Modified scrotal approach for correction of abdominoscrotal hydrocele in children: clinical presentation and description of technique.
OBJECTIVE
To introduce a modified trans-scrotal approach for treatment of abdominoscrotal hydrocele (ASH) in children. The postoperative outcomes are reviewed with long-term follow-up.


METHODS
We described a series of 7 boys (mean age, 23.4 months) who underwent surgical repair of ASH. The diagnosis was made based on physical examination, which revealed a tense hydrocele in association with ipsilateral cystic abdominal mass, confirmed by ultrasonography. After exposing the hydrocele sac through a scrotal incision, tunica vaginalis was opened and marsupialization of the hydrocele along with undermined dartos muscle layer was performed. Follow-up ranged from 9-12 months (average, 10.7 months).


RESULTS
Overall, 10 ASH units (including 3 bilateral) were repaired. All of the affected testicles except one showed some degree of dysmorphism, according to ultrasonography or intraoperative findings, which resolved in all patients 3 months after surgery. There were no early postoperative complications except a mild scrotal edema. Neither recurrences of ASH nor testicular atrophy was observed.


CONCLUSIONS
The diagnosis of ASH should be considered in a boy with hydrocele and concomitant abdominal mass, and can be established by ultrasonographic evaluation. Our experiment suggests that the modified trans-scrotal surgical method for management of ASH is reliable and effective with definite advantages. The high success rate, no extensive dissection of the inguinal canal, or complete excision of the sac, along with safety and simplicity of the procedure and short hospital stay, are important preconditions for the introduction of this method as a valid option for treatment of ASH.
Kajbafzadeh
Abdol-Mohammad
AM
Pediatric Urology Research Center, Department of Urology, Children's Hospital, Medical Center, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir
Talab
Saman Shafaat
SS
Elmi
Azadeh
A
Mahboubi
Amir Hassan
AH
Pourmalek
Paria
P
Esfahani
Shadi Abdar
SA
Emami
Hamed
H
D000005:Abdomen; D000293:Adolescent; D001826:Body Fluids; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D005832:Genital Diseases, Male / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012611:Scrotum; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods