Infant communicating hydroceles--do they need immediate repair or might some clinically resolve?
OBJECTIVE
Infant hydroceles that are communicating by history (fluctuation in size) or examination (reducible fluid) are often repaired soon after presentation. We have followed a series of infant boys with such hydroceles and reviewed their early natural history.


METHODS
Since 1998, we have followed 174 infant boys presenting with an apparent communicating hydrocele without immediate surgical repair. All boys were initially seen before 18 months of age and most (168) by 12 months. Most had been full term at delivery, although 32 had been premature (<37 weeks' gestational age) and 11 extremely so (<32 weeks). Most boys (120) had bilateral hydroceles at presentation.


RESULTS
Of the 110 boys followed to disposition, 69 (62.7%) had complete resolution without surgery by a mean age of 11.7 months. Forty-one patients (37.3%) underwent surgery for correction at a mean age of 14 months because of persistence in size or development of a hernia. Six developed a hernia during observation, none of whom had any episode of incarceration. Only 2 patients with apparent resolution subsequently had recurrence with a hernia. Age at presentation and gestational age at birth showed no effect on resolution. The hydroceles of 64 boys had improved in size after a mean follow-up of 13.9 months when last seen.


CONCLUSIONS
Many infant hydroceles that are communicating by history or examination do resolve clinically without surgery and deserve observation. Progression to hernia was rare in our experience and did not result in incarceration. Consequently, little risk is taken by initial observation.
Koski
Michelle E
ME
Department of Urology, Division of Pediatric Urology, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN 37232-0001, USA. michelle.koski@vanderbilt.edu
Makari
John H
JH
Adams
Mark C
MC
Thomas
John C
JC
Clark
Peter E
PE
Pope
John C
JC
Brock
John W
JW
D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008297:Male; D019370:Observation; D011336:Probability; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D006848:Testicular Hydrocele / Q000175:diagnosis* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000379:methods*