Hydrocele in the pediatric patient: inguinal or scrotal approach?
OBJECTIVE
The recommended approach for repairing hydrocele in children is inguinal to address a patent processus vaginalis. Hydrocele repair in adults is performed with a scrotal incision. We identified an age above which a significant percent of children had noncommunicating hydroceles, justifying a scrotal approach.


METHODS
A retrospective chart review was performed of children undergoing hydrocele repair at our institution between 1998 and 2006. Operative reports were reviewed by 2 investigators and intraoperative findings were recorded for statistical analysis relating age and findings at the time of the procedure using logistic regression and ROC analysis. Laterality and recurrence rates were also noted.


RESULTS
In this retrospective chart review 82.1% of hydroceles in children older than 10 years had intraoperative findings consistent with noncommunicating hydrocele and 86.4% in children older than 12 years were noncommunicating. One hydrocele in the age group older than 12 years was communicating and the history was suggestive of communication. Age was significantly associated with a patent processus vaginalis (OR 0.783, p <0.0001).


CONCLUSIONS
It is possible in children older than 12 years to repair hydroceles through a scrotal incision unless the clinical history is suggestive of a communication. Children younger than 12 years should undergo inguinal exploration for hydrocele repair.
Wilson
Jason M
JM
Department of Urology, University of California-San Francisco, San Francisco, California, USA. jmwilson@salud.unm.edu
Aaronson
David S
DS
Schrader
Ronald
R
Baskin
Laurence S
LS
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008026:Ligation; D008297:Male; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D006848:Testicular Hydrocele / Q000473:pathology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*