Natural History and Conservative Treatment Outcomes for Hydroceles: A Retrospective Review of One Center's Experience

Acer-Demir, Tuğba; Ekenci, Berk Yasin; Özer, Doğancan; Turanoğlu, Mehmet Ali; Haberal, Kadem Cem; Bilgin, Elif; Hiçsönmez, Akgün

doi:10.1016/j.urology.2017.10.003

Cited by 11 publications

(4 citation statements)

References 26 publications

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“…11 Hydroceles that occur following inguinal herniotomy are usually of the noncommunicating type and are likely due to increased serosal fluid production secondary to inflammation. 12 It is postulated that more surgical manipulation results in more oxidative stress, and consequently more inflammation. 13 This could support the findings in this study wherein the Ferguson technique, which involved more manipulation by opening the external oblique aponeurosis, resulted in a significantly higher incidence of post-operative hydrocele.…”

Section: Discussionmentioning

confidence: 99%

A Meta-Analysis on the Comparison Between Pediatric Inguinal Herniotomies Performed With and Without Incising the External Oblique Aponeurosis in Terms of Recurrence and Complications

Tan,

Catangui,

Isabedra

2021

Philipp J Surg Spec

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Rationale: There is a diversity of methods in performing pediatric inguinal herniotomy, but no consensus on which is the gold standard. The two most common are the Ferguson technique and the Mitchell Banks technique. The objective of this meta-analysis was to compare the two techniques in terms of hernia recurrence and post-operative complications: namely hematoma, hydrocele, testicular ascent, and testicular atrophy. Methods: Three randomized controlled trials and one multi-center retrospective study were included in this meta-analysis. Using the Cochrane Collaboration tool and Newcastle-Ottawa quality assessment scale, all studies included were deemed to be of good quality and have low risk of bias. Revman 5.3 was used for all statistical analyses. Results: There was no significant difference in terms of hernia recurrence between the two techniques (OR = 0.85, 95% CI = 0.31- 2.36). For post-operative complications, hematoma (OR = 0.64, 95% CI = 0.37-1.13), testicular ascent (OR = 0.28, 95% CI = 0.05- 1.50), and testicular atrophy (OR = 2.02, 95% CI = 0.54-7.52) did not differ between the two techniques. Only the incidence of postoperative hydrocele significantly differed between the two techniques, being higher when the external oblique aponeurosis was opened (OR = 0.44, 95% CI = 0.27-0.70). Conclusion: Performing pediatric inguinal herniotomy without opening the external oblique aponeurosis is a safe procedure and may be recommended as an optimal choice of method for uncomplicated cases. Key words: Pediatric herniotomy, Mitchell-Banks, Ferguson, external oblique aponeurosis

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Section: Discussionmentioning

confidence: 99%

A Meta-Analysis on the Comparison Between Pediatric Inguinal Herniotomies Performed With and Without Incising the External Oblique Aponeurosis in Terms of Recurrence and Complications

Tan,

Catangui,

Isabedra

2021

Philipp J Surg Spec

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“…Pediatric hydroceles are divided into congenital hydrocele and non-congenital (or acquired) hydrocele. 6 Congenital hydrocele is caused by continued patency of the processus vaginalis. Acer-Demir et al suggested that the prenatal environment, including the hormonal or nutritional status of the mother or the chemical exposure of the mother, was more strongly involved in the development of hydrocele than genetic factors.…”

Section: Discussionmentioning

confidence: 99%

“…Pediatric hydroceles are divided into congenital hydrocele and non‐congenital (or acquired) hydrocele 6 . Congenital hydrocele is caused by continued patency of the processus vaginalis.…”

Section: Discussionmentioning

confidence: 99%

Trends in treatment outcomes of hydrocele in Japanese children: A single‐institute experience

et al. 2020

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Objectives: To investigate trends in treatment outcomes of surgical intervention versus observation for pediatric hydrocele. Methods: This retrospective study included 175 patients diagnosed with hydrocele at our institution. Hydrocele was diagnosed based on medical history, physical examination and ultrasonography findings. The treatment for these patients was divided into two options: surgical intervention or careful follow up; the outcomes were investigated. Results: The median age at diagnosis was 3 months, and a total of 11 patients (6%) were premature at birth. Hydrocele was diagnosed on the right side, the left side and bilaterally in 106 (61%), 46 (26%) and 23 (13%) patients, respectively. A total of 136 patients showed spontaneous improvement at the median 7 months after diagnosis, and 54 patients underwent surgical intervention. The rate of spontaneous resolution deceased with age, but spontaneous resolution was observed in patients aged >2 years. Conclusions: Our findings suggest that spontaneous resolution can be observed in patients aged >2 years, and surgical intervention can be carried out effectively and safely. Infant hydrocele should be followed up carefully for at least 1 year without surgical intervention since diagnosis. Investigation of the optimal timing of and appropriate reason for surgical intervention can lead to better management and outcomes in patients with hydrocele. Further research is warranted to support the current clinical practice.

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“…Different etiologies of hydrocele can be identified: up to 50% are secondary to trauma; less commonly they are due to epididymitis, torsion, and tumors; however, most hydroceles are considered as idiopathic, possibly related to imbalance between fluid production and reabsorption by the mesothelial lining of the tunica vaginalis [5]. A few studies have suggested that hydroceles may interfere with spermatogenesis, and there is debate on the necessity for surgery in pediatric patients as well as on the best timing for intervention [6]. In adults, hydroceles usually do not require treatment unless their size causes difficulties or embarrassment [7].…”

Section: Introductionmentioning

confidence: 99%

Tension hydrocele as an additional cause of acute scrotum: case series and literature review

et al. 2019

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Purpose To describe the correlation between acute scrotum pain and tension hydrocele, focusing on US and Doppler features. Methods and materials We evaluated retrospectively a series of five patients with a long history of hydrocele who were referred to our institutions for increasing acute scrotal pain. Patients were approached with gray scale US of both testes, as well as with color-Doppler and spectral analysis, comparing the results with those after aspiration and symptoms relief. Results All patients had a "simple" hydrocele with no internal septa; the involved testicles had a "flattened" appearance and parenchymal Doppler signals showed increased intratesticular vascular resistance. One patient had a low diastolic flow, compared to the contralateral testis, with an increased RI value, one had no diastolic flow, two patients had retrograde diastolic flow, and the remaining one had no intratesticular flow visible. After decompression, there were disappearance of pain and improved flow with normalization of testicular vascularity; post-ischemic hyperemia was appreciated in the two patients examined immediately after fluid aspiration, while normal flow was seen in three studies carried out the day after. Conclusion To conclude, tension hydrocele is a rare condition that produces alterations of form and circulation of testicles, increase of intraparenchymal vascular resistances and strong and continuous pain, mimicking a testicular torsion. The increase in pressure produces an effect similar to that observed in a compartment syndrome. US findings, together with clinical assessment, indicate when emergency decompression may be appropriate to relieve testicular ischemia.

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Natural History and Conservative Treatment Outcomes for Hydroceles: A Retrospective Review of One Center's Experience

Cited by 11 publications

References 26 publications

A Meta-Analysis on the Comparison Between Pediatric Inguinal Herniotomies Performed With and Without Incising the External Oblique Aponeurosis in Terms of Recurrence and Complications

A Meta-Analysis on the Comparison Between Pediatric Inguinal Herniotomies Performed With and Without Incising the External Oblique Aponeurosis in Terms of Recurrence and Complications

Trends in treatment outcomes of hydrocele in Japanese children: A single‐institute experience

Tension hydrocele as an additional cause of acute scrotum: case series and literature review

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