Abstract：
BACKGROUND: Infantile abdominoscrotal hydrocele is generally managed with early surgery. However, whether these patients actually benefit from an initial watchful waiting strategy is yet to be determined.
METHODS: This single-center, comparative observational analysis included 36 consecutive patients (9 bilateral cases) diagnosed between January 1998 and December 2019. Initial 16 patients (21 lesions) underwent surgical repair shortly after diagnosis (Group A) at a mean (SD) age of 8 (4) months. Remaining 20 patients (24 lesions) underwent initial nonoperative management (Group B). Overall follow-up was 82.74 (63.84) months.
RESULTS: Six lesions of Group B spontaneously regressed at a mean age of 23.8 (7.8) months. Remaining 18 hydroceles underwent surgical management at a mean age of 18.7 (12.6) months. Early postoperative morbidity was high (43%) in both groups (Clavien-Dindo grade I-II). During follow-up, there were 1 recurrent hydrocele and 1 testicular atrophy, both events occurring in Group A patients. Group B patients required a higher need for concomitant ipsilateral orchidopexy (61% versus 14%; p = 0.001), and developed a higher rate of ipsilateral inguinal hernia (39% versus 5%; p = 0.01), occurring within 8.3 (3.53) months of surgery. On multivariable analysis, nonoperative management was associated with unplanned second surgery (odds ratio 5.5, 95% CI 1.25-24.17, p = 0.02), regardless of the type of hydrocelectomy performed.
CONCLUSIONS: Nonoperative management provides effective spontaneous resolution in about 25% of infantile abdominoscrotal hydrocele. Clinicians must balance the potential benefits of such strategy against the impact of pressure induced detrimental effects on the success of future surgery when dealing with longstanding lesions.
METHODS: III.
METHODS: This single-center, comparative observational analysis included 36 consecutive patients (9 bilateral cases) diagnosed between January 1998 and December 2019. Initial 16 patients (21 lesions) underwent surgical repair shortly after diagnosis (Group A) at a mean (SD) age of 8 (4) months. Remaining 20 patients (24 lesions) underwent initial nonoperative management (Group B). Overall follow-up was 82.74 (63.84) months.
RESULTS: Six lesions of Group B spontaneously regressed at a mean age of 23.8 (7.8) months. Remaining 18 hydroceles underwent surgical management at a mean age of 18.7 (12.6) months. Early postoperative morbidity was high (43%) in both groups (Clavien-Dindo grade I-II). During follow-up, there were 1 recurrent hydrocele and 1 testicular atrophy, both events occurring in Group A patients. Group B patients required a higher need for concomitant ipsilateral orchidopexy (61% versus 14%; p = 0.001), and developed a higher rate of ipsilateral inguinal hernia (39% versus 5%; p = 0.01), occurring within 8.3 (3.53) months of surgery. On multivariable analysis, nonoperative management was associated with unplanned second surgery (odds ratio 5.5, 95% CI 1.25-24.17, p = 0.02), regardless of the type of hydrocelectomy performed.
CONCLUSIONS: Nonoperative management provides effective spontaneous resolution in about 25% of infantile abdominoscrotal hydrocele. Clinicians must balance the potential benefits of such strategy against the impact of pressure induced detrimental effects on the success of future surgery when dealing with longstanding lesions.
METHODS: III.
摘要：
背景：婴儿腹囊积液通常通过早期手术治疗。然而,这些患者是否真的从最初的观察等待策略中获益尚待确定.
方法：这种单中心，比较观察性分析包括1998年1月至2019年12月诊断的36例连续患者(9例双侧病例).最初的16例患者（21个病变）在诊断后不久（A组）接受了手术修复，平均（SD）年龄为8（4）个月。其余20例患者（24个病变）接受了初始非手术治疗（B组）。总体随访时间为82.74（63.84）个月。
结果：B组6个病变自发消退，平均年龄为23.8(7.8)个月。其余18例鞘膜积液接受了手术治疗，平均年龄为18.7（12.6）个月。两组（Clavien-DindoI-II级）的术后早期发病率都很高（43％）。随访期间,有1例复发性鞘膜积液和1例睾丸萎缩，这两个事件都发生在A组患者中。B组患者需要更高的同侧睾丸固定术（61％对14％；p=0.001），患侧腹股沟疝的发生率较高(39%对5%;p=0.01),发生在手术后8.3（3.53）个月内。在多变量分析中，非手术治疗与非计划二次手术相关(比值比5.5,95%CI1.25-24.17,p=0.02),无论进行的是什么类型的水切除术。
结论：非手术治疗可在约25％的婴儿腹囊积液中提供有效的自发消退。在处理长期病变时，临床医生必须平衡这种策略的潜在益处与压力诱导的有害影响对未来手术成功的影响。
方法：III.
方法：这种单中心，比较观察性分析包括1998年1月至2019年12月诊断的36例连续患者(9例双侧病例).最初的16例患者（21个病变）在诊断后不久（A组）接受了手术修复，平均（SD）年龄为8（4）个月。其余20例患者（24个病变）接受了初始非手术治疗（B组）。总体随访时间为82.74（63.84）个月。
结果：B组6个病变自发消退，平均年龄为23.8(7.8)个月。其余18例鞘膜积液接受了手术治疗，平均年龄为18.7（12.6）个月。两组（Clavien-DindoI-II级）的术后早期发病率都很高（43％）。随访期间,有1例复发性鞘膜积液和1例睾丸萎缩，这两个事件都发生在A组患者中。B组患者需要更高的同侧睾丸固定术（61％对14％；p=0.001），患侧腹股沟疝的发生率较高(39%对5%;p=0.01),发生在手术后8.3（3.53）个月内。在多变量分析中，非手术治疗与非计划二次手术相关(比值比5.5,95%CI1.25-24.17,p=0.02),无论进行的是什么类型的水切除术。
结论：非手术治疗可在约25％的婴儿腹囊积液中提供有效的自发消退。在处理长期病变时，临床医生必须平衡这种策略的潜在益处与压力诱导的有害影响对未来手术成功的影响。
方法：III.
