Hydrocele, Hernia, Neonatal Torsion, and Scrotal Masses

Hydrocele, Hernia, Neonatal Torsion, and Scrotal Masses

Barry A. Kogan

Hydrocele and Hernia


A. During the third month of gestation, the peritoneal lining of the abdominal cavity protrudes out of the internal inguinal ring following the gubernaculum, which attaches to the base of the scrotum (or, in girls, to the labia major). This is the processus vaginalis. Late in gestation, the testis descends along the same path from the retroperitoneal space through the inguinal canal just posterior to the processus vaginalis and into the scrotum.

B. At approximately the time of birth, the portion of the processus vaginalis between the peritoneum and the scrotum obliterates separating the
residual tunica vaginalis in the scrotum from the peritoneum. If the processus fails to obliterate, it is said to remain patent.

FIG. 5-1 Hydroceles. A: Communicating. B: Noncommunicating.

C. For obvious embryologic reasons, premature infants will have a much higher rate of patency of the processus vaginalis. If the patent processus is large enough to allow bowel to enter, there is an indirect inguinal hernia. If the processus is patent but the connection is small, a communicating hydrocele is likely to result when peritoneal fluid enters the inguinal
canal. If the processus does obliterate, a noncommunicating hydrocele may result by secretion of fluid into the residual tunica vaginalis. This is usually associated with inflammation in the scrotum.

FIG. 5-2 Hernia.


A. Approximately 1% to 3% of boys have a hernia.

B. In premature babies, the rate is approximately 3 times as high depending on the degree of prematurity.

C. About 10% of children with hernias will have a family history of hernia although there is no known inheritance pattern or gene identified.

D. At least one-third are diagnosed before 6 months of age.

E. The M/F ratio is 8/1. The R/L ratio is 2/1 and about 16% are bilateral, more common in younger patients.

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Sep 29, 2018 | Posted by in UROLOGY | Comments Off on Hydrocele, Hernia, Neonatal Torsion, and Scrotal Masses
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