Hydrocelectomy via scrotal incision is a valuable alternative to the traditional inguinal approach for hydrocele treatment in boys

[Hydrocele]

The hydrocele is overall a rare condition in urology. A differentiation between primary and secondary hydrocele is essential for further treatment. A primary hydrocele with a patent vaginal process tends to spontaneously regress in the first 2 years of life in newborns. If treatment is necessary, open as well as laparoscopic methods are available with good results. The treatment of scrotal pathologies, especially secondary hydrocele, often poses a challenge in the clinical practice. Despite the benign nature, supposedly simple surgical techniques and good chances of healing, postoperative complications are frequent. In comparison to open surgery, sclerotherapy provides a good alternative for the treatment of secondary hydrocele.

Gross Hydrocele With Completely Buried Penis: A Case Report

A gross hydrocele is caused by fluid accumulation within a layer wrapped around the testicle, called the tunica vaginalis, derived from the peritoneum. A 65-year-old male complained of a non-tender, fluctuant bulge in his right scrotum despite having a fully buried penis, a large hydrocele, and urinary retention. After ultrasonography, the diagnosis was confirmed, and the patient underwent a successful surgical procedure that included a hydrocelectomy and tunica vaginalis excision. The patient reported few postoperative complications and a notable improvement in his quality of life. Surgery is a successful approach for treating gross hydrocele, with minimal morbidity and excellent cosmetic outcomes.

Use of a risk communication survey to prioritize family-valued outcomes and communication preferences for children undergoing outpatient surgical procedures

BACKGROUND

Effective shared decision-making in pediatric surgery requires clarity regarding which surgical outcomes are most important to patients and their families, and how they prefer to receive the information. Despite how essential this is for effective risk communication, little is known about the communication needs and preferences of patients and their families in elective pediatric surgery.

METHODS

We administered a mailed and online cross-sectional survey in English and French to 548 families before or after surgery for hernia/hydrocele repair or tonsillectomy/adenoidectomy between July 2019 and February 2021. The survey consisted of 22 questions eliciting most valued patient-reported outcomes (PROs) across 4 domains: health-related quality of life (5), functional status (5), symptoms and symptom burden (5), health behaviours and patient experience (7), as well as overall impressions (3), surgical risks (5), communication preferences (4), and demographic questions (16).

RESULTS

The survey was completed by 368 patient families (60 preoperative, 308 postoperative, response rate 67.2%). Most respondents (72%) indicated a significant desire to be informed on all listed PROs alongside surgical complications, and highly valued all functional and quality of life outcomes (92.9% & 89.8%, respectively). Preoperatively, patient families preferred to receive information in the form of pamphlets and websites, whereas postoperatively they preferred direct communication.

CONCLUSION

Families value functional and quality of life PROs as much as clinical outcomes, and increasingly seek more contemporary (electronic) means of risk communication than we currently offer. This data will inform the development of mobile tools for personalized communication in pediatric surgery.

Comparison of the Inguinal and High Scrotal Approaches for the Treatment of Inguinal Hernias in Boys

Background

The conventional groin incision herniotomy is still being adhered to despite high success rate of high scrotal approach. Hence, the aim of this study was to compare the outcomes of high scrotal and conventional approaches for the treatment of inguinal hernia in boys.

Methods

A prospective study of 100 boys with 108 inguinal hernias whose ages were less than 15 years. They were randomized into 2 groups; high scrotal and conventional approaches. Ninety-four patients with 101 hernias were analyzed. The operative time, conversion rate (high scrotal approach), and postoperative complications were reported.

Results

A total of 100 boys with 108 hernias were enrolled but 94 patients with 101 hernias were analyzed. They comprised of 48 patients with 51 hernias in the high scrotal group and 46 patients with 50 hernias in the conventional group. Their age range was between 2 months and 168 months with a mean of 47.9 ± 46.7 months. The conversion rate of high scrotal approach was 1.9%. The mean duration of operation in the high scrotal group was 37.1 ± 13.3 minutes compared with 37.2 ± 15.1 minutes in the conventional group, p = 0.982. Early postoperative scrotal edema was more in the high scrotal group compared to the conventional group, p = 0.018. The Hollander wound evaluation score was better in the high scrotal incision compared to the conventional approach, p = 0.003.

Conclusion

The high scrotal approach may be an alternative to conventional herniotomy in boys.

Laparoscopic vs. Open Repair Surgery for the Treatment of Communicating Hydrocele in Children: A Retrospective Study From a Single Center

Purpose: This study evaluated the outcomes of laparoscopic repair (LR) and open repair (OR) surgery for communicating hydrocele in children.

Patients and Methods: We collected the clinical data and follow-up data of all boys (<14 years) who underwent communicating hydrocele surgery in the pediatric surgery department at Yijishan Hospital of Wannan Medical College from January 2017 to December 2018 and retrospectively analyzed the data.

Results: In this study, 155 patients were retrospectively enrolled, including 90 patients in the OR group and 65 patients in the LR group. There were significant differences in operation time and the recurrence of hydrocele between the two groups. The persistence of scrotal swelling in the LR group was significantly lower than that in the OR group. There was no significant difference in postoperative hospitalization time or incision infection rate between the two groups.

Conclusion: In conclusion, this study shows that laparoscopic treatment of children with communicating hydrocele has the advantages of a hidden incision, a shortened operation time, and a reduced postoperative recurrence rate and can be used as the preferred surgical method. However, laparoscopic treatment should be selected according to the specific condition of each child and cannot completely replace traditional open surgery.