Extraperitoneal repair using modified single-port mini-nephroscopy for pediatric hydrocele: surgical outcomes in 65 children.

OBJECTIVE: The purpose of the study is to introduce our experience of a modified single-port Mini-Nephroscopy technique for the treatment of pediatric hydrocele. METHODS: In this prospective study, 65 male children (age range: 1.5-8 years) with unilateral communicating hydrocele were enrolled between June 2019 and June 2022. The surgical procedure consisted of high ligation of the patent processus vaginalis performed extraperitoneally using a modified single-port nephroscope introduced through a single umbilical incision, facilitated by custom suture-guiding instruments. The primary outcome measures included testicular volume and testicular artery resistance index (RI), which were evaluated via scrotal ultrasonography preoperatively and at scheduled follow-ups of 1 and 6 months. RESULTS: The novel technique was successfully employed in all 65 patients without conversion to open surgery. The mean operative time was remarkably brief (8-10 min), facilitating a 24-hour discharge for all children. Postoperative pain was well-controlled, with mean VAS scores decreasing from 2.1 ± 0.82.1 ± 0.8 at 6 h to 1.2 ± 0.51.2 ± 0.5 at 24 h, indicating only mild and transient discomfort. With a follow-up of 3-18 months, no instances of recurrence, testicular atrophy, or other complications (e.g., knot reactions, iatrogenic ascent) were observed. CONCLUSION: Single-port nephroscopic high ligation holds significant promise for pediatric communicating hydrocele, offering a compelling combination of minimal invasiveness, high operative efficiency, rapid recovery, and an excellent safety profile. These results strongly endorse its consideration as a first-line surgical treatment for this condition.