Hydrocele is defined as the accumulation of fluid between the inner and outer leaves of the membrane (tunica vaginalis) that surrounds one or both testicles in boys. The condition, also known as 'water hernia', can be congenital or can be seen in the child's later life or in adulthood.
How does it develop?
ADuring development in the mother's womb, the testicles in the abdomen reach the testicular sacs towards birth. descends. During this descent, the peritoneum moves along with the testis from the inguinal region to the sacs and forms a pathway. While it should close on its own just before birth, in some cases the closure may not occur and this pathway may remain open. Depending on the degree of opening, inguinal hernia that allows the passage of the intestines may occur in large openings, but a condition called hydrocele may develop in thinner openings that allow the passage of intra-abdominal fluid. Hydroceles usually progress together with inguinal hernia.
Which types are there?
Hydroceles according to the reason of development primary and secondary can be described as related and unrelated according to the way of development. Although hydrocele seen in children is mostly primary, hydrocele in adults mostly occurs secondary to other diseases of the testis. In the presence of a communicating hydrocele, while the child is standing, intra-abdominal pressure increases, while the fluid in the hydrocele sac increases and the sac swells. When the child sleeps, the swelling decreases, but does not disappear completely. In unrelated hydroceles, there is no intra-abdominal connection and the size of the sac does not change during the day.
How is it diagnosed?
The diagnosis of hydrocele is made when the family realizes it at home, and after applying to the doctor. Families apply with the complaint that one testicle of the child is larger than the other or both testicles are larger. The history and physical examination of the Pediatric Surgery specialist are usually sufficient for diagnosis. Ultrasound examination may also be required when other pathologies of the testis are suspected.
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When to consult a doctor?
When swelling is noticed in the testicles, a doctor should be consulted without waiting too long. Although hydrocele is not an emergency, swelling in the testicles can also be a symptom of other emergencies. After the diagnosis of hydrocele is confirmed in the doctor's examination, mostly children are followed up to the age of one. During this period, some children may experience a reduction in hydrocele size and complete disappearance. However, in children whose hydrocele does not regress until the age of one, surgery should be performed so that the testicles are not affected by the heat of the hydrocele fluid.
Hydrocele does not cause pain and discomfort. In case of prolonged presence, the fluid in the sac becomes hot, which adversely affects the development of the testicles.
How is it treated?
The treatment of hydrocele in children is surgical surgery. The surgery is performed on a day-to-day basis. Before the operation, children are examined in detail by Pediatric Surgery and Anesthesiology doctors, and necessary analyzes are made. The feeding time of the child is determined for the day of surgery.
The operation is performed under general anesthesia. The hernia sac is reached through a 2-3 cm incision made in the groin and the sac is tied. The hydrocele sac is then emptied and a part of it is removed. The incision is closed with absorbable sutures. No need for stitches afterwards. Simultaneous circumcision can be performed at the request of the family.
Patients are usually fed two hours after the surgery and are discharged home on the same day. Suppositories or syrup are used for pain relief. He is called for control one or two days after the operation and in the first month. The dressing is opened at the first control and is not repeated. After the dressing is opened, children can take a bath. At the end of the first week, they can return to their normal activities.
The risk of recurrence after surgery is low. Complications such as infection and bleeding, although rare, can be seen. Although the swelling subsides immediately after the operation, it starts to occur again towards the evening and returns to normal in about two weeks. This does not mean that the hydrocele recurs and is related to edema at the surgery site.
Cord cyst
The peritoneum, which remains open during the descent of the testicles into the sac, subsequently If the scrotum is closed from both sides, a cystic formation develops in the inguinal region, with both sides closed. This pathology, called cord cyst, usually manifests itself between the ages of 1-2 years.
The treatment of a cord cyst is surgical and it must be removed with an incision made in the groin. If it is not removed, it may cause cosmetic disfigurement in the groin, the risk of exposure to trauma, and the testis to be affected by the heat effect of the fluid inside. Its treatment is surgery.
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