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Brian A. Roelof, M.D. Hydrocele All men have a small amount of clear yellow fluid surrounding each testicle. When there is an excessive amount of the fluid around the testicle, it is called a hydrocele. This is a common problem in newborn boys, but often goes away during the first year or two of life. The testicle develops within the abdominal cavity. In the 8th or 9th month of gestation, the testicle usually travels through a canal passing through the abdominal wall into the scrotum. As this happens, there can be a persistent channel from the abdominal cavity to the testicle. If that occurs, then fluid that is loose in the abdominal cavity can flow into the scrotum and surround the testicle. The water channel usually closes off spontaneously or shortly after birth and any excessive fluid around the testicle is absorbed. However, if this canal (patent processus vaginalis) persists, it is called a communicating hydrocele. A communicating hydrocele is usually noted as an enlargement of one half of the scrotum. The parents often note that when the child has been sleeping or quiet that there is less fluid (swelling) in the scrotum and when the child has been up and playing or particularly after crying hard, etc., that there is more fluid (swelling) in the scrotum. This occurs because the fluid flows freely from the abdominal cavity into the scrotum and back. Premature infants have a higher incidence of communicating hydroceles than full term babies. At times a noncommunicating hydrocele may be present. That is a hydrocele that does not have a fluid connection (canal) to the abdominal cavity. In rare instances, the hydrocele fluid may be the result of testicular tumors, infections, injuries, etc. It is possible for the hydrocele to be present in the spermatic cord rather than immediately around the testicle. Since a communicating hydrocele has an open channel from the abdominal cavity to the scrotum, it is possible for intestines, bladder, etc., to pass down through the canal. This is called a hernia and should be fixed. We often watch the communicating hydroceles until after one or two years of age to see if they will spontaneously correct themselves. If not, surgery is usually recommended. Hernia If the canal between the abdominal cavity and the testicle remains open, this is called a patent processus vaginalis. This usually closes off at about the time of birth. If it remains persistent, it is possible for abdominal contents such as intestines, fat, or ovaries to pass into the canal. These structures usually slide back and forth, but at times can become stuck. If they become stuck in the canal, this is called an incarcerated hernia. If your child has a persistent lump or bulge in the groin area, he should be seen quickly. If he is having pain or particularly fussy, he must be seen immediately as the intestines or other contents can become strangulated. This could potentially become a life threatening situation. Correction of Hydrocele/Hernia We correct a hydrocele or hernia with an operation. We make a small surgical cut in the groin area. We then explore the canal containing the blood vessels and sperm ducts to the testicle. We find the open channel and free it from the remaining structures. We then separate them and tie them off. This takes care of the hernia problem and stops the fluid from passing from the abdomen to the scrotum. Possible complications from this operation are bleeding, infection, persistent pain, and sometimes, a recurrence of the hydrocele. Hernias in children are different from those in adults. Children's hernias usually do not involve any weakening of the muscle. That means that children will not need any muscle repair. The operation is usually done as an outpatient procedure. It is performed under a general anesthetic. A local anesthetic is used at the end of the procedure to minimize the postoperative discomfort. At times, a caudal anesthetic may be used to minimize the postoperative pain. |
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