Guide for families of children with hydrocele
What is a hydrocele?
Hydrocele is a painless collection of fluid between the inner and outer membranes surrounding the testis. The testicles normally form inside the baby's abdomen and then descend into the scrotum before birth. During this descent, they drag the peritoneum along with them. This connection is often closed before birth, and these membranes become closed membranes that surround the testicles. A hydrocele occurs when this connection is somehow left open or the production of fluid by these membranes continues .
There are two types: associated with the peritoneal cavity (communicating) or unrelated (non-communicating, simple). When communicating, the swelling decreases when the baby is lying down, but does not completely disappear. When standing, the swelling increases as the intra-abdominal fluid fills the hydrocele sac. In the non-communicating type, it has no relation with the peritoneum. This type usually occurs at an older age. Although it is more common on the right, it is often bilateral. It is found in many children with an inguinal hernia.
What are the symptoms?
It is often noticed when the baby is born. The family or the doctor who first examines the baby sees a large, tight and shiny swelling in both bags or on one side. This is often referred to by families as one testicle is larger or smaller than the other.
What are the surgical requirements?
Hydrocele in children does not cause pain and hydrocele does not harm the testicle. For this reason, it is necessary to follow up at certain intervals after birth. Most hydroceles unrelated to the peritoneum resolve spontaneously within the first 2 years with resorption of the fluid. Therefore, it should not be operated before this time. Hydroceles with inguinal hernia and giant hydroceles that are increasing in size are operated without waiting. It is not recommended to aspirate hydrocele fluid (draining the fluid with the help of a syringe) in the baby, because there is a risk of infection.
How is the preparation for the surgery done?
If hydrocele persists in children older than two years of age, the patient is given the day of surgery. Approximately 3-4 days before the operation, blood analysis, urinalysis, biochemical analyzes and lung film required for anesthesia approval are requested. If these tests are evaluated by the anesthesiologist and there is no problem, the child's eating and drinking is stopped at least 6 hours before the surgery.
How is the surgical procedure done?
In order to prevent infections that may occur before and after the surgery, antibiotic treatment is given to prevent infection. The surgery is performed under general anesthesia. The hydrocele sac is intervened with an incision of approximately 2-3 cm from the inguinal region and the hydrocele sac is removed. In case of accompanying inguinal hernia, hernia repair is also done at the same time. Hydrocele generally does not recur after surgery. The surgical success rate is 99%.
How are children followed up in the early and late postoperative period?
After the surgery, nothing is started by mouth until the child's bowel sounds start or until the gas starts (approximately 4-6 hours). During this period, intravenous fluid support is given. He is discharged in the evening or the next morning on the same day. After discharge, daily dressing is done for 1 week and prescribed antibiotics and painkillers are used. The stitches dissolve on their own within 10 days or if non-melting stitches are used, the stitches should be removed one week after the operation. Bathing is not recommended for a week.
The child is checked 1 week and 1 month after the operation. It is necessary to consult a doctor in cases such as swelling, redness, fever, general condition disorder at the wound site.
What are the complications?
Allergic, heart and lung problems related to anesthesia may occur during and after the operation, albeit at a very low rate. Complications related to the wound site (opening of the wound, infection), postoperative bleeding into the scrotum, and the need for reoperation may develop, albeit at a very low rate, after surgery.