PEDIATRIC UROLOGY

doi: 10.1590/S1677-55382010000400028

Infant communicating hydroceles -- do they need immediate repair or might some clinically resolve?
Koski ME, Makari JH, Adams MC, Thomas JC, Clark PE, Pope JC 4th, Brock JW 3rd
Department of Urology, Division of Pediatric Urology, Monroe Carell Jr Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA
J Pediatr Surg. 2010; 45: 590-3

• Purpose: Infant hydroceles that are communicating by history (fluctuation in size) or examination (reducible fluid) are often repaired soon after presentation. We have followed a series of infant boys with such hydroceles and reviewed their early natural history.
  Materials and Methods: Since 1998, we have followed 174 infant boys presenting with an apparent communicating hydrocele without immediate surgical repair. All boys were initially seen before 18 months of age and most (168) by 12 months. Most had been full term at delivery, although 32 had been premature (<37 weeks’ gestational age) and 11 extremely so (<32 weeks). Most boys (120) had bilateral hydroceles at presentation.
  Results: Of the 110 boys followed to disposition, 69 (62.7%) had complete resolution without surgery by a mean age of 11.7 months. Forty-one patients (37.3%) underwent surgery for correction at a mean age of 14 months because of persistence in size or development of a hernia. Six developed a hernia during observation, none of whom had any episode of incarceration. Only 2 patients with apparent resolution subsequently had recurrence with a hernia. Age at presentation and gestational age at birth showed no effect on resolution. The hydroceles of 64 boys had improved in size after a mean follow-up of 13.9 months when last seen.
  Conclusions: Many infant hydroceles that are communicating by history or examination do resolve clinically without surgery and deserve observation. Progression to hernia was rare in our experience and did not result in incarceration. Consequently, little risk is taken by initial observation.

• Editorial Comment
  The authors of this retrospective study propose that observation of communicating hydroceles in young infants is warranted given a fairly high resolution rate and low rate of progression to a true hernia in their series. In addition, there were no episodes of incarceration of these hernias. Because the natural tendency of most pediatric urologists and pediatric surgeons is to repair communicating hydroceles near the time of presentation, we have previously had little data to demonstrate the natural history of these patients. This series provides nice data for us and suggests that observation may be reasonable for many of these patients. I suspect that over a 9-year period of time, there were more than 174 patients younger than 18 months who presented to their institution with a communicating hydrocele. It would be interesting to know what criteria were used to determine which patients should be followed and which patients should be repaired without observation.

M. Chad Wallis
Division of Pediatric Urology
University of Utah
Salt Lake City, Utah, USA
E-mail: chad.wallis@hsc.utah.edu