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Early Surgery Versus Watchful Waiting Strategy for Infantile Abdominoscrotal Hydrocele
Silvia Ceccanti1, Corrado de Vito2, Giuseppe Migliara2
1Pediatric Surgery Unit, Sapienza University of Rome, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, RM, 00161, Italy.
Insights
Watchful waiting may lead to spontaneous resolution in some infantile abdominoscrotal hydrocele cases. However, nonoperative management can increase risks of future complications and unplanned surgeries.
Area of Science:
- Pediatric Surgery
- Urology
- Developmental Pediatrics
Background:
- Infantile abdominoscrotal hydrocele is typically treated with early surgery.
- The efficacy of watchful waiting for infantile abdominoscrotal hydrocele remains unclear.
Purpose of the Study:
- To compare surgical repair with nonoperative management for infantile abdominoscrotal hydrocele.
- To evaluate outcomes and complications associated with different management strategies.
Main Methods:
- A single-center observational study included 36 patients with infantile abdominoscrotal hydrocele.
- Patients were divided into early surgical repair (Group A) or initial nonoperative management (Group B).
- Follow-up duration was over 80 months.
Main Results:
- Six lesions in Group B (25%) regressed spontaneously.
- Group A experienced 1 recurrent hydrocele and 1 testicular atrophy.
- Group B had higher rates of ipsilateral orchidopexy and inguinal hernia, and unplanned second surgeries.
Conclusions:
- Nonoperative management achieves spontaneous resolution in approximately 25% of infantile abdominoscrotal hydrocele cases.
- Clinicians should weigh the benefits of nonoperative management against potential negative impacts on future surgical success for prolonged lesions.
Background:
Infantile abdominoscrotal hydrocele is generally managed with early surgery. However, whether these patients actually benefit from an initial watchful waiting strategy is yet to be determined.
Methods:
This single-center, comparative observational analysis included 36 consecutive patients (9 bilateral cases) diagnosed between January 1998 and December 2019. Initial 16 patients (21 lesions) underwent surgical repair shortly after diagnosis (Group A) at a mean (SD) age of 8 (4) months. Remaining 20 patients (24 lesions) underwent initial nonoperative management (Group B). Overall follow-up was 82.74 (63.84) months.
Results:
Six lesions of Group B spontaneously regressed at a mean age of 23.8 (7.8) months. Remaining 18 hydroceles underwent surgical management at a mean age of 18.7 (12.6) months. Early postoperative morbidity was high (43%) in both groups (Clavien-Dindo grade I-II). During follow-up, there were 1 recurrent hydrocele and 1 testicular atrophy, both events occurring in Group A patients. Group B patients required a higher need for concomitant ipsilateral orchidopexy (61% versus 14%; p = 0.001), and developed a higher rate of ipsilateral inguinal hernia (39% versus 5%; p = 0.01), occurring within 8.3 (3.53) months of surgery. On multivariable analysis, nonoperative management was associated with unplanned second surgery (odds ratio 5.5, 95% CI 1.25-24.17, p = 0.02), regardless of the type of hydrocelectomy performed.
Conclusions:
Nonoperative management provides effective spontaneous resolution in about 25% of infantile abdominoscrotal hydrocele. Clinicians must balance the potential benefits of such strategy against the impact of pressure induced detrimental effects on the success of future surgery when dealing with longstanding lesions.
Level Of Evidence:
III.
