The outcomes of conservative management and the natural history of asymptomatic hydroceles in children

Pediatr Surg Int. 2020 Oct;36(10):1189-1195. doi: 10.1007/s00383-020-04720-1. Epub 2020 Jul 22.


Purpose: To elucidate the natural history of asymptomatic hydroceles (AHs) in children with conservative management and to discuss management strategies for AHs in children.

Methods: We retrospectively reviewed 113 children with AHs who were followed without immediate surgery. Patients were divided into four groups according to age at presentation; group 1: ≤ 1 month, group 2: 1-12 months, group 3: 12-24 months, and group 4: > 24 months. Ages at spontaneous resolution or surgery were reviewed. To assess the effect of AH on the testis, testicular size before and after conservative management was compared in 11 cases.

Results: In groups 1, 2, 3, and 4, spontaneous resolution occurred in 94.3%, 75.0%, 65.0%, and 33.3%, and the average time to resolution from presentation was 5, 5, 17, and 9 months, respectively. 41 patients underwent surgery at a mean age of 4.2 years. The testicular size did not differ significantly between before and after conservative management (14.4 vs. 14.5 mm, p = 0.483).

Conclusion: About one-third of children over 2 years of age achieve spontaneous resolution. Hydroceles with conservative management may not affect the testicular size. Thus, initial conservative management before surgery is recommend for AHs in children, even over 2 years of age.

Keywords: Asymptomatic; Children; Conservative management; Hydrocele; Natural history; Spontaneous resolution.

MeSH terms

  • Asymptomatic Diseases*
  • Child
  • Child, Preschool
  • Conservative Treatment / methods*
  • Humans
  • Male
  • Retrospective Studies
  • Testicular Hydrocele / therapy*
  • Treatment Outcome