About pediatric hydrocele
What is pediatric hydrocele?
- While hydroceles may occur in either gender, they are much more common in males.
- A hydrocele is a collection of clear fluid in a thin walled sack present in the scrotum.
- Hydroceles may be either one sided or occupy both sides.
- Hydroceles are painless, soft swellings and may be either present at birth (congenital) or develop later.
- A very large majority of hydroceles present at birth resolve spontaneously by one year of age.
- Hydroceles that are not congenital or those still present after one year of age generally warrant surgical correction.
- There are other conditions that must be considered when evaluating a boy with chronic, non-tender scrotal swelling. These include hernia, varicocele and tumor. Physical examination is very helpful in sorting through these options. Rarely are diagnostic or invasive studies necessary.
What is a hydrocele?
A hydrocele is a scrotal collection of clear fluid ("hydro" = water) in a thin walled sack ("cele" = swelling) that also contains the testicle. Less frequently, due to the common embryological background of male and female gonadal structures, female children or women may also experience a hydrocele. In this case, the sack and connection exist in the labia majora (the outermost and larger of the two labial structures). Because of less potential concern for complications in females with hydroceles, this article will focus predominantly on the male gender. A hydrocele may involve either one side (unilateral) or both sides (bilateral) of the scrotum.
What are the symptoms for pediatric hydrocele?
Pediatric hydrocele is an abnormal collection of fluid, in the scrotal sac in male children. A scrotal sac is a bag-like structure that contains testicles. Commonly hydroceles are asymptomatic. However, in severe cases, it may cause discomfort or pain. Pediatric hydroceles are either congenital or acquired. Congenital hydroceles are those caused by abnormal developments during the fetal stage of life. During the third week of pregnancy, a membrane structure called processus vaginalis covers the testis when it gets separated from the abdomen. Over time processus vaginalis obliterates, and now the testis is covered by tunica vaginalis. In children with congenital hydrocele, the processus vaginalis does not obliterate and establishes a connection between the scrotum and abdomen. It leads to the movement of fluid into the scrotal sac. Pediatric hydroceles are also caused by infections, traumatic injuries to the scrotum, and malignancies. Symptoms Pediatric hydroceles are usually painless. However, in some cases, it may cause discomfort. Pain is rare and occurs when the hydrocele enlarges at a fast pace. The patients may also feel heavy in the scrotal sac. It causes discomfort. Some children who are shy and feel reserved at young ages may experience psychological distress.
What are the causes for pediatric hydrocele?
Pediatric hydrocele is an abnormal collection or accumulation of fluid between parietal and visceral layers of tunica vaginalis that surrounds the testes, and spermatic cord. It may be congenital or acquired. Causes There are four causes as listed below: 1. Infections: filariasis, tuberculosis of the epididymis, and syphilis 2. Traumatic injury to the scrotum 3. Malignancies such as advanced prostate cancer. 4. Absence of obliteration of processus vaginalis During fetal development, the testis is formed retroperitoneally within the pelvis in the abdomen. After three weeks into gestation, the testis moves out of the abdomen and descends into the scrotum. During the descent, a covering membrane called processus vaginalis accompanies the testis. Over time, the proximal portion of the processus disappears, and the distal portion continues as tunica vaginalis to cover the anterior, lateral, and medial surface of the testis. If the proximal portion of the processus does not obliterate, there forms a continuum between the peritoneal cavity and scrotum. It leads to a collection of watery fluid between the layers of tunica vaginalis. Based on the site of obliteration, hydroceles are of four types; • Congenital: processus remain completely patent • Infantile: processus obliterates at the level of the deep inguinal ring, and a small distal part of it remains. • Encysted hydrocele of the cord: both distal and proximal portion of processus obliterates, but the central portion remains patent and fluid accumulates within it. • Vaginal: processus vaginalis remains patent around the testes leading to fluid collection only around the testis.
What are the treatments for pediatric hydrocele?
In 95% of congenital (present at birth) hydroceles, the natural history is one of gradual and complete resolution by one year of age. For those lasting longer than one year or for those non-communicating hydroceles that manifest after the first year, surgical repair is indicated since these rarely resolve spontaneously.
What are the risk factors for pediatric hydrocele?
A tracheostomy tube is inserted in the trachea, which effectively bypasses the obstruction in the oral pharynx and hypopharynx.