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.
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.
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
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.
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.
- 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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Pediatric Urological Surgery
Should Know About