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Natural History and Conservative Treatment Outcomes for Hydroceles: A Retrospective Review of One Center's Experience
Tuğba Acer-Demir1, Berk Yasin Ekenci2, Doğancan Özer2
1Department of Pediatric Surgery, Faculty of Medicine, Başkent University, Ankara, Turkey.
Insights
Pediatric hydroceles often resolve spontaneously, especially noncongenital types. Congenital hydroceles require longer observation, up to two years, while noncongenital hydroceles need at least six months of monitoring.
Area of Science:
- Pediatric Urology
- Epidemiology
- Surgical Outcomes
Background:
- Hydroceles are common in pediatric patients.
- Understanding hydrocele progression is crucial for appropriate management.
- Previous studies have varied in their focus on congenital versus noncongenital hydroceles.
Purpose of the Study:
- To determine epidemiological characteristics of pediatric hydroceles.
- To analyze the natural progression and resolution rates of hydroceles in children.
- To provide evidence-based recommendations for hydrocele management.
Main Methods:
- Retrospective review of 355 pediatric patients diagnosed with hydroceles.
- Data collection included patient demographics, hydrocele type, associated pathologies, and treatment outcomes.
- Medical records and family interviews were utilized for comprehensive data gathering.
Main Results:
- Congenital hydroceles were associated with higher rates of premature birth (32.5%) compared to noncongenital hydroceles (15.9%).
- Associated conditions included inguinal hernias (12.2%), cryptorchidism (7.5%), and varicoceles (6.0%).
- Among patients over one year old without surgery, spontaneous resolution occurred in 77.8% within 6 months and 96.3% within 1 year.
Conclusions:
- Conservative management with observation is recommended for pediatric hydroceles.
- Congenital hydroceles warrant observation for up to two years.
- Noncongenital hydroceles require observation for at least six months, with earlier surgical intervention indicated for associated pathologies.
Objective:
To elucidate epidemiological data and hydrocele progression, we reviewed pediatric patients diagnosed with hydroceles in our institution retrospectively.
Materials And Methods:
We reviewed data from 355 pediatric patients with hydroceles. Questionnaires regarding age at diagnosis, time of delivery, presence of hydroceles in the father and brothers, age at recovery, age at surgery, cause of hydrocele (if present), type of hydrocele, associated pathologies, treatments, and posthydrocelectomy complications were completed by reviewing patients' medical records and interviewing their families.
Results:
Patients with congenital hydroceles were more frequently born prematurely (32.5%) than were patients with noncongenital hydroceles (15.9%; P = .001). Fathers of 10 patients (3.7%) and brothers of 21 patients (7.7%) also had hydroceles. Hydroceles were associated with inguinal hernias on the same side (12.2%), cryptorchidism (7.5%), varicoceles (6.0%), and testis torsion (0.5%). Among patients aged >1 year (n = 185), 27 did not undergo operations and healed spontaneously at an average of 5.30 ± 3.36 months. For children aged >1 year who did not undergo surgery, the rate of spontaneous recovery within 6 months was 77.8% and that within 1 year was 96.3%.
Conclusion:
Until strong evidence of hydrocele-induced testicular damage in children arises, we recommend following up congenital hydroceles until at least 1 year and preferably 2 years of age. We recommend following up noncongenital hydroceles for at least 6 months and preferably 1 year if there is no associated pathology indicating the need for earlier surgery such as an inguinal hernia, cryptorchidism, tense hydrocele, testis torsion, or testis mass.
