Pediatric
Hydrocele in Infants and Children
Hydrocele in Infants and Children
A parent's guide to the swelling, treatment decisions, surgery and recovery
Sources reviewed: 4 November 2026
First, what is a hydrocele?
If you notice swelling around your child's testicle, one possible cause is a hydrocele. This means fluid has collected in the covering around the testicle. It can affect one side or both, and it is usually painless. We still need to examine your child, because swelling in this area can have other causes. [4,6]
Where does the fluid come from?
Before birth, the testicles move down from the abdomen into their usual position. A small passage may remain open between the abdomen and the area around the testicle. Fluid can travel through it. This is called a communicating hydrocele, and the swelling may change size during the day. If the passage has closed but fluid remains trapped, it is called a non-communicating hydrocele. [4,8]
A congenital hydrocele is not caused by something the mother did during pregnancy. If swelling first appears in an older child, we assess the cause. Inflammation, injury and other conditions can also produce fluid around the testicle. [1,5]
Is it the same as an inguinal hernia?
No. A hydrocele contains fluid. With an inguinal hernia, tissue from the abdomen, such as bowel, can pass through the opening. A child may have both, and a hernia changes the treatment plan. [4,5]
Sudden severe pain, or a hard, painful swelling, especially with vomiting, needs emergency assessment. Do not assume it is just the hydrocele. A trapped hernia or a twisted testicle must be ruled out promptly. [4]
Does my child need an ultrasound?
We can often diagnose a hydrocele from the history and examination. An ultrasound is useful if the diagnosis is uncertain, the testicle cannot be properly examined, or another condition is suspected. A scan is not needed for every child. [1,6]
Does every hydrocele need an operation?
No. Many infant hydroceles settle without surgery. Observation is usually the first approach during the first year, provided there is no associated hernia or concerning testicular condition. For selected children, observation can continue beyond the first birthday. We consider the child's age, examination and whether the swelling is improving. [1,2,3]
Even an apparently communicating hydrocele in an infant does not automatically require immediate surgery. Some resolve during observation. This is different from a confirmed inguinal hernia. Observation should include a review plan and advice about changes that need medical attention. [2]
We discuss surgery when the hydrocele does not settle over time or becomes large and troublesome. Suspected hernia or underlying testicular disease requires earlier assessment and treatment according to the cause. There is no single operation age that suits every child. [1,3,5]
What happens during surgery, and how long does it take?
The operation commonly takes about 30 to 60 minutes. It may take more or less time depending on the findings, whether one or both sides need treatment, and the approach. Preparation, anesthesia and recovery add to the time your child spends away from the ward. [4,7]
General anesthesia is usually used. For a communicating hydrocele, the surgeon closes the open passage and drains the collected fluid. This can be done through a small groin incision; a laparoscopic approach is another option in suitable cases. Keyhole surgery is not necessary for every child. The skin is usually closed with stitches that dissolve. [1,8]
What are the risks?
Complications are uncommon, but bleeding, wound infection and recurrence can occur. Injury to the sperm-carrying tube or the blood vessels supplying the testicle is rare. The anesthetist will also explain anesthesia risks in relation to your child's age and health. [6,7]
How should we prepare?
• Tell the team about medical conditions, allergies, medicines and any previous anesthesia problems. Tests are arranged according to your child's assessment. [5,11]
• Contact the team if your child develops a cough, cold or fever before surgery. The timing may need to change after assessment. [6]
• Follow the hospital's written fasting instructions. Ask specifically about breastfeeding, milk and other fluids. Different intake types have different fasting requirements. [6,7]
• Make sure you understand the reason for surgery, the proposed approach, pain relief and home care. [5,11]
When can my child feed, and when can we go home?
Once your child is sufficiently awake, the recovery team will guide you about restarting breastfeeding or age-appropriate fluids, then the usual diet as tolerated. Most children go home the same day after satisfactory recovery, comfort and feeding or drinking. Very young infants and some children with other medical conditions may need overnight observation. [5,8,9]
Some wound discomfort, bruising and swelling around the testicle are expected. Use the pain medicine, dose and timing provided for your child's age and weight. Swelling can take several weeks to settle fully. Its presence on the first day does not, by itself, mean the operation has failed. Overall, the area should gradually improve. [6,9]
What should we do at home?
Keep the wound clean and follow the hospital's dressing and bathing instructions. When the wound can get wet depends on how it was closed. Do not pull off the adhesive or apply creams unless advised. [8,9]
Allow gentle activity as comfort improves. School-age children often return within a few days to a week, once comfortable enough to take part. Cycling, straddle toys, rough play and strenuous sport are usually restricted for about two to three weeks, sometimes longer according to the surgeon's instructions. [7,8]
Before leaving, obtain written advice about pain relief, wound care, activities, follow-up and whom to contact with concerns. [6,9]
When should we seek help?
Contact the team promptly for increasing or uncontrolled pain, spreading wound redness or warmth, discharge, persistent bleeding, repeated vomiting, difficulty passing urine or fever. [8,9]
Sudden severe pain with swelling around the testicle needs emergency assessment before or after surgery. A baby younger than three months with a temperature of 38°C or higher needs urgent medical assessment. Breathing difficulty or being hard to wake requires emergency help. [4,10]
1. European Association of Urology / European Society for Paediatric Urology. EAU Guidelines on Paediatric Urology, 2026: Hydrocele. Clinical guideline. Open source
2. Koski ME, et al. Infant communicating hydroceles—do they need immediate repair or might some clinically resolve? Journal of Pediatric Surgery. 2010;45(3):590-593. DOI: 10.1016/j.jpedsurg.2009.06.026. PMID: 20223325. Open source
3. Kurobe M, et al. The outcomes of conservative management and the natural history of asymptomatic hydroceles in children. Pediatric Surgery International. 2020. DOI: 10.1007/s00383-020-04720-1. PMID: 32700002. Open source
4. American Academy of Pediatrics, HealthyChildren.org. Grant C, Jaeger C. Scrotal Swelling in Children: What Is a Hydrocele? Parent education. Open source
5. Great Ormond Street Hospital. Inguinal hernias and hydroceles. Parent information. Open source
6. Cambridge University Hospitals. Hydrocele – in boys. Version 9; approved 22 December 2025. Parent information. Open source
7. Royal Berkshire NHS Foundation Trust. Hydrocele repair. February 2025. Paediatric patient leaflet. Open source
8. Seattle Children's. Hydrocele Repair: Care After Surgery. Parent information. Open source
9. University College London Hospitals. Hydrocele. Updated 16 February 2026. Postoperative patient information. Open source
10. NHS. High temperature (fever) in children. Infant fever thresholds and emergency symptoms. Open source
11. Great Ormond Street Hospital. About Anaesthetic Pre-operative Assessment. Parent information. Open source
Full guide written by Dr. Tamer Elalfy