A hydrocele is a build-up of fluid inside the scrotum. The scrotum is the skin sac that holds the testicles. This fluid accumulation in the scrotum makes them look swollen or enlarged, but hydroceles are usually painless. Hydroceles occur more commonly in infants, especially premature infants, but can occur at any age. A hydrocele in infants rarely causes other associated symptoms. When it does, the symptoms can include pain or discomfort in the scrotum, feeling as though the scrotum is heavy or full and swelling or irritation in the skin around the scrotum. These hydroceles in infants usually go away on their own by end of one year of age, without any treatment. Most hydroceles develop before the child is born. About 5% of male babies have hydroceles at birth, with the chances higher if the baby is born prematurely. During development of a male foetus in pregnancy, the testes are formed in the abdomen and gradually descend down to their final position in the scrotum, normally by the time of birth. These testes descend through a sac like structure, which should seal off as soon as the testes are in the scrotum. Delayed or failure of this sac-like structure to close off will lead to leaking of normal fluids from the abdomen into the scrotum, causing the hydrocele. In such cases, this fluid might appear on and off in the affected scrotum depending largely on the baby’s positioning (increasing with standing or sitting and tending to resolve as the baby sleeps on his back, as the fluid follows gravity and leaks back into the abdomen as the baby lays on his back). Delayed closure of the sac will lead to trapped fluid inside the scrotum and this fluid normally won’t show any changes in size according to the baby’s position. As the child grows, this sac can seal off and any fluid trapped inside the scrotum is re-absorbed by the body leading to complete resolution of the hydrocele without necessitating any treatment. In adults, this can be as a result of either an injury or inflammation to the scrotum or an infection, including a sexually transmitted infection (STI) and these will usually need surgery to heal. It is however good practice that proper medical evaluation be sought for any scrotal swellings to rule out more serious causes of scrotal swelling such as hernias (which can lead to an intestine being trapped into the scrotum and this can be fatal) or a twisted testis, although most of these are usually very painful. The diagnosis of these hydroceles in babies is usually simple to make by listening to history of the symptoms and examining the baby. Usually additional tests are not needed unless the presentation is not that obvious where investigations such as an ultrasound scan imaging can be done to confirm and rule out other conditions which might mimic a hydrocele. After confirmation of a hydrocele in the baby, the doctor might advise to watch it up to the age of 2 years or less, for any resolution depending on the type of hydrocele the baby has. If self-resolution fails, treatment is surgery to drain the fluid from the scrotum or close the abnormal communication between the scrotum and abdomen. This can be done as a day care surgery, with the baby going home the same day of operation, as soon as he wakes up fully from general anaesthesia. It is important to know that these hydroceles in babies aren’t dangerous and call for no cause of anxiety to the mothers. Dr Ian Shyaka , Resident in Plastic surgery, Rwanda Military Hospital, iangashugi@gmail.com
