If Your Child has an Inguinal Hernia, Hydrocele or Undescended Testicles. A Guide for Parents

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1 Introduction Urology Clinic If Your Child has an Inguinal Hernia, Hydrocele or Undescended Testicles A Guide for Parents Three of the most common birth defects in males are an inguinal hernia, hydrocele, and undescended testis. These defects which may occur on one side or both are present at birth. In the case of a hernia or hydrocele, however, the problem may not be diagnosed until later in life. Surgical correction is often recommended and usually scheduled as an elective rather than an emergency procedure.

2 What Causes Inguinal Hernias, Hydrocele or Undescended Testes? Inguinal hernias, hydrocele, and undescended testicles are closely related since they share a common cause. During development of the baby, the testicular tissue splits away from the area of the kidney and descends down the posterior abdominal wall, behind the intestines, until each testicle reaches the lower groin area. From there, the testicles move across a tunnel-like pathway called the inguinal canal which carries them through the abdominal muscles and allows the testes to finally settle in the scrotum.

3 Surrounding each testicle and carried along with it is a sac of abdominal wall lining. After the testicles are in place, the sac lining should close and will maintain the testicles in their proper place and prevent any small bowel from entering the canal. The downward movement of the testicles usually occurs by the end of the pregnancy. Hernia For unknown reasons, this normal sequence of development sometimes is interrupted or incomplete. If the sac remains open in the groin area after the testicle settles in the scrotum, an inguinal hernia is present. A hernia is suspected when a boy (and sometimes a girl) has a bulge in the groin area caused by abdominal contents, usually small bowel pushing into the open sac. The bulge may be more pronounced during crying or straining or during physical exercise in an older boy. Surgical correction of the hernia is recommended to prevent the possibility of an intestinal loop from being wedged into the sac, a painful condition known as incarcerated hernia. The repair consists of an incision in the groin down to the sac which is then closed off permanently. Hydrocele A hydrocele may be found in a newborn boy. Towards the end of pregnancy, each testicle descends from the abdomen into the scrotum alongside a channel through the groin. This channel normally closes before or shortly after birth. When the channel stays open, fluid can run from the abdominal cavity into the scrotum. This is called a communicating hydrocele. Fluctuation or change in the size of the hydrocele is common due to the back and forth movement of fluid from the abdomen to the scrotum. A large hydrocele may be tense and give a

4 bluish appearance to the scrotum but generally should not cause pain. Often, the communicating channel will close without treatment before the age of one, and the hydrocele may disappear. If a hydrocele causes symptoms or persists beyond one year of age, repair may be recommended. Undescended Testicle The testicles, where male hormones and sperm are produced, begin their development in the abdomen next to the kidneys. With growth before birth, they normally descend through the groin into the scrotal sac. In some boys, the descent of one or both testicles is incomplete, with the testicle coming to lie somewhere along the course of its descent from the abdomen to the scrotum. This is often detected by physical examination shortly after birth. An undescended testicle may come down on its own in the first few months of life. In general, if such spontaneous descent does not occur after one year of age, your urologist will likely recommend surgery to bring the testicle into the scrotum. Surgical correction of an undescended testicle (orchidopexy) is usually recommended before 18 months of age. This procedure requires a general anesthetic. During the surgery, a groin incision is made to locate the testicle. The hernia sac is closed, and the testicle is freed. The testicle is placed in the scrotum and attached to the scrotum so that it should not retract back to its previous position. If the testicle is not found in the groin or scrotum, it may be necessary to examine the abdomen by passing a miniature telescope through the belly button (laparoscopy). Hospital Stay All of these operations are done under a general anesthetic as an out-patient through the Day Surgery Unit. Pain after surgery is usually minimal and controlled with Acetaminophen (Tylenol, Tempra or generic brands). Recovery requires 5-7 days at home plus restricted activity depending on the age. Testicular Self-Examination Cancer of the testicles occurs rarely among adult men. However, research has shown that a testicle which was undescended at birth is slightly more at risk developing a tumor (even if an orchidopexy was performed during infancy). For this reason, the Canadian Cancer Society recommends that testicular examination (TSE) be performed monthly after puberty.

5 Special Instructions: Questions: Peter A. Anderson, MD, FRCSC Dawn L. MacLellan, MD, FRCSC Rodrigo Romao, MD

6 IWK Urology, Halifax, N.S. PL-0051 Last Update: 03/14 Next Review: March 2017