Hydrocele in Children in Lebanon — القيلة المائية عند الأطفال

What Is a Hydrocele?

A hydrocele is a fluid-filled sac surrounding the testicle that causes swelling in the scrotum. It is one of the most common conditions seen in newborn boys and young children. During fetal development, the testicles descend from the abdomen into the scrotum through a passage called the processus vaginalis. Normally, this passage closes before or shortly after birth. When it remains partially open, abdominal fluid can flow into the scrotum, creating a communicating hydrocele. When the passage has closed but fluid remains trapped around the testicle, it is called a non-communicating (or simple) hydrocele. Hydroceles are usually painless and are not harmful to the testicle, but they require proper evaluation to distinguish them from more serious conditions such as inguinal hernia.

Signs and Symptoms

The primary sign of a hydrocele is painless swelling of one or both sides of the scrotum. In a communicating hydrocele, parents often notice that the swelling changes in size — it may be smaller in the morning and larger after activity or crying, because fluid shifts with gravity and abdominal pressure. A non-communicating hydrocele tends to remain a stable size. The swelling is typically soft and smooth. If the scrotal swelling becomes suddenly tense, painful, or red, or if the child is vomiting, parents should seek urgent medical attention — these signs may indicate an incarcerated inguinal hernia or testicular torsion rather than a simple hydrocele.

When to See a Pediatric Urologist

Parents should consult a pediatric urologist if their child has persistent scrotal swelling beyond 12 months of age, if the hydrocele is increasing in size, or if there is any concern about an associated inguinal hernia. In newborns, a small hydrocele identified at birth can be monitored, as many will resolve spontaneously within the first year of life. However, evaluation by a specialist ensures the diagnosis is correct and rules out conditions that may look similar, such as an inguinal hernia, varicocele, or testicular tumor. Early referral also gives parents a clear timeline and plan.

How Is It Diagnosed?

Diagnosis is primarily clinical, based on physical examination. The pediatric urologist will assess the size, consistency, and transillumination of the scrotal swelling — when a light is held against the scrotum, a hydrocele will glow (transilluminate) because it contains clear fluid, whereas a solid mass will not. The doctor will also examine the inguinal (groin) region to check for a hernia. In most cases, no imaging is needed. However, an ultrasound may be ordered if the physical examination is inconclusive, if the child has bilateral swelling, or if there is concern about the underlying testis.

Treatment Options

For infants under 12 to 18 months, a communicating hydrocele is typically observed, as it may resolve on its own once the processus vaginalis closes naturally. If the hydrocele persists beyond this age, surgery is recommended. The standard procedure is an inguinal hydrocelectomy, performed through a small incision in the groin crease. The surgeon identifies and ligates (ties off) the open processus vaginalis to stop fluid from flowing into the scrotum, and drains the existing fluid. This is the same fundamental approach used to repair a pediatric inguinal hernia, because the underlying anatomy is identical — an open processus vaginalis. The surgery is performed as an outpatient procedure under general anesthesia and typically takes less than 30 minutes. Aspiration (draining the fluid with a needle) is not recommended in children because it does not address the cause and the fluid will return.

Dr. Kallas Chemaly's Approach

Dr. Kallas Chemaly performs hydrocele repair as a short outpatient procedure with an emphasis on minimal scarring and rapid recovery. He uses a small inguinal incision placed in a natural skin crease, resulting in a nearly invisible scar once healed. His fellowship training at Robert-Debré (Paris), Queen Fabiola (Brussels), and HFME (Lyon) ensures that even cases associated with inguinal hernia or bilateral involvement are managed with precision. He takes the time to explain the condition, the natural history, and the surgical plan to parents in Arabic, French, or English — so families understand when observation is appropriate and when surgery is the right choice. Most children return to normal activity within a few days of surgery.

References

• Stanford Medicine Children's Health: Hydrocele in Children
• Children's National Hospital: Pediatric Hydrocele
• MedlinePlus Medical Encyclopedia: Hydrocele