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Decision making in the management of hydroceles in infants and children

Hussein Naji1, Ingimar Ingolfsson, Daniel Isacson

  • 1Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-171 76, Stockholm, Sweden. hussein.naji@karolinska.se

European Journal of Pediatrics
|November 23, 2011
PubMed

Insights

Most infantile hydroceles resolve spontaneously within the first year of life. Surgery for pediatric hydrocele is typically reserved for cases with associated inguinal hernia or those that become excessively large.

Area of Science:

  • Pediatric Surgery
  • Urology

Background:

  • Hydroceles are common in infants, presenting a diagnostic and management challenge.
  • Evidence-based guidelines are needed for managing pediatric hydroceles based on age and clinical presentation.

Purpose of the Study:

  • To establish evidence-based decision-making criteria for managing pediatric hydroceles.
  • To correlate hydrocele outcomes with patient age, signs, and symptoms.

Main Methods:

  • Prospective cohort study of 261 pediatric patients with hydroceles (December 2001-December 2005).
  • Group 1: 121 infants (<1 year) monitored for spontaneous resolution.
  • Group 2: 140 children (1-12 years) who underwent surgery, with data on age, side, diurnal changes, and surgical findings.

Main Results:

  • 89% of infantile hydroceles (Group 1) resolved spontaneously or improved significantly within the first year.
  • Only 11% of infants required surgery, primarily for associated inguinal hernia (7%) or huge hydrocele (3%).
  • In Group 2, 83% presented within the first 5 years; 92% exhibited diurnal size variations.

Conclusions:

  • Infantile hydroceles demonstrate a high rate (89%) of spontaneous resolution due to changes in the processus vaginalis.
  • Surgical intervention in the first year is indicated only for associated inguinal hernias or significantly enlarged hydroceles.
Abstract

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