eMedicine Specialties > Pediatrics: Surgery > Urology

Hydrocele and Hernia in Children: Follow-up

Author: Joseph Ortenberg, MD, Clinical Professor of Urology and Pediatrics, Louisiana State University School of Medicine, New Orleans; Director of Urologic Education, Children's Hospital, New Orleans;
Coauthor(s): Sean Collins, MD, Assistant Professor or Urology, Department of Urology, Louisiana State University Health Sciences Center - New Orleans; Christopher C Roth, MD, Fellow, Department of Pediatric Urology, Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center
Contributor Information and Disclosures

Updated: Sep 21, 2009

Follow-up

Further Inpatient Care

  • Postoperative details: Formerly premature infants younger than 60 weeks’ postconceptual age should be admitted for 24 hours to monitor for apnea and other anesthesia-related complications.

Complications

  • The overall operative complication rate associated with hydroceles and hernias is 1.7%-8%.
    • Infertility may result from bilateral injury to the vas deferens or injury to the vas of a solitary testis. Presence of a vaslike structure in the pathology specimen does not necessarily indicate injury to the vas, as up to 6% of specimens contain müllerian ductal remnants with a histologic appearance very similar to the vas.
    • An incarcerated hernia may compromise blood flow to the testicle prior to surgery. The rate of testicular atrophy after repair of an incarcerated hernia can be as high as 19%. Testicular atrophy may also result from intraoperative injury to the testicular blood supply.
    • As with any surgery, hematomas may occur. A hematoma usually does not need to be explored unless the hematoma continues to enlarge or becomes infected. Scrotal elevation is encouraged, and analgesics are administered.
    • As in any surgery, wound infections can occur.
    • Hypesthesia and neuropathic pain can result from nerve entrapment or injury.
    • Secondary cryptorchidism may result from excessive scar formation and ascent of the testicle with growth.
    • Recurrence of the hydrocele may be seen in less than 5% of cases. If the hydrocele does not disappear spontaneously after one year, reoperation is indicated.

Prognosis

  • With open surgery, ipsilateral recurrence rates are less than 1%. The ipsilateral recurrence rate following laparoscopic inguinal hernia repair is 3.4%.
  • Recurrences are usually associated with comorbid conditions. The occurrence of a metachronous contralateral hernia is inversely related to age and can be as high as 12%.

Miscellaneous

Special Concerns

  • Hernias can be found in children with genital ambiguity and disorders of sexual differentiation. Although rare, these conditions deserve special consideration.
  • In phenotypic males with müllerian-inhibiting substance (MIS) deficiency, persistent müllerian structures (eg, fallopian tube, uterus) may herniate through a patent processus vaginalis. In fact, the initial finding may be a hernia in many of these patients.
  • In phenotypic females with a 46 XY karyotype and androgen insensitivity, bilateral inguinal hernias may be found to contain the testes. In these instances, a biopsy of the gonad is recommended to establish the genotypic sex and to aid in further management. Immediate versus delayed orchiectomy must then be considered.
  • Fortunately, these circumstances represent the minority of children with inguinal hernias.
 


More on Hydrocele and Hernia in Children

Overview: Hydrocele and Hernia in Children
Differential Diagnoses & Workup: Hydrocele and Hernia in Children
Treatment & Medication: Hydrocele and Hernia in Children
Follow-up: Hydrocele and Hernia in Children
References
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References

  1. Esposito C, Valla JS, Najmaldin A, et al. Incidence and management of hydrocele following varicocele surgery in children. J Urol. Mar 2004;171(3):1271-3. [Medline].

  2. Kaya M, Huckstedt T, Schier F. Laparoscopic approach to incarcerated inguinal hernia in children. J Pediatr Surg. Mar 2006;41(3):567-9. [Medline].

  3. Boocock GR, Todd PJ. Inguinal hernias are common in preterm infants. Arch Dis Child. Jul 1985;60(7):669-70. [Medline].

  4. Hata S, Takahashi Y, Nakamura T, et al. Preoperative sonographic evaluation is a useful method of detecting contralateral patent processus vaginalis in pediatric patients with unilateral inguinal hernia. J Pediatr Surg. Sep 2004;39(9):1396-9. [Medline].

  5. Hosgor M, Karaca I, Ozer E, et al. The role of smooth muscle cell differentiation in the mechanism of obliteration of processus vaginalis. J Pediatr Surg. Jul 2004;39(7):1018-23. [Medline].

  6. Kapur P, Caty MG, Glick PL. Pediatric hernias and hydroceles. Pediatr Clin North Am. Aug 1998;45(4):773-89. [Medline].

  7. Schier F, Montupet P, Esposito C. Laparoscopic inguinal herniorrhaphy in children: a three-center experience with 933 repairs. J Pediatr Surg. Mar 2002;37(3):395-7. [Medline].

  8. Shirvani AR, Ortenberg J. Communicating hematocele in children following splenic rupture: diagnosis and management. Urology. Apr 2000;55(4):590. [Medline].

  9. Skoog SJ, Conlin MJ. Pediatric hernias and hydroceles. The urologist's perspective. Urol Clin North Am. Feb 1995;22(1):119-30. [Medline].

  10. Weber T, Tracy T. Groin hernias and hydroceles. In: Pediatric Surgery. 2nd ed. WB Saunders Co; 1993:562.

  11. Wiener ES, Touloukian RJ, Rodgers BM, et al. Hernia survey of the Section on Surgery of the American Academy of Pediatrics. J Pediatr Surg. Aug 1996;31(8):1166-9. [Medline].

  12. Yerkes EB, Brock JW, Holcomb GW, Morgan WM 3rd. Laparoscopic evaluation for a contralateral patent processus vaginalis: part III. Urology. Mar 1998;51(3):480-3. [Medline].

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Further Reading

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Keywords

hydrocele, hernia, process vaginalis, PV, inguinal hernia, inguinal canal, scrotum

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Contributor Information and Disclosures

Author

Joseph Ortenberg, MD, Clinical Professor of Urology and Pediatrics, Louisiana State University School of Medicine, New Orleans; Director of Urologic Education, Children's Hospital, New Orleans;
Joseph Ortenberg, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Society of University Urologists
Disclosure: Nothing to disclose.

Coauthor(s)

Sean Collins, MD, Assistant Professor or Urology, Department of Urology, Louisiana State University Health Sciences Center - New Orleans
Sean Collins, MD is a member of the following medical societies: American Urological Association and Louisiana State Medical Society
Disclosure: Nothing to disclose.

Christopher C Roth, MD, Fellow, Department of Pediatric Urology, Children's Hospital of Oklahoma, University of Oklahoma Health Sciences Center
Christopher C Roth, MD is a member of the following medical societies: Alpha Omega Alpha and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Howard M Snyder III, MD, Professor, Department of Surgery, Division of Pediatric Urology, University of Pennsylvania School of Medicine
Howard M Snyder III, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, and National Kidney Foundation
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Harry P Koo, MD, Chairman of Urology Division and Director of Pediatric Urology, Virginia Commonwealth University; Professor of Surgery, VCU School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond
Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Marc Cendron, MD, Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston
Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology
Disclosure: Nothing to disclose.

 
 
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