A hydrocele is an accumulation of fluid around the testicle. These fluid collections are not harmful to the testicle and their cause differs depending on the age at which they are noted. Many boys are noted to have hydroceles at the time of birth. The majority of these do not change in size throughout the day, and with time approximately 95% will resolve without treatment. In other boys (either newborn or before the age of puberty), their hydrocele will be noted to change in size throughout the day. Often parents will note that the scrotum will be normal or close normal in size first thing in the morning and gradually increase in size as the day goes on. These hydroceles, which change in size, are known as “communicating” hydroceles. They occur due the opening through which the testicle descended into the scrotum remaining open and allowing movement of fluid from the abdomen into the scrotum. They can be considered a minor variant of a hernia. Surgical correction is recommended for “communicating” hydroceles and involves closing the communication so that fluid can no longer move between the abdomen and scrotum. In males after the age of puberty, hydroceles are not longer “communicating” and instead are due to an excess accumulation of fluid excretion or inadequate fluid absorption by the sac which surrounds the testicle called the tunica. These “noncomunicating” hydroceles are not related to hernias, and may occur after injuries to the scrotum or testicle. Surgery is recommended when these become of such size to be of significant bother to the patient. Surgical correction of “noncommunicating” hydroceles involves draining the fluid and removing the tissue that is responsible for the fluid accumulation.
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