1530 ADOLESCENT HYDROCELECTOMY A SCROTAL OR INGUINAL APOPROACH?

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia I1 Apr 20121530 ADOLESCENT HYDROCELECTOMY A SCROTAL OR INGUINAL APOPROACH? Jason P. Van Batavia, Angela M. Fast, and Kenneth I. Glassberg Jason P. Van BataviaJason P. Van Batavia New York, NY More articles by this author , Angela M. FastAngela M. Fast New York, NY More articles by this author , and Kenneth I. GlassbergKenneth I. Glassberg New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1298AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Hydroceles found early in life are associated with a patent processus vaginalis, which requires correction via an inguinal approach. When hydroceles present later in adulthood, they are rarely associated with a patent processus vaginalis and a transscrotal approach is preferred. Adolescent boys are between these extremes and the correct approach to hydrocele repair is unclear. In patients undergoing laparoscopic varicocelectomy (LV) and who coincidentally had a known hydrocele that required surgery, we sought to determine laparoscopically how often these patients had an open ring to extrapolate what approach, inguinal vs. scrotal, should be used for the for adolescent hydrocelectomy, whether or not a varicocele is present. METHODS Using our IRB-approved prospectively maintained adolescent varicocelectomy database, the operative reports and charts of all patients that underwent LV were reviewed. Data was collected on boys who underwent simultaneous LV and hydrocelectomy and the presence of ipsilateral open or closed internal inguinal rings were noted. The approach to hydrocelectomy, ie. inguinally vs. scrotally, was also recorded and in all cases a Jaboulay-type repair was performed. At the time of transscrotal hydrocelectomy, the cephalad portion of the hydrocele was probed to detect for a proximal patent processus vaginalis. RESULTS Of 412 patients who underwent LV since 1997, operative reports were available in 306 (mean age 15.7 yrs, 50 bilateral). Ten boys had known right hydroceles, 2 had known left hydroceles, and 1 had bilateral hydroceles at the time of presentation. Of these 14 hydroceles in 12 patients (4% of all LV patients), only 2 (both on the right) were associated with widely open internal inguinal rings. Both of these right hydroceles were repaired with an inguinal approach and all others were repaired transscrotally. The patient with bilateral hydroceles had closed rings bilaterally. No recurrences were noted after repair. CONCLUSIONS In this cohort of adolescents undergoing laparoscopic correction of varicoceles, only 14% of synchronous hydroceles were associated with an open internal inguinal ring or patent processus vaginalis that required inguinal repair. The majority can be repaired safely with a transscrotal approach. On the basis of these observations, we believe that adolescents undergoing hydrocelectomy should be approached transscrotally and recognize that 14% might need an additional inguinal incision. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e619 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason P. Van Batavia New York, NY More articles by this author Angela M. Fast New York, NY More articles by this author Kenneth I. Glassberg New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...