The outcomes of conservative management and the natural history of asymptomatic hydroceles in children
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In brief
In brief
Retrospective study of 113 children with asymptomatic hydroceles demonstrates high spontaneous resolution rates with conservative management: 94% in infants under 1 month, declining to 33% in children over 2 years. Testicular size remained unaffected during observation, supporting initial conservative approach even in older children before considering surgical intervention.
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Abstract
Purpose
To elucidate the natural history of asymptomatic hydroceles (AHs) in children with conservative management and to discuss management strategies for AHs in children.
Methods
We retrospectively reviewed 113 children with AHs who were followed without immediate surgery. Patients were divided into four groups according to age at presentation; group 1: ≤ 1 month, group 2: 1–12 months, group 3: 12–24 months, and group 4: > 24 months. Ages at spontaneous resolution or surgery were reviewed. To assess the effect of AH on the testis, testicular size before and after conservative management was compared in 11 cases.
Results
In groups 1, 2, 3, and 4, spontaneous resolution occurred in 94.3%, 75.0%, 65.0%, and 33.3%, and the average time to resolution from presentation was 5, 5, 17, and 9 months, respectively. 41 patients underwent surgery at a mean age of 4.2 years. The testicular size did not differ significantly between before and after conservative management (14.4 vs. 14.5 mm, p = 0.483).
Conclusion
About one-third of children over 2 years of age achieve spontaneous resolution. Hydroceles with conservative management may not affect the testicular size. Thus, initial conservative management before surgery is recommend for AHs in children, even over 2 years of age.