External Genital Anomalies in Boys: Difference between revisions

Line 304:

=== Management ===

* '''Hydroceles~~'''~~

** '''Both communicating and non-communicating hydroceles may resolve spontaneously in infants''' (CW12 p392 and CW11)

==== Hydroceles ====

*** '''No indication for surgery within the first 24 months of age'''

* '''Both communicating and non-communicating hydroceles may resolve spontaneously in infants''' (CW12 p392 and CW11)

**** '''Indications for intervention:'''

** '''No indication for surgery within the first 24 months of age'''

***** '''Hydrocele associated with inguinal hernia'''

*** '''Indications for intervention:'''

***** '''Hydrocele develops when child is several years old'''

**** '''Hydrocele associated with inguinal hernia'''

***** '''Hydrocele enlarges during the period of observation'''

**** '''Hydrocele develops when child is several years old'''

* '''Inguinal Hernia~~'''~~

**** '''Hydrocele enlarges during the period of observation'''

** '''Require surgical repair shortly after diagnosis, given the significant risk of associated complications'''

** '''Standard Inguinal Hernia Repair'''

==== Inguinal Hernia ====

*** '''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'''

* '''Require surgical repair shortly after diagnosis, given the significant risk of associated complications'''

*** '''In peripubertal boys with hydrocele, determine if hydrocele is communicating or scrotal.'''

* '''Standard Inguinal Hernia Repair'''

**** '''If communicating, inguinal approach is preferred'''

** '''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'''

**** '''If scrotal, trans-scrotal hydrocele approach is performed as in adults''' and an inguinal incision made only if a proximal communication is identified.

** '''In peripubertal boys with hydrocele, determine if hydrocele is communicating or scrotal.'''

*** '''Complications'''

*** '''If communicating, inguinal approach is preferred'''

**** Early postoperative complications, including bleeding and infection, are rare after standard hernia repair

*** '''If scrotal, trans-scrotal hydrocele approach is performed as in adults''' and an inguinal incision made only if a proximal communication is identified.

**** '''Recurrent inguinal hernia'''

** '''Complications'''

***** Rate after uncomplicated open repair: 0.5-1%

*** Early postoperative complications, including bleeding and infection, are rare after standard hernia repair

***** 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.

*** '''Recurrent inguinal hernia'''

***** '''Laparoscopic inguinal hernia repair associated with higher risk of recurrence''' (up to 4%) '''than with open repair'''

**** Rate after uncomplicated open repair: 0.5-1%

**** '''Secondary cryptorchidism''', testicular atrophy, and vasal injury is not well defined.

**** 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.

***** If a testis is incompletely descended or retractile, orchidopexy should be performed at the time of herniorrhaphy

**** '''Laparoscopic inguinal hernia repair associated with higher risk of recurrence''' (up to 4%) '''than with open repair'''

** Assessment of the contralateral internal ring

*** '''Secondary cryptorchidism''', testicular atrophy, and vasal injury is not well defined.

*** 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

**** 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

== Varicocele ==

@@ Line 304: / Line 304: @@
 === Management ===
-* '''Hydroceles'''
-** '''Both communicating and non-communicating hydroceles may resolve spontaneously in infants''' (CW12 p392 and CW11)
+==== Hydroceles ====
-*** '''No indication for surgery within the first 24 months of age'''
+* '''Both communicating and non-communicating hydroceles may resolve spontaneously in infants''' (CW12 p392 and CW11)
-**** '''Indications for intervention:'''
+** '''No indication for surgery within the first 24 months of age'''
-***** '''Hydrocele associated with inguinal hernia'''
+*** '''Indications for intervention:'''
-***** '''Hydrocele develops when child is several years old'''
+**** '''Hydrocele associated with inguinal hernia'''
-***** '''Hydrocele enlarges during the period of observation'''
+**** '''Hydrocele develops when child is several years old'''
-* '''Inguinal Hernia'''
+**** '''Hydrocele enlarges during the period of observation'''
-** '''Require surgical repair shortly after diagnosis, given the significant risk of associated complications'''
-** '''Standard Inguinal Hernia Repair'''
+==== Inguinal Hernia ====
-*** '''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'''
+* '''Require surgical repair shortly after diagnosis, given the significant risk of associated complications'''
-*** '''In peripubertal boys with hydrocele, determine if hydrocele is communicating or scrotal.'''
+* '''Standard Inguinal Hernia Repair'''
-**** '''If communicating, inguinal approach is preferred'''
+** '''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'''
-**** '''If scrotal, trans-scrotal hydrocele approach is performed as in adults''' and an inguinal incision made only if a proximal communication is identified.
+** '''In peripubertal boys with hydrocele, determine if hydrocele is communicating or scrotal.'''
-*** '''Complications'''
+*** '''If communicating, inguinal approach is preferred'''
-**** Early postoperative complications, including bleeding and infection, are rare after standard hernia repair
+*** '''If scrotal, trans-scrotal hydrocele approach is performed as in adults''' and an inguinal incision made only if a proximal communication is identified.
-**** '''Recurrent inguinal hernia'''
+** '''Complications'''
-***** Rate after uncomplicated open repair: 0.5-1%
+*** Early postoperative complications, including bleeding and infection, are rare after standard hernia repair
-***** 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.
+*** '''Recurrent inguinal hernia'''
-***** '''Laparoscopic inguinal hernia repair associated with higher risk of recurrence''' (up to 4%) '''than with open repair'''
+**** Rate after uncomplicated open repair: 0.5-1%
-**** '''Secondary cryptorchidism''', testicular atrophy, and vasal injury is not well defined.
+**** 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.
-***** If a testis is incompletely descended or retractile, orchidopexy should be performed at the time of herniorrhaphy
+**** '''Laparoscopic inguinal hernia repair associated with higher risk of recurrence''' (up to 4%) '''than with open repair'''
-** Assessment of the contralateral internal ring
+*** '''Secondary cryptorchidism''', testicular atrophy, and vasal injury is not well defined.
-*** 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
+**** 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
 == Varicocele ==