HYDROCELE

Complications are largely avoided with meticulous dissection and gentle tissue handling. In

addition, extensive dissection should be avoided, as it increases the risk for nerve damage,

vascular damage leading to testicular atrophy, and postoperative hematomas.

Injury to spermatic cord structures: The vas or testicular vessels may be injured in 1-3%

of inguinal approaches. Some testicular shrinkage has been described in nearly 10% of

children undergoing inguinal hernia repair.

Recurrence: Recurrence of the hydrocele after inguinal approaches is most often reactive

in nature and usually resolves within several months. Rarely, aspiration or scrotal surgery

is warranted.

Bleeding/scrotal hematoma: Either poor intraoperative hemostasis or excessive cord

dissection (with inguinal approaches) may result in postoperative bleeding. Hematomas

typically resolve over time. If the patient has evidence of ongoing bleeding or is

extremely symptomatic, exploration and hematoma evacuation is warranted.

Ilioinguinal/genitofemoral nerve injury: These nerves may be entrapped or divided during

inguinal approaches. The injury may be temporary or permanent.

Wound infection: Postoperative wound infections are quite uncommon, particularly in

children. Wound infections should be managed with antibiotics and, if necessary, opening

the wound.

Prognostic

Inguinal repairs of communicating hydroceles are exceedingly successful, with a less than 1%

recurrence rate. If a unilateral approach is completed, the small but recognized risk for a

metachronous hydrocele or inguinal hernia developing remains, but the rate is likely less than

10%. Likewise, recurrence after tunica excision is also uncommon.

Follow-Up

At least one postoperative follow-up visit is recommended. For small infants, chronic recurring

hydroceles, or patients with unsuspected intraoperative findings, more protracted follow-up

evaluations may be warranted biweekly, monthly, or every 2-3 months to ensure complete

recovery and normal testicular size and architecture.