Abstract
PurposeThe aim of this study was to determine the current UK practice regarding timing of surgical repair of hydroceles in young boys.MethodsThrough a validated, online survey, participants were asked their preferred management option in five different clinical scenarios across five age ranges.Results71 responses were included in the analysis. The most common age to offer surgical intervention for a congenital hydrocele that is stable or increasing in size, or a hydrocele of the cord is 24–36 months. For a stable hydrocele presenting after 12 months of age, the most common age to offer repair is between 36 and 48 months. Approximately ¼ of respondents defer surgery until 4 years of age for any stable hydrocele. For a congenital hydrocele that is decreasing in size, the majority of respondents (57%) do not offer surgical intervention even over 4 years of age. The majority of respondents (61%) do not differentiate between communicating and non-communicating hydroceles when considering age for repair.ConclusionThese results suggest that there is uncertainty regarding the optimum age for PPV ligation and adequate underlying variability in practice to support a prospective study of the optimum age for hydrocele repair and the natural history of PPV closure.
Highlights
Idiopathic hydrocele is a common reason for referral to the paediatric surgery outpatient clinic and nearly 3000 operations for hydrocele are performed by surgeons each year in England [1]
The majority of respondents (61%) do not differentiate between communicating and non-communicating hydroceles when considering age for repair. These results suggest that there is uncertainty regarding the optimum age for patent processus vaginalis’ (PPVs) ligation and adequate underlying variability in practice to support a prospective study of the optimum age for hydrocele repair and the natural history of PPV closure
The International Pediatric Endosurgery Group states that most surgeons advocate observation before 12 months of age and that the majority of patent processus vaginalis’ (PPVs) will close within the first 12–24 months of life; they do not provide a specific recommendation for the age at which surgery should occur [4]
Summary
Idiopathic hydrocele is a common reason for referral to the paediatric surgery outpatient clinic and nearly 3000 operations for hydrocele are performed by surgeons each year in England [1]. Traditional surgical teaching has been that hydroceles that are persistent into the third year of life should be repaired [2]. Current guidelines offer limited recommendations in relation to the timing of surgery [4, 5]. The International Pediatric Endosurgery Group states that most surgeons advocate observation before 12 months of age and that the majority of patent processus vaginalis’ (PPVs) will close within the first 12–24 months of life; they do not provide a specific recommendation for the age at which surgery should occur [4]. According to national data from the UK, the most frequent age at which surgery takes place is between 24 and 36 months [1]
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