The purpose of this study was to investigate the prognosis for fertility in children with hydrocele. Our results show that hydrocele seems to be more of a symptom than an actual pathological entity. It occurs both with an open and a closed processus vaginalis. Bilateral hydrocele seems to be a rare occurrence, mostly affecting infants or children under 1 year of age. Hydrocele on its own seems to have no direct effect on later fertility. In the presence of certain associated pathological findings, however, the testes are significantly altered. Children with hydrocele and pathological findings are significantly older than hydrocele patients with no associated pathology. As a practical recommendation, hydrocele does not require immediate surgery. In the presence of hydrocele and certain associated pathology, however, surgery makes good sense.