Pediatric Urology: Hernia and Hydrocele

In normal testicular development the testicle descends and travels through the abdomen into the scrotum during the last few months of pregnancy. Typically the ‘tunnel’ from the abdomen to the scrotum (called the processus vaginalis) closes at birth or during the first year of life. However, it is not uncommon for the tunnel to remain open allowing fluid or bowel to enter, which is called a hydrocele or hernia.

Inguinal hernias occur in up to 4% of children and 30% of premature infants. Hernias are nine times more common in boys and are most commonly (60%) found on the right side.

When there is just fluid in the scrotum it is called a hydrocele and this typically resolves within the first year. If a hydrocele gets larger (rather than smaller), causes pain or discomfort and persists beyond the first year of life, surgical intervention is necessary. If bowel gets down into the inguinal canal or scrotum, it is called a hernia. If this causes discomfort, becomes red and hard, or makes the child ill (that is, vomiting, nausea, fever), surgical intervention is necessary.

Surgical Repair of Hernias and Hydroceles in Children

Parents naturally are concerned about surgery and have many questions. Parents should be reassured to know that a hernia/hydrocele repair is one of the most common procedures preformed. Children will not be allowed to eat or drink anything before surgery because general anesthesia is used. The procedure is preformed in Day Surgery, which means that your child should be able to go home after surgery once he is stable. An exception to this may be the child who has other special medical needs requiring closer post-op monitoring.

The surgery itself involves very small incisions in the inguinal canal and the scrotum. Sometimes it may be necessary to do this on both sides if there is a concern that an opening exists on the other side as well. Parents should also know that, in addition, it is not uncommon for the surgeon to make a small incision in the umbilicus in order to use a scope (laparoscopy) to fully evaluate the hernia(s).

Post-operative care and follow-up of Hernia or Hydrocele Surgery in Children

• Activity: Recovery is quite rapid and many children return to full activity almost immediately.
• Surgical Site: There is no special care for the incision. Leave the surgical dressing or tape in place until it comes off by itself.
• Bathing: It is okay to bathe your son the day after surgery. A warm bath without soap will help reduce swelling and discomfort. Change diapers as you would normally as infections are very unlikely.
• Bruising/swelling: You can expect bruising or swelling of the scrotum. This should resolve over the next few weeks.
• Diet: Start with clear liquids. When clears are tolerated without vomiting, you may advance to regular foods.
• Pain Relief: We recommend alternating Tylenol or Ibuprofen for the first few days after surgery. You may give it as directed on the bottle or package. Older children may require a stronger pain medication.