Pediatric Urological Surgery

Disorders of the Scrotum

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

1. Usually your child will be discharged from the hospital the same day of his surgery.
2. Discomfort may be expected for several days after the surgery. Tylenol is most helpful.
3. Sponge bathe your child in the three days following the procedure. Regular baths or showers may be resumed after that.
4. 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.
5. If you are worried about your child's progress, call the pediatric urologist for further advice.
6. A follow-up appointment should be made with the pediatric urologist two weeks after surgery.

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