Hydroceles and Hernias Referral Guidelines

Hydroceles and Hernias

The testicles develop in the abdomen. Shortly before birth, they descend into the scrotum because they require a cooler temperature to develop normally and produce sperm. As the testicles leave the abdomen, they push the lining of the abdominal cavity ahead of them. This lining covers the testicles and forms a tube-like connection between the abdominal. Cavity and the scrotal sac. Normally, this connection seals off alter the testicles reach the scrotum.

Hernias: When the connection between the abdominal calling hydrocele. In infants and young children, hernias are usually small and only fluid can pass through them. it the connection is large, intestine can pass into the scrotum which can usually be manually pushed back into the abdomen.
Hydroceles: A simple hydrocele occurs when excessive fluid accumulates around the testicle but there is no connection to the abdomen. Most hydroceles are small and cause no symptoms or harm to the testicle or child.

How should I initially evaluate and manage my patient?

Initial Evaluation:

The primary care provider should perform physical examination and confirm presence of fluid in the scrotum.
A sonogram is not necessary for initial evaluation. Instead, a penlight or otoscope light can be used in a darkened room to transilluminate the scrotum. A fluid-filled scrotum will allow light to pass through and the testicle might even be seen. Failure to transilluminate should be further evaluated with a scrotal sonogram.

Initial Management:

There is no management required by the primary care provider.

When should I refer my patient?

How can I refer my patient?

What can my patient expect from a visit to Children’s National?

Your patient will undergo a physical examination by one of the pediatric urologists. If a hydrocele or hernia is confirmed, then surgery may be offered.

All hernias are offered surgery since they will not resolve spontaneously. Small and soft hydroceles do not require surgery but larger hydroceles should be treated as they can confound routine physical examination of the testis.

With the child under anesthesia, a 1 to 1 ½ inch incision is made in the groin.

Hernias: The connection between the abdomen and scrotal sac is then closed. It is unusual for childhood hernias to return after repair.
Hydroceles: The fluid is removed and the wall of the hydrocele sac is either partially removed or stitched to prevent the hydrocele from coming back. Hydroceles return in up to 5 out of 100 cases.