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What Are Inguinal and Scrotal Disorders?
Disorders involving a child’s inguinal (groin) and scrotal area are frequent and the most common condition treated by the pediatric surgeons at UPMC Children's Hospital of Pittsburgh. While inguinal and scrotal disorders are common, each disorder has unique attributes and treatment.
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What Are the Types and Symptoms of Inguinal and Scrotal Disorders?
The array of inguinal and scrotal disorders includes hydrocele, inguinal hernia, undescended testicle, torsion of the testis or appendix testis, and rarely testicular tumors.
- Hydrocele — A hydrocele is simply a sac of water. Sometimes, a hydrocele is the first stage of a hernia and can be treated the same as an inguinal hernia. There are, however, several types of hydroceles, and each may require a different treatment approach. Often, a painless hydrocele may develop after a child has a virus or has experienced trauma to the testicles. These should be examined and monitored, but rarely is surgery needed. They shrink and may disappear on their own.
- Inguinal Hernia — Inguinal hernias are the most prevalent of all inguinal and scrotal disorders. In short, a hernia is a sac of tissue that protrudes through the abdominal lining. Usually, the sac closes and disappears before birth. But in about 20% of infants, the sac does not close and pushes through the lower abdominal muscles. This sac is typically filled with fluid or tissue. Hernias are usually noticed first by the parents as a small bulge in the lower abdomen or sometimes an enlarged scrotum in boys. Hernias often occur simultaneously with undescended testes.
- Testicular Tumors — Tumors of the testis are rare in childhood and usually appear as slowly growing, painless masses. They are often mistaken for hernias and are usually found accidentally during surgery.
- Torsion — Torsion means twisting of an organ and risks losing the blood supply to that organ. Torsion can be a rather dramatic event and requires a quick and precise diagnosis and treatment. Torsion of a testicle may occur when it lacks its normal attachments to the scrotum. This condition is sometimes called the “bell clapper” deformity. When it happens, the blood supply to the testicle is twisted or kinked, preventing proper flow. Torsion is almost always accompanied by excruciating pain.
- Undescended testicle — An undescended testicle occurs when the testicle fails to travel down into the scrotum by the time of birth. At birth, four out of every 100 males will have an undescended testicle; however, in three of these four, the testicle will have descended into a satisfactory position by the age of 1.
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How Do You Treat Inguinal and Scrotal Disorders?
Hydrocele
Sometimes, a hydrocele is the first stage of a hernia and can be treated the same as an inguinal hernia. There are, however, several types of hydroceles, and each may require a different treatment approach.
Often, a painless hydrocele may develop after a child has a virus or has experienced trauma to the testes. These should be examined and monitored, but rarely is surgery needed. They shrink and may disappear on their own.
A hydrocele that develops rapidly without explanation (for example, after a viral illness or trauma to the testicles) may require an early ultrasound of the scrotum. The surgical approach is often through the scrotum, after it’s determined that no small hernia is involved. Otherwise, an inguinal approach is used, especially in a patient of school-age.
Inguinal hernia
The surgical procedure to repair an inguinal hernia is low-risk and done using a general anesthetic. Using a one-inch incision, the surgeon can disconnect the sac and suture the remaining tissue.
Testicular tumors
Tumors of the testicles are rare in childhood and often have no symptoms. They are often mistaken for hernias and usually are found accidentally during surgery. Surgery is used to remove the mass through a groin incision. Further treatment depends on the type of tumor and its extent of spread.
Torsion
Torsion means the twisting of an organ, and it risks losing the blood supply to that organ. This can be a rather dramatic event and requires quick and precise diagnosis and treatment.
Torsion of the testicles may occur when the testicles lack their normal attachments to the scrotum. This is sometimes called the “bell clapper” deformity. When this happens, the blood supply to the testicle is twisted or kinked, preventing proper flow. Torsion is almost always accompanied by excruciating pain.
Surgery is almost always required to prevent loss of the testicle. During surgery, the surgeon will “unkink” the blood flow and sometimes “pex” or affix the testicle in place to avoid further twisting.
Testicular torsion is most common in the 4- to 11-year-old age group and often occurs after moderate activity. Early surgical repair can preserve fertility. For the testicle that has been twisted for longer than 24 hours, removal is generally recommended.
Undescended testis
Although an undescended testicle is not a health risk, surgery should be performed to relocate the testicle into the scrotum to allow normal development to occur. This procedure is like that of the hernia, done with a small groin incision. The testicle is placed into the scrotum by lengthening the tissue and blood vessels that supply it. Occasionally, more than one surgery is required. Rarely, the testicle will not continue to develop for unknown reasons.
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Why Choose UPMC for Inguinal and Scrotal Disorders Care?
At UPMC Children’s, every child diagnosed with a colorectal condition is handled with an individualized treatment plan and family-centered care. In addition, cutting-edge research and the latest technology provide our patients with the best possible outcomes.
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