Editing External Genital Anomalies in Boys (section)

=== Management ===

==== Hydroceles ====
* '''Both communicating and non-communicating hydroceles may resolve spontaneously in infants''' (CW12 p392 and CW11)
** '''No indication for surgery within the first 24 months of age'''
*** '''Indications for intervention:'''
**** '''Hydrocele associated with inguinal hernia'''
**** '''Hydrocele develops when child is several years old'''
**** '''Hydrocele enlarges during the period of observation'''

==== Inguinal Hernia ====
* '''Require surgical repair shortly after diagnosis, given the significant risk of associated complications'''
* '''Standard Inguinal Hernia Repair'''
** '''The traditional surgical approach to repairing an indirect inguinal hernia or communicating hydrocele is high ligation of the hernia sac at the level of the internal inguinal ring. This carries a high success rate'''
** '''In peripubertal boys with hydrocele, determine if hydrocele is communicating or scrotal.'''
*** '''If communicating, inguinal approach is preferred'''
*** '''If scrotal, trans-scrotal hydrocele approach is performed as in adults''' and an inguinal incision made only if a proximal communication is identified.
** '''Complications'''
*** Early postoperative complications, including bleeding and infection, are rare after standard hernia repair
*** '''Recurrent inguinal hernia'''
**** Rate after uncomplicated open repair: 0.5-1%
**** Causes include failure to properly identify or ligate the sac during the original procedure; a tear in the sac, leaving a strip of peritoneum along the cord; damage to the floor; or a missed direct hernia at the original exploration.
**** '''Laparoscopic inguinal hernia repair associated with higher risk of recurrence''' (up to 4%) '''than with open repair'''
*** '''Secondary cryptorchidism''', testicular atrophy, and vasal injury is not well defined.
**** If a testis is incompletely descended or retractile, orchidopexy should be performed at the time of herniorrhaphy
* Assessment of the contralateral internal ring
** The need to assess the patency of the contralateral processus vaginalis or of the internal inguinal ring in children with a unilateral hernia remains controversial