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Hydrocele in the pediatric patient: inguinal or scrotal approach?
Jason M Wilson1, David S Aaronson, Ronald Schrader
1Department of Urology, University of California-San Francisco, San Francisco, California, USA. jmwilson@salud.unm.edu
Insights
Children over 12 can have hydrocele repair via scrotal incision if no communication is suspected. Younger children require inguinal exploration for hydrocele repair, optimizing surgical approach based on age.
Area of Science:
- Pediatric Surgery
- Urology
Background:
- Hydrocele repair in children typically uses an inguinal approach to manage a patent processus vaginalis.
- Adult hydrocele repair commonly employs a scrotal incision.
Purpose of the Study:
- To determine the age threshold at which a significant percentage of pediatric hydroceles are noncommunicating, justifying a scrotal approach.
- To refine surgical strategies for pediatric hydrocele repair based on intraoperative findings and patient age.
Main Methods:
- Retrospective chart review of pediatric hydrocele repairs (1998-2006).
- Analysis of operative reports by two investigators to record intraoperative findings.
- Statistical analysis using logistic regression and ROC analysis to correlate age with hydrocele type.
Main Results:
- 82.1% of hydroceles in children >10 years and 86.4% in children >12 years were noncommunicating.
- Age was significantly associated with a patent processus vaginalis (OR 0.783, p <0.0001).
- Only one hydrocele in the >12 years group was communicating, with suggestive clinical history.
Conclusions:
- Pediatric hydrocele repair can be performed via scrotal incision in patients older than 12 years, unless clinical history suggests communication.
- Inguinal exploration is recommended for hydrocele repair in children younger than 12 years.
Purpose:
The recommended approach for repairing hydrocele in children is inguinal to address a patent processus vaginalis. Hydrocele repair in adults is performed with a scrotal incision. We identified an age above which a significant percent of children had noncommunicating hydroceles, justifying a scrotal approach.
Materials And Methods:
A retrospective chart review was performed of children undergoing hydrocele repair at our institution between 1998 and 2006. Operative reports were reviewed by 2 investigators and intraoperative findings were recorded for statistical analysis relating age and findings at the time of the procedure using logistic regression and ROC analysis. Laterality and recurrence rates were also noted.
Results:
In this retrospective chart review 82.1% of hydroceles in children older than 10 years had intraoperative findings consistent with noncommunicating hydrocele and 86.4% in children older than 12 years were noncommunicating. One hydrocele in the age group older than 12 years was communicating and the history was suggestive of communication. Age was significantly associated with a patent processus vaginalis (OR 0.783, p <0.0001).
Conclusions:
It is possible in children older than 12 years to repair hydroceles through a scrotal incision unless the clinical history is suggestive of a communication. Children younger than 12 years should undergo inguinal exploration for hydrocele repair.
