Generally hydroceles in young boys shares the same underlying aetiology as indirect inguinal herniae – failure of closure of the patent processus vaginalis following testicular descent.
The diameter of the patent processus vaginalis is what differentiates hernia from hydrocele – in hydroceles it only allows passage of intraperitoneal fluid.
Non-communicating hydroceles are very rare prior to puberty.
Communicating hydroceles common in newborn boys – 2 – 5 %.
- More than 90 % will resolve within the first year of life with closure of PPV.
- Some more will further resolve in the second year of life.
Presentation:
- Presents as a painless swelling which may be variable in size or fluctuating in size, typically worse at the end of the day.
- Occasionally may develop following viral illness or VP shunt insertion.
- Occasionally may be secondary to tumour or incarcerated omental hernia.
- Principal differential diagnosis is inguinal hernia – which may be reducible cf. hydrocele. Transillumination may not be reliably diagnostic in infants.
- Encysted hydroceles (of the cord) may present as a lump in the groin. A hydrocele of the cord will move when testis is pulled downward, cf. a hernia which won’t.
- Ultrasound is helpful in non clear cut cases.
Management:
- Conservative management for first 1-2 years of congenital hydroceles, most will resolve
- If persisting beyond 1-2 years, operative management can be considered
- If new hydrocele not present in childhood, consider exploration and operative intervention
- Groin incision, mobilisation of the cord, separation of the vessels and vas from processus vaginalis and ligation at the junction to peritoneal cavity. Then drain the fluid.
- Same as for inguinal hernia
- If concern for non communicating hydrocele – combine with scrotal procedure to evert sac