Cord cysts and hydroceles, which are common in boys, stem from the baby's developmental process in the womb. During pregnancy, the ovaries descend into the scrotum, a sac located in the baby's abdomen, until birth, and are associated with the inguinal canal not closing completely during this journey. This causes fluid accumulation around the ovaries, leading to a condition called a hydrocele, also known as a water hernia.

In some cases, a duct remaining open in the peritoneum can later close, causing a bilateral, closed cyst to form between the abdomen and the scrotum. This condition is called a cord cyst. These conditions, which usually do not cause pain or discomfort, are most noticeable by swelling in the scrotum.

Hydroceles and cord cysts usually resolve on their own, but in some cases, surgery may be necessary. These surgical procedures, which take 30-60 minutes, are usually performed as outpatient procedures. Children can go home the same day and resume their normal physical activities.

What is Cord Cyst and Hydrocele?

Cord cyst and hydrocele are two different medical conditions that are frequently seen in boys.

Cord cyst: In boys, the ovaries, which develop in the womb, finally reach the scrotum. During this journey, an opening may sometimes occur in the inguinal canal through which the ovaries pass. If this opening doesn't close, the peritoneum can be occluded by both the abdomen and the scrotum, creating a bilateral, closed cyst. This condition is called a cord cyst or cord hydrocele.

Hydrocele: The testicles, which travel from the baby's abdomen to the scrotum, pass through a duct during the final months of pregnancy. Normally, this duct closes a few days before birth, severing the connection between the abdomen and the scrotum. However, in some cases, this duct doesn't close, and fluid inside the abdomen can flow into the scrotum through this narrow opening, causing swelling around the testicles. This condition is called a "hydrocele," or more commonly, a "water hernia." Hydroceles are common in newborns.

Both conditions are generally painless and do not usually require surgery. However, if symptoms persist or complications develop, surgery may be necessary.

What are the Types of Hydrocele?

Types of hydrocele include:

• Testicular Hydrocele: If the hydrocele is limited to the inner and outer membrane surrounding the testicle, it is called testicular hydrocele.
• Cord Cyst: When the processus vaginalis becomes a cystic structure as a result of a partial closure between the inner orifice of the inguinal canal and the sacs, it is called a cord cyst.
• Communicating Hydrocele: A communicating hydrocele occurs when the peritoneal membrane descending into the scrotum is completely open and connected to the peritoneal cavity. In this type of hydrocele, the swelling increases when the child is standing and moving, but decreases or disappears when the child is sleeping or lying quietly. It is more common on the right side and is usually bilateral.
• Noncommunicating Hydrocele: A noncommunicating hydrocele occurs when the peritoneal cavity is not connected to the peritoneal cavity by the peritoneal membrane that descends into the scrotum. In this type of hydrocele, the swelling does not change throughout the day or with changes in activity level.
• Abdominoscrotal Hydrocele: This type of hydrocele is less common and extends from the scrotum into the abdominal cavity. It can compress the abdominal organs and kidneys.

What are the Symptoms of Cord Cyst and Hydrocele?

Cord cyst and hydrocele symptoms include:

Symptoms of hydrocele:

• A hydrocele usually doesn't cause any pain. However, depending on the severity of the swelling, you may experience pain or discomfort.
• A significant swelling occurs in the scrotum (sac).
• A visible or palpable fullness is felt in the scrotum due to fluid filling.
• Hydrocele is characterized by swelling that increases when the baby is standing and moving and decreases or disappears when the baby sleeps.

Cord cyst symptoms:

• Cord cyst or cord hydrocele occurs when fluid in the abdominal cavity passes through the opening and collects in the terminal part of the duct as intra-abdominal pressure increases.
• During examination, a mass is felt in the inguinal canal.
• During ultrasound , a mass that looks like a fluid sac covered with a membrane is detected.
• The most common symptom of a cord cyst is swelling or fullness in the scrotum.
• In some cases, discomfort may be felt due to the weight of the cord cyst structures. If the fluid within the cyst becomes infected, babies may experience pain.

Cord cysts and hydroceles are usually painless, although swelling or fullness is a prominent symptom.

How are Cord Cysts and Hydroceles Diagnosed?

Cord cyst and hydrocele can be diagnosed using the following methods:

• Physical Examination and Transillumination: A baby with a hydrocele has a fluid-filled swelling in the groin or scrotum that doesn't cause discomfort but can fluctuate in size throughout the day. When a light source is shined on the scrotum of a patient with a hydrocele in a dark room, a bright light reflex is elicited, as the fluid transmits light, indicating the presence of fluid within the hydrocele. This method is called transillumination. Transillumination can be helpful in diagnosing a hydrocele, but it may not be sufficient to provide a 100% definitive diagnosis.
• Scrotal Ultrasound : Scrotal ultrasound is used to assess the amount of hydrocele fluid and the structures within the cyst. This is a radiation-free diagnostic method. Ultrasound can help assess the amount of fluid within the cyst, its shape, and the presence of other structures.

Scrotal ultrasonography can also help differentiate other conditions, such as cord cysts and incarcerated inguinal hernias, allowing for accurate diagnosis and appropriate treatment planning.

How are Cord Cyst and Hydrocele Treatments Applied?

Treatment for cord cysts and hydroceles usually requires surgery. Treatment methods include:

Hydrocele treatment:

• The vast majority of communicating hydroceles resolve spontaneously by age one. Therefore, surgery should be planned only if the duct persists until age one.
• It is very rare for a cord cyst to resolve spontaneously. Due to the risk of infection, pressure on the cysts in the inguinal canal can cause infection, which may require surgical intervention.
• The baby is usually expected to complete the first 6 months of life to be suitable for surgery, but it is recommended that the baby be over one year old for surgery.

Surgical treatment:

• Surgery for cord cysts and hydroceles is performed through an approximately 1-2 cm incision along the lines above the groin and below the abdomen.
• During surgery, the hydrocele is located and freed from surrounding tissue. The sperm ducts and vessels leading to the testicle are examined.
• The inguinal canal is ligated with absorbable stitches at the site where it enters, and the sac is removed. If an organ is present and undamaged, it is pushed back into the abdomen, and the canal is ligated to prevent fluid flow.
• The surgery usually takes 30-60 minutes and is performed as an outpatient procedure. Children can be discharged the same day and resume their normal activities.
• In case of abdominoscrotal hydrocele, surgery is necessary as soon as the diagnosis is made.
• During the treatment process, circumcision may also be performed in appropriate cases.

Needle aspiration: Draining congenital hydroceles by needle aspiration is risky and generally not recommended. This approach can lead to serious complications such as infection, so it is generally not recommended.

The treatment choice is determined by the patient's condition, symptoms, and medical history. The treatment method employed generally yields successful results and improves patients' quality of life.

Is Cord Cyst Dangerous?

A cord cyst is generally harmless and, in most cases, does not pose a serious health problem. However, in some rare cases, complications can arise. For example, a cord cyst can become infected, causing pain, redness, and swelling. An infected cord cyst can be serious and may require medical attention.

Additionally, a cord cyst can sometimes cause the testicles to rotate or compress blood vessels. This can obstruct blood flow to the testicles and require emergency surgery.

Generally, cord cysts are harmless and may go away on their own. However, it is important to consult a healthcare professional if you experience any symptoms or concerns.