whether or not there are any underlying conditions, such as epididymitis, testicular torsion, or testicular malignancy (cancerous condition of the testis).

2. Ultrasonography: Scrotal pain or an inability to distinguish the testicular structure through probing are indications for ultrasonography because the test can reveal great detail of the testicular parenchyma. Ultrasonography can be performed. During the ultrasonography examination, a hydrocele will appear as a region surrounding the testis that is echo lucent or anechoic (areas on an ultrasound that appear dark or black). The hydrocele could be measured and characterized more accurately with the use of ultrasonography as well. Through ultrasonography, a clear distinction can be made between testicular atrophy, spermatoceles, and testicular malignancies.

• Duplex Ultrasonography: The information acquired through duplex ultrasonography pertains to the testicular blood flow, which is reduced or absent in hydroceles caused by testicular torsion. In the case of epididymitis-related secondary hydroceles, the epididymal flow would be increased. In addition, duplex imaging helps determine the regurgitant flow (backflow) in varicoceles.

• Plain Abdominal Radiography: An incarcerated (structure is trapped or confined within a tight space or cavity) inguinal hernia is occasionally identifiable by the presence of gas over the groin area on a simple abdominal radiograph.

What Are the Treatment Options and Management Therapies for Congenital Hydrocele?

Surgery is the preferred treatment for hydrocele, and it is necessary when the condition becomes severe or symptomatic. If congenital hydroceles do not cure naturally, a herniotomy (surgical procedure performed to repair a hernia) is performed. In contrast, some hydroceles diminish when the fundamental underlying condition resolves by treatment. There are two standard surgical techniques for hydrocelectomy:

1. Plication: This procedure is suitable for hydroceles with thin walls. Due to the limited dissection, the risk of hematocele or infection is greatly diminished.

2. Excision and Eversion: This procedure is appropriate for big hydroceles with thick walls. It entails subtotal excision of the tunica vaginalis and everting of the sac behind the testicles, followed by placement of the testicles in a newly generated pocket between the fascial layers of the scrotum.

3. Aspiration: This is an alternative treatment for hydrocele, especially for those who cannot undergo surgery. Within a week or so, hydrocele fluid almost always reaccumulates. In addition, the risk of infection is significant following aspiration. It has been demonstrated that aspiration followed by an injection of a sclerosant (Tetracycline or Doxycycline) is successful.

What Are the Complications Following the Surgery for Hydrocele?

The complications include bleeding, the formation of cysts or tumors following the surgery, and edema (swelling) of the scrotal sac can occur.

What Will Be the Treatment Outcome?

The treatment outcome for a congenital hydrocele will be good, but the outcome for a hydrocele that started in adulthood depends on the factor that caused it. Most hydroceles present at birth go away by the end of the first year. If they do not go away, they can be fixed with surgery, which has a high success rate and an excellent long-term outcome. When done by a skilled doctor, repairing a hydrocele does not put the testicles at risk or cause the problem of recurrence.

Conclusion:

Even while hydroceles in babies typically recover on their own, careful monitoring is still required because of the condition. Parents have an important part to play in this regard. It is recommended that a surgeon be consulted to manage such hydroceles if they last beyond the age of two years.