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Noticing a swelling in your baby boy’s scrotum can be frightening. In most cases, this is caused by a harmless condition called a hydrocele — and for the majority of newborns, it resolves on its own within the first year of life. This guide explains what hydrocele is, what causes it, how it is treated, and when to seek specialist advice.
Baby boys affected at birth
Resolve in first year
Child goes home same day
A hydrocele is a collection of fluid inside the thin pouch (sac) that surrounds the testicle in the scrotum. This fluid makes the scrotum look swollen or enlarged, but in most cases it is completely painless. Hydroceles are very common in newborns, particularly in premature babies, though they can also develop at any age.
The condition is not dangerous in itself, but it does need to be properly assessed by a doctor to rule out other causes and to determine whether it will resolve on its own or require treatment.
A hydrocele is one of the most common conditions seen by paediatric surgeons. Up to 1 in 10 baby boys is born with one. In most cases it disappears without any treatment before the baby’s first birthday. You are not alone — and with the right assessment, your child will be well looked after.
During pregnancy, the testicles develop inside the baby’s abdomen and then gradually move down into the scrotum through a canal. A protective sac travels with the testicles through this canal. Normally, this canal and sac close completely once the testicles are in position.
When the canal or sac does not close properly, fluid can accumulate around the testicle — resulting in a hydrocele. The type of hydrocele depends on how and where this incomplete closure occurs.
There are four main types of hydrocele, each with different causes and treatment approaches:
| Type | Description | Treatment |
|---|---|---|
| Non-communicating Hydrocele | Most common in newborns. Fluid trapped at birth. Often resolves within 12 months. | Mild |
| Communicating Hydrocele | Canal remains open; fluid moves in and out. Size changes during the day. | Moderate |
| Reactive Hydrocele | Caused by infection, injury or testicular torsion. Treated with medication. | Varies |
| Hydrocele of the Cord | Fluid trapped in spermatic cord. Requires surgery. | Surgical |
boys born to fathers or brothers with hypospadias are at higher risk
certain gene changes may alter hormone activity during fetal development
mothers over 35 may have a slightly higher risk of having an affected child
use of fertility treatments or hormone therapies during pregnancy
incomplete development in some preterm babies
possible links to pesticides and industrial chemicals are being studied, though not yet confirmed
Most hydroceles cause no pain and are discovered simply because the scrotum looks larger than normal. Common signs include:
Diagnosis is straightforward and is made through a thorough physical examination by a paediatric surgeon. The doctor will review the history of the swelling, examine the scrotum carefully, and may use one or both of the following tests:
No blood tests are required to diagnose a straightforward hydrocele, though they may be arranged if an infection or other underlying cause is suspected.
The treatment approach depends on the type of hydrocele, the age of the child, and how long the swelling has been present.
For non-communicating hydroceles in babies under 12 months, the standard approach is careful observation. The surgeon will monitor the hydrocele over time. In the majority of cases, the body absorbs the fluid and the swelling disappears naturally before the child’s first birthday. No medication or surgery is needed during this period.
If the hydrocele is reactive — caused by infection or inflammation — it is treated with antibiotics or anti-inflammatory medicines. Once the underlying cause is resolved, the hydrocele usually improves.
Surgery is recommended in the following situations:
The surgical procedure — called a hydrocelectomy — is a day surgery, meaning your child goes home the same day. It is performed under general anaesthesia. The surgeon makes a small cut in the groin crease, drains the fluid, removes a portion of the sac, and if a hernia is present, repairs it at the same time. Dissolvable stitches are used, so there is nothing to remove afterwards.
Pain after this surgery is generally manageable and not a major concern. Simple oral pain relief medicines are usually enough to keep your child comfortable during recovery at home.
The overall success rate is more than 95% across all types of hypospadias. Mild varieties have very high success rates with a single surgery. In complex cases, more than one surgery may be needed, but outcomes are generally excellent in experienced hands.
In the vast majority of cases, hypospadias does not cause infertility. Many men with untreated mild hypospadias father children without difficulty. However, in severe varieties — particularly when combined with undescended testes or a significantly bent penis — fertility can be affected. This makes timely treatment all the more important.
In mild types, size is not significantly different from other children. In severe varieties, the penis may be smaller than average, both before and after puberty. Your surgeon can discuss this with you in detail during the consultation.
MIP is a rare, mild form of hypospadias that is usually only discovered during circumcision, because the foreskin appears completely normal at birth. Once the foreskin is removed, the urethral opening is found to be wider than normal or in a slightly different position. It is treated in the same way as other distal types.
There is a higher-than-average chance of recurrence in families where hypospadias has already occurred. If you have concerns about future pregnancies, speak with your doctor or a genetic counsellor for personalised guidance.
The time it takes to complete the surgery for hypospadias varies depending on how severe it is. Mild cases of hypospadias can take 1-3 hours, but more severe forms may require three or more hours.
Hypospadias surgery at KidsCare Hospital Rawalpindi is performed by two highly experienced paediatric surgeons. Dr. Muhammad Umar Nisar is a (Neonatal, Paediatric & Laparoscopic Surgeon) with over 15 years of experience, specialising in complex urological repairs including multi-stage hypospadias surgery. Dr. Muhammad Umar Qureshi is also a Neonatal, Paediatric & Laparoscopic Surgeon with 10+ years of experience, skilled in both routine and advanced paediatric surgical procedures. Together, they bring decades of combined expertise to ensure the safest and most effective outcomes for your child.
KidsCare Hospital Rawalpindi is a trusted centre for paediatric surgery in the twin cities of Rawalpindi and Islamabad. Our dedicated paediatric surgical team has successfully treated children with all types and severities of hypospadias — including complex cases requiring multi-stage repair. We offer a child-friendly environment, experienced neonatal and paediatric surgeons.. Parents from across Rawalpindi, Islamabad, and surrounding areas choose KidsCare Hospital for the quality of care and the reassurance of being in specialist hands from the very first consultation.
