When the testicle moves out of the abdomen and into the scrotum during pregnancy, a “sac” of tissue sticks to the front of the testicle and descends with it. This normally closes before birth, trapping some fluid inside the sac, known as a hydrocele. Newborn boys usually have these hydroceles, which sometimes can be quite large, but these resolve themselves without treatment.
This is an infant with large hydroceles on both sides that nearly hide the penis. Despite this appearance, nearly all newborn hydroceles resolve themselves without surgery.
A hernia in a child occurs when this sac does not close or comes open later and intestines or other structures within the abdomen enter the sac. Fortunately, the risk of intestines becoming trapped and injured in a hernia is very small in most children, especially after infancy. Surgery is done to replace structures back into the abdomen and to close the sac. This can be done with a skin incision in the groin, or using laparoscopy. At PARC Urology we do laparoscopic repair in most children, which needs only a tiny puncture through the groin skin.
The tiny puncture wound used in a laparoscopic hernia repair to close the sac is seen in the groin (arrow).
A “communicating hydrocele” means the sac is open or comes open later, but only fluid, not intestines, is within the sac. These are also common in infants, but most will close on their own within the first 2 years of life and do not need surgery. Some will also close on their own in older boys, and the risk of a communicating hydrocele becoming a hernia and trapping intestines is very low. Our specialists usually suggest a time of observing a new hydrocele to see if it will close on its own. If it doesn’t, the short laparoscopic procedure to close the sac can correct the problem with a very high success rate.