Hydrocele
The testicles form by the kidneys during development in the womb and slowly make their way down to the scrotum through an opening in the inguinal canal. Normally the testicles descend completely and the opening is then closed spontaneously. Sometimes before the opening is closed abdominal fluid can make its way into the scrotum and the fluid becomes trapped around the testicle. This is called a hydrocele.
Many infants are born with hydroceles and for the most part the fluid is absorbed by the body over time and the swelling decreases. In this case, surgery is not required. If the swelling goes up and down over time, a hernia may be the correct diagnosis. If the swelling does not decrease, or actually increases over time, the hydrocele may need to be corrected surgically.
A hydrocelectomy (removal of hydrocele) is done under general anesthesia and is a day surgery- meaning the patient can go home the same day. Once the patient is put to sleep a camera is placed in through the patient’s belly button to examine the inguinal canal better and rule out a hernia. Once it is visualized that the inguinal canal is indeed closed and there is no hernia, we will then make an incision in the scrotum to remove the fluid. The surgeon will then turn the hydrocele sac on itself so a hydrocele does not occur again.
Inguinal Hernia
Before a baby is born, the testicles start up by the kidneys during development and make their way down to the scrotum through an opening in the groin called the inguinal canal. This opening should then close completely. If the opening does not close it is called a hernia. A hernia allows abdominal fluid, and/or loops of intestine, to move down to the scrotum and back up when there is high pressure in the abdomen ( i.e. crying, bowel movements, or bearing down). Hernias are rarely painful but can feel uncomfortable. Parents will notice the patient's scrotum gets bigger and smaller throughout the day.
It is important to correct an inguinal hernia because there is a small risk that the bowel (part of the intestine) can get stuck and strangulated in the opening. This can cut off blood supply and cause the bowel to die. In this case, the patient would need emergent surgery. Signs of intestinal strangulation include: swelling of scrotum that is red or purple and hard, unable to reduce (push the swelling back up to the abdomen), vomiting, or inconsolable child. If any of these occur please call a physician who will most likely direct you to the emergency room.
Surgical correction of an inguinal hernia is done electively under general anesthesia and is a day surgery- meaning the patient will go home the same day. Once the patient is put to sleep, a camera will be placed through the patient’s belly button to ensure this is an inguinal hernia and not any other abnormalities such as a hydrocele (see below). Once it is confirmed it is an inguinal hernia (by noting there is still an opening in the inguinal canal) we will then make an incision in the groin to close the hernia. We will then check the area again with the camera through the belly button to ensure it is closed.
Testicle Pain
Testicle pain can be due to many causes. Some causes just require rest and some ibuprofen. Some require antibiotics, some require immediate surgical invention. Some have no cause, or at times presumed to be caused by an irritated nerve, or common things like constipation or trauma..
Workup usually involves a physical exam to determine if there is a hernia, hydrocele, testicular torsion, orchitis and/or epididymitis. Sometimes a scrotal ultrasound is needed to help delineate the cause.
A urine analysis should also be performed to ensure infection is not a cause. A thorough history about sexually transmitted disease should also be obtained.
Based on these findings and history, a diagnosis will be made and a management plan will be put into place.
If there is ever any suspicion of a sudden pain, and/or scrotal swelling go to the nearest Emergency Room to ensure it is not testicular torsion. If the swelling is present but not very tender call my office for an evaluation.
Undescended Testicle
Before a baby is born, testicles start up by the kidneys during development in the womb and slowly make their way down to the scrotum (the sack of skin beneath the penis) through an opening in the groin called the inguinal canal. Sometimes, the testicles do not completely descend on their own. When this happens they can be anywhere from the abdomen, to the inguinal canal, or the upper scrotum.
Normally we give the testicles time to descend on their own. Typically 70 percent of testicles will descend by 6 months, 85% by 9 months, and 90% by 1 year. If the testicle has not descended by a year it is very unlikely it will. In that scenario we would recommend surgical correction.
Surgery is needed to bring the testicle down to the scrotum because the scrotum is the correct environment for the testicle to develop. When the testicle is higher up, it is in a warmer temperature which is not ideal for normal growth. The testicle also needs to be in the scrotum so the patient can perform testicular exams when he is older to notice whether there are any abnormalities that need to be further assessed.
This surgery is called an orchidopexy and is done under general anesthesia. This is a day surgery as the patient will go home the same day. There are a few different possibilities on the specifics of the surgery.
If the testicle is felt during exam we will make an incision in the inguinal canal to find the testicle followed by an incision in the scrotum to bring the testicle down.
If the testicle is not felt on exam we will need to put a camera in through the patient’s belly button to look for the testicle in the abdomen.
Should the testicle be found in the abdomen, and it is low enough, we will bring it down that day.
If the testicle is found very high up in the abdomen, we will need to perform the surgery in stages. First the surgery requires cutting a specific blood supply that is tethering the testicle high up. Then 6 months later we will bring the testicle down completely.
If the testicle is not found or is found to be very abnormal we will discuss the possibility of removing the testicle during surgery. This will be a conversation the surgeon and parents will have before any decision is made.