What are the clinical manifestations of hydrocele in children?

There are two types of hydrocele in children, primary and secondary. If it is primary, it is difficult to find a clear cause and the disease progresses slowly. However, if it is secondary, the cause is still very obvious and most pediatric patients will not have obvious discomfort. If it is primary, the primary disease can be treated, and surgical treatment can also be adopted.

1. Clinical manifestations

When children develop hydrocele, it is usually a cystic tumor in the scrotum or spermatic cord. Most children do not feel any discomfort. The size can vary greatly, and most are oval. The scrotal skin of primary hydrocele is normal, has high tension and is translucent. Congenital hydrocele can be squeezed out when the patient lies flat, so that the fluid can gradually shrink or even disappear completely. Most hydroceles are unilateral. In the case of secondary hydrocele, we should be alert to the presence of lesions in the testicles and epididymis, such as tuberculosis, tumors, and parasitic infections.

2. Treatment Methods

1. Treatment of primary disease

It is suitable for patients with a slow course of the disease, little fluid accumulation, low tension and no long-term growth, and no obvious symptoms. After successful treatment of the underlying disorder, a hydrocele often resolves on its own without the need for surgery. In addition, hydrocele in children under 2 years old can often be absorbed on its own and does not require surgery.

2. Surgery

(1) Indications for surgery: ① Hydrocele in infants under 2 years old can generally be absorbed on their own, but when the amount of fluid is large and there is no obvious spontaneous absorption, surgical treatment is required. ② For hydrocele in infants under 2 years old, accompanied by congenital groin pain or the possibility of testicular lesions, early surgery is necessary. ③ Patients over 2 years old with communicating hydrocele or larger testicular hydrocele with clinical symptoms affecting their quality of life should be given surgical treatment. However, hydrocele caused by epididymitis and testicular torsion should be excluded.

(2) Main surgical method: Surgery is the safest and most reliable method to treat hydrocele. The surgical methods include: testicular tunica vaginalis inversion, testicular tunica vaginalis plication, tunica vaginalis excision, and communicating hydrocele is often treated with an oblique inguinal incision with high cutting and suturing of the processus vaginalis at the internal ring. For spermatic cord hydrocele, the cyst must be completely peeled off and removed.

(3) Surgical complications: The surgical complications are low, mainly bleeding, infection, edema, vas deferens damage, and testicular atrophy and infertility caused by damage to the spermatic artery.

3. Differential Diagnosis

Hydrocele in children should be differentiated from hernia in treatment. The fluid in most children's hydrocele comes from the abdominal cavity and is not congenital hydrocele. Once the hernia is treated, the hydrocele will naturally heal. Hernia is a typical symptom of hernia that can be seen and felt. A lump will appear. The lump may disappear during sleep but will become larger during crying. Auxiliary examinations can be used for identification: ① The transillumination test is positive, but it may be negative when secondary inflammation and bleeding occur. ②B-ultrasound examination can further clarify the diagnosis. It helps to differentiate hydrocele, varicocele, testicular torsion, etc., and is also of great significance for secondary hydrocele caused by suspected testicular tumors.