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Snapshot
  • A 6-year-old boy presents to the pediatrician’s office for a well-child visit. He has no complaints and enjoys going to school. He is tracking along well on his weight and height chart at the 60% percentile. His parents have no concerns. On physical exam, the physician notices a tense and non-tender mass in the scrotum. The mass transilluminates when light is shone through it. His physician recommends waiting 6 months before deciding whether or not to proceed with a surgical correction.
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
      • indication
        • if hydrocele does not self-resolve during monitoring (see above)
  • Non-operative
    • aspiration and sclerotherapy
      • indications
        • for patients wanting a less invasive option
Complications
  • Testicular damage
  • Subfertility

 

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