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Hernia/Hydrocele
A hernia or hydrocele is a result
of the same basic abnormality: a persistent communication
(opening) between the abdominal cavity and the scrotum.
A hydrocele develops as fluid from the abdomen flows into
the scrotum, while a hernia represents segments of bowel
passing through the opening. A hernia may result in a
number of complications. A segment of the bowel may become
stuck (incarcerated) in this narrow pathway (processus
vaginalis). It may be injured (strangulation), or place
pressure on the spermatic cord. resulting in testicular
damage. Hydrocele fluid does not cause injury but it is
a warning sign that a communicating pathway exists that
may eventually develop into a hernia.
Treatment
To avoid complications, a hernia requires
elective surgical correction. Fortunately, hydroceles
often disappear on their own, and I recommend surgery
only for those that remain in children after 2 years of
age. The surgery is essentially the same for both conditions.
A small (1-2 inch) incision is made in a skin crease in
the child's groin. The surgeon then "ties off the
opening between the abdomen and the scrotum. The surgery
takes about 30 minutes under general anesthesia, with
the child going home on the same day.
Testis Torsion
• Painful swelling of a child's
scrotum should alert his parents to consult with their
doctor immediately. An accurate evaluation of this situation
is essential. It may indicate a twisting of the spermatic
cord (tesis torsion) interrupting the blood supply to
the testicle. Unfortunately, the testicle is easily damaged
when blood flow is inadequate, often within only a few
hours. If there is a possibility of testis torsion, emergency
surgery is necessary to preserve testicular function.
Treatment
A small incision allows accurate investigation
and treatment of the problem. After untwisting the testicle,
the surgeon will either fix it to the scrota] wall (orchidopexy)
or remove it (orchiectomy) if it has been irreversibly
damaged. In these situations the opposite testicle must
be fixed to the scrotal wall to prevent the possibility
of torsion to the other testicle in the future.
Varicocele
•A varicocele is composed of
multiple dilated veins (spermatic veins) which, if present,
can be detected upon examination of the child's scrotum.
They are found in children after about 10 years of age,
usually on the left side. The presence of a varicocele
has been associated with infertility in later life. In
these cases, the testicle has become damaged over time.
Surgical correction is recommended when there is a relatively
large varicocele and the testicle has decreased in size
(atrophy). Data strongly suggests early varicocele ligation,
tying off the dilated veins, reduces any potential damage
to the testicle and improves future fertility. TREATMENT:
Surgery is performed through a small hernia-type incision,
the surgeon then dividing the most dilated veins.
Post-Operative Instructions
- Usually your child will be discharged
from the hospital the same day of his surgery.
- Discomfort may be expected for several
days after the surgery. Tylenol is most helpful.
- Sponge bathe your child in the three
days following the procedure. Regular baths or showers
may be resumed after that.
- Your child may return to school
in two to three days. He should avoid strenuous activities
such as wrestling, gymnastics, swimming, or ball playing,
for one week.
- If you are worried about your child's
progress, call the pediatric urologist for further advice.
- A follow-up appointment should be
made with the pediatric urologist two weeks after surgery.
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