Before birth, the testicle descends from the abdominal cavity to the scrotum, along an open channel that usually closes by the time a child is born. Girls also have this open channel. If the channel does not close, a hernia or hydrocele may develop. A hernia occurs when a piece of intestine slides into the channel. If the channel is more narrow, only fluid from the abdominal cavity can filter down, which may surround the testicle in the scrotum, a condition known as a hydrocele.
Hernia: A hernia can be a serious problem at any age because it can cause the intestine to become trapped (called an incarcerated hernia) or lose its blood supply (a strangulated hernia). Therefore, it's best to fix a hernia as an elective surgery soon after it is diagnosed. Incarcerated or strangulated hernias may require emergency surgery.
Hydrocele: Hydroceles are very common in newborn boys, and may change in size as normal abdominal fluid flows in and out of them. They may be very large, although they do not cause any injury to the testicle. Since the channel is usually narrower than with a hernia, it may close by itself in the first three to six months of life. As it closes, the fluid in the hydrocele "sac" will often gradually be reabsorbed by the body.
Symptoms of a Hernia
A hernia causes a bulge in the groin area. A hernia can occur when your child cries, coughs or strains. If the bulge does not disappear by itself or with gentle pressure, bring your child to the doctor immediately. If intestine is trapped in a herniated channel, your child may become feverish, fussy or start vomiting. If a hydrocele alone is present, the scrotum on that side will be enlarged and may appear bluish in color.
A hernia is more likely to develop on the side of an undescended testicle. This is because the testicles form in the abdomen, and descend before birth in most cases. In undescended testicles, the connection between the testicle and the abdomen often fails to close as it normally does. Also, torsion (twisting) of the testicle is more likely to occur, which can result in loss of the testicle. There is also a slightly increased risk of testicular cancer in testicles that are undescended. However, since testicular cancer is rare to begin with, it is still uncommon in men who had an undescended testicle. The risk is higher if the testicle was in the abdomen, and there is some evidence that bringing the testicle down during early childhood may reduce this risk.
Who Gets Hernias?
Hernias are more common in boys with undescended testicles and in children who are born prematurely. The risk may also be higher for children who have a surgical shunt tube connecting the brain to the abdomen. Girls may also get hernias, although it is less common.
Once diagnosed, treatment is recommended as soon as feasible. Surgery is done under general anesthesia, with an incision made in the groin area, usually in a natural skin fold. The channel is separated from the other tissues and tied off. If the hernia is only on one side, there is about a 10 to 20 percent risk of a hernia on the opposite side if your child is less than one year old, and five percent if he or she is older.
It is usually best to wait until your child is close to one year of age to see if the hydrocele will recede or disappear. If it remains, the same type of surgery as for a hernia can be done. Surgery will sometimes be performed earlier if, after six months of age, the hydrocele is very large or continues to shrink and expand, or if a hernia is also present. A hydrocele that changes in size means that the connection to the abdomen hasn't closed. This is essentially the same as a hernia.
Unless your child is less than two or three months old, this type of surgery is usually performed without an overnight stay in the hospital. The procedure usually takes an hour or less. The stitches are placed under the skin and dissolve, and the surgical glue falls off on its own one or two weeks after surgery. Your child may need either acetominophen or ibuprofen every four to six hours as needed for pain after surgery. He should avoid strenuous activity for two weeks after surgery, and should wait for 24 hours to bathe. He may be able to return to school as early as two to three days after surgery. An appointment should be made to see the doctor one to two weeks after surgery.
Potential Complications from Surgery
Complications from surgery are very rare, but are more likely if your child has previous groin surgery. Possible risks include infection, bleeding recurrence, pulling up of the testicle, and injury to the testicle or its ducts.
When to Call the Doctor
After surgery, call your physician if your child runs a fever (over 101.5 degrees), has worsening pain, redness that spreads around the incision, swelling or drainage, or if you have any other questions or concerns.
Pediatric Urology at Cedars-Sinai
Children are affected by different urologic conditions than adults, and their smaller bodies respond differently to anesthesia and surgical incisions. For these reasons, the Cedars-Sinai Urology Academic Practice is guided by the philosophy that pediatric patients are best evaluated and treated by pediatric specialists. Andrew Freedman, MD, the Urology Academic Practice's pediatric urologist, devotes his practice to the evaluation and treatment of children. Board certified in Pediatric Urology he offers broad experience in minimally invasive laparoscopic procedures. Dr. Freedman is experienced in robotic procedures adapted for the needs of children. The majority of his procedures are conducted on an outpatient basis, with both outpatient and inpatient surgeries attended by specialized pediatric anesthesiologists.