Hydrocele, known colloquially as a water hernia, is especially common in newborns.
During the development of the fetus in the womb, between 12 and 14 weeks, the testicles or ovaries form in the abdomen near the kidneys. As the baby continues to develop, they gradually move towards the lower abdomen. As it moves down, part of the peritoneum (the membrane lining the inside of the abdomen) adheres to the testis and forms a sac with it, and is pulled into the scrotum (scrotum). A similar process occurs in girls when the round ligament of the uterus descends into the groin. This sac is known as the processus vaginalis.
This sac should normally close towards birth. If fluid comes from the abdomen before closing, stays around the testis and becomes imprisoned, it becomes a hydrocele. Sometimes, with a small amount of opening of the closed canal in advanced ages, fluid can enter around the testicle and form a hydrocele.
Types of Hydrocele
We divide the hydrocele we see in babies or children into two;
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Communican hydrocele: Here, the peritoneum descending to the esophagus is completely open. When the child lies down during the night or during the day, the fluid returns to the abdomen, and the amount of fluid increases when standing. Painless swelling in the testicles that grows slowly over time is among the symptoms of hydrocele.
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Non-communican hydrocele: It is the most common type in the neonatal period. The fluid around the testis has no relation with the intra-abdominal cavity. The pouch is closed. The size of the hydrocele does not change. Under normal conditions, this liquid is absorbed slowly in babies after birth.
Sometimes it may occur as a result of testicular tumor, kidney tumor, trauma or testicular rotation in advanced ages. Therefore, it should be investigated whether there is an underlying cause in older children.
How is hydrocele diagnosed?
It is detected in the form of a water sac around the testis in the physical examination performed after birth in newborns. It is painless. Fluid does not decrease by suppressing the hydrocele. On the other hand, in communicating hydroceles, the amount decreases as the fluid will go into the abdomen with pressure.
It is sometimes difficult to distinguish from a strangulated hernia in non-communicant cases that occur suddenly. In this case, by holding a light source from the bottom of the bag, we can understand whether there is an organ (such as the intestine) in the bag.
What is the treatment for hydrocele?
Non-communican hydrocele in newborns is usually expected until the age of two. However, if the hydrocele is very large and it is thought that it may damage the testis, surgery can be decided after the age of one. In these patients, the procedure of draining the fluid with a needle should never be performed. As it does not cure, it can create a risk of infection in the testis.
In those who are communicating, the treatment is surgery. Hydrocele seen in children is usually accompanied by hernia. In the case of hydrocele seen with hernia, immediate surgical intervention is recommended. It is the same as inguinal hernia surgery. It is a day surgery.