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Minor surgery

What is pediatric hydrocele?

Hydrocele is a collection of fluid around the testes in the scrotum of boys (common) or in the groin/ lateral pubic area of girls (uncommon).

Cause

For boys, the hydrocele occurs because the passage, through which the testes travelled from the abdominal cavity down to the scrotum, remains opened. Peritoneal fluid travels downwards by gravity and is collected in the scrotum as hydrocele.

For girls, there is an abnormal communication between the main peritoneal cavity and the hydrocele (formally called Hydrocele of Nuck). Peritoneal fluid travels downwards by gravity and is collected in the groin / lateral pubic area as hydrocele.

Symptoms

Hydroceles may present as scrotal swellings in a boys or groin / lateral pubic swellings in a girls. Hydroceles are usually asymptomatic at the beginning. If hydroceles are not treated, they usually will become larger and cause dragging discomfort. Large hydroceles may affect the normal activities of boys and girls. So, most hydroceles, which do not resolve after 18-24 months of observation, need surgery.

Sometimes, hydrocele occurs with hernia, early surgery is indicated for the risk of hernia strangulation.

Diagnosis

Most hydrocele can be diagnosed clinically by shining a torch to the swelling. A sign called tranillumination (the whole swelling becomes illuminated) confirmed the presence of fluid collection. Most surgeons will have an ultrasound scan to confirmed the diagnosis.

Treatment

Some of the hydroceles will resolve spontaneously and majority do not. Most hydroceles, which do not resolve after 18-24 months of observation, need surgery. Sometimes, hydrocele occurs with hernia, early surgery is indicated for the risk of hernia strangulation.

Hydrocele surgery is a simple and safe surgery requiring general anesthesia. Minimal access surgery involves making an 1cm length groin skin crease incision on the side of the hydrocele. The connection between the peritoneal cavity and the hydrocele cavity is divided and ligated. The collected fluid is drained and the hydrocele is opened wide, partly excised or cauterized to reduce the chance of recollection. The wound is closed below the skin with absorbable sutures and the wound is sealed with new generation aseptic acrylic acid rapid glue and water proof dressing. The whole procedure takes about 15-20min.

Patients can have a shower and return to normal activities the same day after surgery; they can resume exercise and swimming 4 weeks after operation.

Frequently Asked Questions

Q: What is hydrocele? Is hydrocele a kind of cancer?
A: Hydrocele is a collection of fluid around the testes in the scrotum of boys (common) or in the groin/ lateral pubic area of girls (uncommon). Nearly all of the hydroceles are benign and are not cancer.

Q: Is it necessary to treat all hydroceles immediately?
A:  No. Hydroceles are usually asymptomatic at the beginning. If hydroceles are not treated, they usually will become larger and cause dragging discomfort. Large hydroceles may affect the normal activities of boys and girls. So, most hydroceles, which do not resolve after 18-24 months of observation, need surgery.

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