Pediatric Urology

• What is a hydrocele or hernia?

A hydrocele is a collection of fluid around the testicle. In children, this fluid comes down from the normal fluid that is present in the abdomen into a balloon-like structure around the testicle (called the "tunica vaginalis"). The neck of this balloon runs along the spermatic cord and opens into the abdomen. Normally, this neck closes off by itself within the first year of life. If it does not close off, it continues to let fluid come through and it may enlarge. If the opening becomes large enough a piece of the bowel may slip into it. This is called a "hernia." If the bowel in a hernia becomes trapped it might swell and choke off its blood supply, which can be life-threatening.

• How do I know if my child has a hydrocele or hernia?

A parent usually notices a hydrocele or hernia by detecting a bulge or swelling in the scrotum or above this in the groin. If this bulge gets bigger and smaller, it suggests that the opening is big enough to permit free flow of the fluid in and out of the tunica vaginalis. Girls can also get hernias and the bulge or swelling will be noted along the outside of the vagina in the labia.

• Is surgery necessary?

Most infants with a hydrocele will have it go away as the opening closes off within the first year of life and require no surgery. If the hydrocele persists, it is unlikely to go away by itself and should be surgically corrected. If the hydrocele has a big enough opening to let fluid flow freely in and out (as noted by the swelling-getting bigger and smaller) it is unlikely to close on its own and surgery is indicated. A hernia (when a piece of bowel extends through the opening) can be very dangerous and should always be surgically corrected.

• What is the surgery like?

The operation is performed by a small incision made in the groin. The abnormal opening is found and closed off and the fluid in the sac is drained. Almost all children will go home on the same day of surgery. There are no drains or stiches to be removed .

• What can I expect following surgery?

Your child will go home on the day of surgery. The diet should start with liquids and then advance to soft food and solid food over the next 12 to 24 hours. Most children only require pain medication for 1 to 2 days after the operation. It is not unusual to see some swelling in the scrotum after surgery which will also go away over the next several weeks.

• What is hypospadias?

Hypospadias is one of the most common conditions referred to a pediatric urologist. It is a condition where the urinary channel in a boy (called the "urethra"), does not come out at the tip of the penis. The cause is usually not known, although it does occur in some families. About 1 out of every 300 boys is born with this condition. The opening to the urinary channel may come out anywhere along the undersurface of the shaft of the penis or even as far back as beneath the scrotum. The foreskin on a penis with hypospadias is also abnormal. Frequently, a bend in the penis toward the boy's feet occurs with hypospadias.

• Is surgery necessary?

If the opening of the hypospadias is out along the shaft, and the penis is straight, the only reason to operate is to make it look normal. If the opening of the urethra is further back on the penis or scrotum, or if it has a severe bend in it, then it may interfere with urination, sexual intercourse and fertility.

• When should surgery be performed?

Most pediatric urologists believe the ideal timing for correction of hypospadias is between 6 and 18 months of age. It is believed that both the adverse psychological effects of parental separation as well as genital awareness are decreased at this age.

• What is the surgery like?

There are many different techniques for hypospadias repair. The best technique depends on the child's specific form of hypospadias and the pediatric urologist repairing the hypospadias should be familiar with these different techniques. With modern techniques, almost all children with hypospadias are now treated in one operation. Your child will go home on the same day of surgery with a bandage on his penis that will stay in place for about two days. Frequently a tube (called a "stent") is also left in the penis. This tube is held in place with one stitch and will be removed in our clinic in about 7-10 days.

• In many of the children who are diagnosed prenatally, the condition disappears spontaneously by the time of birth or soon after.
• In children who have mild or, sometimes, moderate hydronephrosis, kidney function is commonly unaffected and the condition may resolve over a period of time after delivery.

• Hydronephrosis affects the drainage of urine from the urinary system—the kidneys, ureters, bladder and urethra. When the urinary system is impaired, this can cause the urine to back up and the kidney to swell.
• Hydronephrosis affects about 1 in 100 babies.
• Hydronephrosis is typically caused by either something blocking urine flow or by urine leaking backward through the urinary system (reflux). Identifying the cause of your child’s hydronephrosis will help determine how we recommend treating it.
• Your doctor will describe your child’s hydronephrosis as mild, moderate or severe. This description is based on how much the kidney is stretched and how much the urinary flow is impaired. Your doctor will tell you whether your child’s hydronephrosis affects one kidney (unilateral) or both kidneys (bilateral).
• Hydronephrosis can be detected via ultrasound. More than half of the cases resolve by the time the baby is born or soon after.
• The likelihood of surgery depends on the cause and severity of your child’s hydronephrosis. Surgery for mild cases is unlikely. For moderate cases, surgery occurs 25 percent of the time. Children with severe hydronephrosis will need surgery 75 percent of the time.