Congenital Hydrocele Research Articles

Prevalence of congenital cryptorchidism in China: A nationwide population-based surveillance study, 2007-2021.

Despite cryptorchidism being a common genital abnormality in male newborns with significant prevalence variations globally, there is a notable scarcity of epidemiological data on this condition in China. This study aimed to delineate the prevalence pattern of cryptorchidism in Chinese population over the past 15 years using nationwide surveillance data. Data from the China National Population-based Birth Defects Surveillance System (2007-2021) were analyzed to calculate the prevalence rates of cryptorchidism, stratified by birth year, maternal age, maternal residence, and geographic region. Adjusted prevalence rate ratios were computed using Poisson regression, while trends in prevalence and average annual percent change (AAPC) were assessed using the joinpoint regression model. During the study period, a total of 1,833 cases of cryptorchidism were identified among 2,565,964 full-term male births, resulting in prevalence rates of 7.14, 5.60, and 1.54 per 10,000 births for overall, isolated, and associated cryptorchidism, respectively. The overall prevalence increased from 3.86 to 11.20 per 10,000 births, with an AAPC of 7.9% (95% confidence interval: 5.5-11.0). Significant variations were observed across maternal age (<20 years, 7.62/10,000; 20-24 years, 6.14/10,000; 25-29 years, 6.96/10,000; 30-34 years, 7.48/10,000; ≥35 years, 9.22/10,000), maternal residence (urban vs. rural, 10.99/10,000vs. 2.86/10,000), and geographic region (eastern, 12.38/10,000; central, 2.36/10,000; western, 2.63/10,000). Approximately one-third of cryptorchidism cases were bilaterally, while two-thirds were unilateral. Commonly observed associated abnormalities included congenital hydrocele testis, as well as anomalies in the genital organs, circulatory system, and musculoskeletal system. Despite lower rates compared to other countries, the increasing trend in prevalence of cryptorchidism necessitates further investigation and intervention.

Hydrocele of the Nuck canal

The process vaginalis in the inguinal canal forms the canal of Nuck, which is a homolog of the process vaginalis in women. Incomplete obliteration of the vaginal process causes an indirect inguinal hernia or hydrocele of the canal of Nuck, a very rare condition in women. A hydrocele of the Nuck canal, although rare, should be considered in the differential diagnosis in girls with inguinal swelling. Establishing a definitive diagnosis on physical examination is difficult, radiological imaging can help diagnosis, but surgical exploration is essential for the final diagnosis. The authors report a case of congenital hydrocele in a 2-year-old girl and review the literature on this rare entity whose diagnosis can be made by surgical exploration.

Frequency Risk Factors and Pattern of Congenital Anomalies in Neonates in Nawabshah Pakistan

Objectives: The objectives of this study were to determine the frequency, risk factors and pattern of congenital anomalies in neonates admitted at a tertiary care hospital.&#x0D; Methodology: It was a descriptive cross-sectional study. Research was conducted at NICU Pediatric ward, PMCH Nawabshah. Duration of study was 6 months after the approval of synopsis from January 2020 to July 2020. This study involved 300 neonates in NICU which were screened for congenital anomalies. Age, gender and birth weight of the neonate was recorded. Mothers were also enquired about consanguinity and use of folic acid and smoking and diabetic status during pregnancy. Frequency and type of birth defect were noted and were compared across various subgroups based on various neonatal and maternal factors.&#x0D; Results: The mean age of the neonates was 10.5±7.4 days while the mean birth weight was 2.89±0.74 Kg. There were 174 (58.0%) male and 126 (42.0%) female neonates with a male to female ratio of 1.4:1. 77 (25.7%) neonates were low birth weight. Birth defect was noted in 35 (11.7%) neonates. 3 neonates had multiple anomalies. The frequency of birth defects was significantly higher in women with no use of folic acid during pregnancy (14.8% vs. 5.2%; p-value=0.015) and cousin marriage (16.6% vs. 2.8%; p-value&lt;0.001).&#x0D; Conclusion: In the present study, 11.7% of neonates had birth defects comprising of congenital hydrocele, spina bifida, cleft lip/palate and club foot that were associated with lack of folic acid use during pregnancy and cousin marriages. Public awareness against cousin marriages and antenatal counseling of mothers for routine folic acid use during pregnancy should be assured for this.

Abnormal Glycerol Metabolism in a Child with Global Developmental Delay, Adrenal Insufficiency, and Intellectual Disability

After an uncomplicated birth and initial symptom-free period, a 7-day-old male infant presented with poor feeding, hypotension, hyponatremia (123 mmol/L; reference interval, 135–148), hyperkalemia (9.0 mmol/L; reference interval, 3.5–5.5), and increased blood urea nitrogen. A diagnosis of primary adrenal insufficiency was made following an adrenal ultrasound remarkable for no discernable adrenal tissue. Subsequent fluorescent in situ hybridization studies revealed deletions in the region containing the NR0B1 ,5 IL1RAPL1 , and GK genes in both the patient (for which he was treated with adrenocorticosteroids) and his asymptomatic mother. At approximately 4 years of age, he experienced a hypoglycemic episode (plasma glucose, 42 mg/dL). Fasting triglyceride level was also increased at 465 mg/dL (reference interval, <250). Approximately 1 year later, he presented again to the emergency room with vomiting, headaches, lethargy, cramps, and diarrhea. Clinical examination showed a developmentally delayed child with hypotonia and strabismus. He had iatrogenic Cushing syndrome. There was evidence of microorchidism, meatal stenosis, congenital hydroceles, and bilateral inguinal hernia. As part of follow-up studies, an array comparative genomic hybridization was performed. A urine specimen was also collected for organic acid analysis using GC-MS (Fig. 1). Fig. 1. Organic acid analysis of patient urine using GC-MS. Urine organic acids were extracted into ethyl acetate/ether and converted to trimethylsilyl derivatives before analysis using a GC 6890N/MS 5975 system equipped …

Altered Integrins Expression of Patients Affected by Cryptorchidism

Objectives: The study aimed to investigate the expression of the integrin isoforms α7A and β1A, expressed by myogenic precursor cells, and α7B and β1D, expressed by mature muscle cells in the cremaster of patients affected by an undescended testis. Methods: Fifteen samples of cremaster were obtained from patients undergoing surgery for an undescended testis. Thirty control specimens of cremaster were harvested from patients with congenital hydrocele or inguinal hernia. Immunofluorescent analysis was carried out using anti-α7A, β1A, α7B, and β1D integrin antibodies. Sections were observed using confocal laser scanning microscopy. Results: As compared with controls, a significant loss of a α7B (p = 0.0355) and β1D (p = 0.0069) integrins and a higher expression of α7A (p = 0.0003) and β1A (p = 0.0150) was detected in the cremaster of patients affected by an undescended testis. Conclusions: Our data document a critical alteration of the cytoskeleton of cremasteric smooth muscle cells in patients with an undescended testis. This might explain the altered function in smooth muscle cells in cremaster implied during testicular descent. We therefore speculate that the postnatal splicing of α7A to α7B and of β1A to β1D integrins is delayed. This could account for the common clinical scenario of spontaneous descent of the testes in the first months of life.

A study of clinical evaluation and management of inguinoscrotal swelling in paediatric age group

Background: Inguino-scrotal swellings are one of the commonest problems in infancy and childhood throughout the world. They represent the conditions most frequently requiring surgical repair in the paediatric age group. In many of these cases, clinical examination may suffice to obtain a definite diagnosis, but when the diagnosis is inconclusive, ultrasonography can play an important role. Post-operative complications are usually rare following elective operation whereas minor complications do occur after emergency operation. In this study we evaluated various presentations of inguino-scrotal swellings, their management and complications in paediatric age group.Methods: This is a hospital based prospective study, to have an overview of a spectrum of the paediatric cases admitted in the department of surgery with inguino-scrotal swelling that includes 40 patients with age below 13 years, irrespective of sex. Data regarding clinical features, birth history, immunization, family history various blood and radiological investigations was noted. Incidences of associated anomalies, complications and any form of treatment given to the patient were recorded and findings were analysed.Results: Out of 40 cases, all were males with maximum number of cases between the age group of 3-4 years.24 cases were right sided, 12 left sided and 4 bilateral. Hydrocele was associated with 10 of the cases, undescended testis with 2 cases and 1 had encysted hydrocele of the cord. There were no complicated cases like incarceration, obstruction or strangulation. Post-operative complications were noted in 4 cases, out of which 2 were wound haematoma and one case each of wound infection and stitch granuloma.Conclusions: Childhood inguinal hernias are more common on right side due to delay in descent of right testis and males are more commonly affected. Congenital hydrocele may involutes spontaneously, so we should observed at least upto 1 year of age before considering repair but not in the case of congenital inguinal hernia. Inguinal herniotomy in children is a safe and effective operation.

Natural History and Conservative Treatment Outcomes for Hydroceles: A Retrospective Review of One Center's Experience

To elucidate epidemiological data and hydrocele progression, we reviewed pediatric patients diagnosed with hydroceles in our institution retrospectively. We reviewed data from 355 pediatric patients with hydroceles. Questionnaires regarding age at diagnosis, time of delivery, presence of hydroceles in the father and brothers, age at recovery, age at surgery, cause of hydrocele (if present), type of hydrocele, associated pathologies, treatments, and posthydrocelectomy complications were completed by reviewing patients' medical records and interviewing their families. Patients with congenital hydroceles were more frequently born prematurely (32.5%) than were patients with noncongenital hydroceles (15.9%; P = .001). Fathers of 10 patients (3.7%) and brothers of 21 patients (7.7%) also had hydroceles. Hydroceles were associated with inguinal hernias on the same side (12.2%), cryptorchidism (7.5%), varicoceles (6.0%), and testis torsion (0.5%). Among patients aged >1 year (n = 185), 27 did not undergo operations and healed spontaneously at an average of 5.30 ± 3.36 months. For children aged >1 year who did not undergo surgery, the rate of spontaneous recovery within 6 months was 77.8% and that within 1 year was 96.3%. Until strong evidence of hydrocele-induced testicular damage in children arises, we recommend following up congenital hydroceles until at least 1 year and preferably 2 years of age. We recommend following up noncongenital hydroceles for at least 6 months and preferably 1 year if there is no associated pathology indicating the need for earlier surgery such as an inguinal hernia, cryptorchidism, tense hydrocele, testis torsion, or testis mass.

Current practice regarding timing of patent processus vaginalis ligation for idiopathic hydrocele in young boys: a survey of UK surgeons

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.

Laparoscopic Herniotomy – A Single Centre Study of 150 Cases

Pediatric patients presenting as inguinal hernia or congenital hydrocele is common ailment encountered in surgical practice and herniotomy is a very common surgical procedure performed. Open procedure is gradually being replaced by laparoscopic approach because of the distinct advantages of early recovery, short stay and better cosmetic results. 150 pediatric patients of inguinal hernia or congenital hydrocele were subject of this study. These patients were subjected to laparoscopic herniotomy performed at the neck of the sac and proximal part of peritoneum was closed with non-absorbable polypropyelene suture with aspiration of scrotal sac, if required. Average age of patients was 6.5 year with 93.35% male. 70.6% had inguinal hernia and 29.4% had congenital hydrocele). 68% patients had right sided and 10.6% clinically bilateral lesion. Operating time was 25 minutes in unilateral and 34.8 minutes in bilateral procedure. Postoperative stay was 1.06 days. No intraoperative complication was noted. Recurrence rate was 1.33% and conversion rate was 0.66%. Laparoscopic herniotomy is safe, well tolerated and effective procedure with early recovery, short operating time, less postoperative pain, free of complication, shorter post-operative hospital stay and very low recurrence. It can detect contralateral patent processus vaginalis and bilateral closure of it can be done through same approach.

The challenging sonographic inguinal canal evaluation in neonates and children: an update of differential diagnoses

Bulging of the inguinal region is a frequent complaint in the pediatric population and sonographic findings can be challenging for radiologists. In this review we update the sonographic findings of the most common disorders that affect the inguinal canal in neonates and children, with a focus on the processus vaginalis abnormalities such as congenital hydroceles, indirect inguinal hernias and cryptorchidism, illustrated with cases collected at a quaternary hospital during a 7-year period. We emphasize the importance of correctly classifying different types of congenital hydrocele and inguinal hernia to allow for early surgical intervention when necessary. We have systematically organized and illustrated all types of congenital hydrocele and inguinal hernias based on embryological, anatomical and pathophysiological findings to assist readers in the diagnosis of even complex cases of inguinal canal ultrasound evaluation in neonates and children. We also present rare diagnoses such as the abdominoscrotal hydrocele and the herniation of uterus and ovaries into the canal of Nuck.

Scrotal pathology evaluation among primary health care physicians

Introduction: Prompt evaluation of patients with scrotal complaint is recommended. Patients with testicular torsion need urgent medical attention. In contrast, neonate with congenital hydrocele has a benign course and needs reassessment within a year. Objectives: To determine scrotal pathology assessment pattern among primary health care providers (PHCPs) in Eastern Province, Saudi Arabia. Materials and methods: Cross-sectional study among 257 physicians using a questionnaire. The questionnaire consisted of two clinical scenarios, the first on acute scrotum and the second on congenital paediatric hydrocele. The chi-squared test was used to analyse categorical variable while the t -test was used for continuous variables. Logistic regression was used to assess factors affecting scrotal evaluation. Results: Out of 257 questionnaires that were distributed, 170 were completed by PHCPs and analysed. The mean age of PHCPs was 34.7 years [standard deviation (SD) ±9.8] and mean experience was 9.9 years (SD ±10.2). Only 16 PHCPs (9.4%) stated that they do scrotal examination on a regular basis. Most PHCPs referred patients with acute scrotum to other specialists (49%) rather than to emergency services (32.9%). Thirty-eight PHCPs (22.3%) reported that they prefer to investigate either by laboratory or imaging modality before treating patients with acute scrotum. When asked about neonates with congenital hydrocele, most of the PHCPs (51.2%) reported that they tend to assure the parent and then reassess the patient after 1 year. However, a significant number of PHCPs (22.9%) stated that they recommended referral for surgical correction. Using logistic regression analysis, it was found that Saudi PHCPs tend to have more appropriate management than other nationalities (P≤ 0.001). Conclusions: Patients with scrotal complaints should have prompt and appropriate care. PHCPs tend to have significant delays in the care of patients with acute scrotum problems.

Congenital Anomalies at Birth: A Hospital Based Study in UAE

Introduction: It is widely acknowledged that congenital anomalies heavily contribute to infant morbidity and mortality worldwide, with an estimated 9 million infants (7% of all births) born annually having a serious congenital anomaly that result in death or lifelong disability. The objective of our study was to estimate the frequency of congenital anomalies at the Gulf Medical College Hospital and Research Center, Ajman and to estimate the proportion of births with congenital anomalies per 1,000 live births. Materials and Methods: It was a Hospital-Record based descriptive study of the 1,222 consecutive live births from December 2007 to June 2008. Results: There were 84 cases of congenital anomalies among the 1,222 live births; the rate of anomalous births was 68.7 per 1,000 live births or 6.9%. Anomalies of the genitourinary system (40.5%) were the most common, followed by musculoskeletal (28.6%) and cardiovascular (10.7%). Gastrointestinal, chromosomal and multiple system anomalies accounted for 3.6% each and miscellaneous anomalies were seen in 7.1%. Central Nervous system (2.4%) anomalies were the least. Congenital hydrocele (19.0%) was seen to have the highest frequency amongst all recorded anomalies, followed by Talipes or Clubfoot (14.3%). 9.3% of the male and 4.3% of the female population of live births had a congenital anomaly. Birth Weight (p=0.005) and Gender (p=0.001) were found to have significant association with the frequency of birth defects. Maternal Age, gravidity, parity, previous abortions, VDRL and Hepatitis B status, Gestational Diabetes, Pregnancy Induced Hypertension, gestational age, maternal and infant blood group, nationality and consanguinity showed no statistically significant association with congenital anomalies. Conclusion: The proportion of congenital anomalies found in our study is alarmingly high and emphasizes the need for more accessible nationwide screening, counseling and surveillance systems. J. Nepal Paediatr. Soc. 32(2) 2012 105-112 doi: http://dx.doi.org/10.3126/jnps.v32i2.5995

Testicular Torsion in a Hydrocele

A 6-week-old male infant with congenital bilateral hydroceles presented with a reddish, painful, and swollen left scrotum of 2 days' duration. There were no signs of inguinal hernia or fever. A flashlight test revealed transillumination of a right hydrocele and opacity of the left scrotum. Ultrasonography revealed a 1.0-cm3 testis on the right side and a 1.45-cm3 testis on the left with associated scrotal edema. Doppler studies revealed obstruction of blood flow to the left testicle. These findings confirmed the diagnosis of left-sided testicular torsion. Surgical exploration revealed the left testicle to be necrotic; unilateral orchidectomy was performed. The infant . . .

Congenital hydrocele: Prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria

Objective To determine the prevalence and spontaneous resolution of congenital hydrocele diagnosed in male neonates who underwent circumcision at our centre. Patients and methods All male neonates presented for circumcision at the University of Benin Teaching Hospital, Benin City, Nigeria between January 2002 and December 2006 were examined for the presence of hydrocele. Those diagnosed with this condition were recruited and followed up in a surgical outpatient clinic for 2 years. The number of cases of spontaneous resolution and age at which this occurred were documented on a structured pro forma. Results A total of 2715 neonates were circumcised and 128 (4.7%) were diagnosed with 163 cases of hydrocele, while 27 cases in 25 (0.9%) children failed to resolve at the age of 2 years. Neonatal hydrocele was bilateral in 112 (68.7%), and there were 20 (12.3%) right and 31 (19.0%) left. Among those with hydrocele, 28.1% were delivered preterm and resolution was spontaneous in many of them, with no observed significant statistical difference to those delivered full term ( P = 0.4740). Of the 163 hydrocele cases, 136 (83.4%) resolved spontaneously by age 18 months with peak resolution at 4–6 months. No spontaneous resolution occurred after 18 months and no hydrocele-related complication occurred during follow up. Conclusion Neonates with congenital hydrocele should be observed for spontaneous resolution for at least 18 months before being subjected to surgery.

Testicular Volume Before and After Hydrocelectomy in Children

The purpose of this study was to investigate whether there is an association between communicating congenital hydroceles and testicular volume in children. Seventeen children with unilateral communicating congenital hydroceles who underwent hydrocelectomies were included in the study. Testicular volumes were measured before and after hydrocelectomy on both the affected and unaffected sides. We found statistically significant differences in testicular volumes between the normal sides (mean +/- SD, 0.62 +/- 0.24 mL) and the sides with hydroceles (0.72 +/- 0.26 mL) before surgery (P < .001) and in testicular volumes of the sides with hydroceles before (0.72 +/- 0.26 mL) and after (0.60 +/- 0.19 mL) surgery (P < .001). There was no significant difference in testicular volumes before (0.62 +/- 0.24 mL) and after (0.62 +/- 0.21) surgery on the normal sides (P = .978). The mean decrease in volume of the testes with hydroceles after hydrocelectomy was approximately 15%. This study shows that there is an association between congenital communicating hydroceles and testicular volume in children. Clinicians should be aware that there is a decrease in testicular volume after hydrocelectomy so they do not misdiagnose this change as postoperative trauma or atrophy.

Effect of endosulfan on male reproductive development.

There is experimental evidence of adverse effects of endosulfan on the male reproductive system, but there are no human data. Therefore, we undertook a study to examine the relationship between environmental endosulfan exposure and reproductive development in male children and adolescents. The study population was composed of 117 male schoolchildren (10-19 years of age) of a village situated at the foothills of cashew plantations, where endosulfan had been aerially sprayed for more than 20 years, and 90 comparable controls with no such exposure history. The study parameters included recording of clinical history, physical examination, sexual maturity rating (SMR) according to Tanner stages, and estimation of serum levels of testosterone, luteinizing hormone (LH), follicle-stimulating hormone, and endosulfan residues (70 study and 47 control subjects). Mean +/- SE serum endosulfan levels in the study group (7.47 +/- 1.19 ppb) were significantly higher (p < 0.001) than in controls (1.37 +/- 0.40 ppb). Multiple regression analysis showed that SMR scoring for development of pubic hair, testes, penis, and serum testosterone level was positively related to age and negatively related to aerial exposure to endosulfan (AEE; p < 0.01). Serum LH levels were significantly positively related to AEE after controlling for age (p < 0.01). The prevalence of congenital abnormalities related to testicular descent (congenital hydrocele, undescended testis, and congenital inguinal hernia) among study and controls subjects was 5.1% and 1.1%, respectively, but the differences were statistically nonsignificant. Our study results suggest that endosulfan exposure in male children may delay sexual maturity and interfere with sex hormone synthesis. Our study is limited by small sample size and nonparticipation.

Intestinal atresia presenting as bilateral scrotal pneumatocele: A case report

The authors report on a newborn baby with congenital hydrocele in whom pneumoscrotum developed. Air and meconium were found over the hernia sac, owing to ileal atresia with perforation. Gas in the scrotum usually is inside herniated bowel, but it can be the first sign of pneumoperitoneum. J Pediatr Surg 37:E2. Copyright © 2002 by W.B. Saunders Company.

Frequency of non-hormonal contraception around conception and association with congenital malformations in offspring.

A case-control study using data on deliveries in the mid-1970s at five Connecticut hospitals (cases, n = 1427; controls, n = 3001) found little relationship between delivery of a malformed infant and use by the mother of nonhormonal contraceptive methods at conception. Of particular interest was the lack of an association with use of the rhythm method (odds ratio (OR) = 1.02, 95% confidence limits (CL) = 0.73, 1.42), spermicides (OR = 1.26, 95% CL = 0.85, 1.85) at conception and a modest association for the intrauterine device (IUD) one week before conception (OR = 1.99, 95% CL = 0.98, 4.04). Continued use of the IUD after conception may further increase the risk for malformations but this observation was statistically unreliable in the present study. Mothers of newborns with cleft lip and palate (OR = 2.91) and congenital hydrocele (OR = 4.64) were more frequent rhythm users at conception, and mothers of newborns with multiple anomalies had more recent IUD exposure (OR = 9.87), but these and all other specific congenital malformation groups were not significantly related to any non-hormonal contraceptive after adjustment for multiple observations. Potentially confounding maternal risk factors were controlled.

Antepartum Ultrasonic Diagnosis of Congenital Hydrocele

Ultrasound scans are presented in 2 cases of bilateral congenital hydroceles. In both cases, large scrotal sacs were identified and seen to contain prominent fluid collections. In one case, the testes were identified within the fluid. No testes were seen in the other patient, who subsequently proved to have bilateral undescended testicles.

Torsion of spermatic cord in neonate

Torsion of the spermatic cord in the neonate should no longer be considered a clinical rarity. Effectual diagnosis is totally dependent on prompt detection of an asymptomatic, irreducible scrotal swelling that fails to transilluminate. Immediate surgical exploration is indicated. Detorsion and careful inspection for signs of circulatory return should be undertaken in every case. Frankly necrotic testes should probably be removed, but conservation of testicular tissue is otherwise strongly recommended, even in the borderline cases. After detorsion testis must be firmly fixed in proper position. Prophylactic contralateral orchiopexy appears to be advisable, unless a congenital hydrocele intervenes. Most importantly, to avert the grim prognosis this condition bears, we must continually alert our colleagues responsible for neonatal care to the possibility of torsion of the spermatic cord in the immediate postpartum examination of every newborn male infant.