Hydrocele

Snaphot

• A 6-month old boy is brought to the pediatrician’s office for evaluation of a “lump” in his genital area. His birth history is unremarkable and he has been feeding and eating well. His parents report no other concerns. On physical exam, there is a tense and non-tender mass in the scrotum. The transillumination test is positive. The parents are counseled about his condition and reassured that this will most likely resolve spontaneously.

Introduction

• Clinical definition
  • swelling in scrotum due to fluid accumulation between parietal and visceral layers of tunica vaginalis
  • communicating hydroceles
    • incomplete closure of processus vaginalis
    • account for most cases of hydroceles in infants and children
  • non-communicating hydroceles
    • complete closure of processus vaginalis
    • most often idiopathic
    • account for all cases of adult hydroceles
• Epidemiology
  • incidence
    • 1% of adult men
    • 1-4.7% of male infants
• Etiology
  • adults and adolescents
    • trauma
    • infection
      • acute epididymitis
      • mumps
    • tumor
      • mesothelioma
      • 10% of testicular tumors present with hydrocele
  • infants and children (congenital)
    • incomplete obliteration of processus vaginalis
• Prognosis
  • natural history of disease
• congenital hydrocele usually resolves spontaneously by 1 year of age

Presentation

• Symptoms
  • painless bulge of genitals
• Physical exam
  • scrotum
    • nontender
    • tense
    • fluid-filled
    • enlarged
  • scrotum transilluminates
• positive transillumination test 

Imaging

• Ultrasound
  • indications
• only if diagnosis is uncertain or suspicion for tumor

Differential

• Varicocele
• “bag of worms”

Treatment

• Conservative
  • monitoring
    • indications
      • monitor for 6-9 months for small noncommunicating hydrocele in adults
      • monitor until after 1 year of age for communicating hydrocele in infants
• Operative
  • surgical hydrocelectomy
    • indications
• if hydrocele does not self-resolve

Complications

• Testicular damage
• Subfertility