Updated: 12/18/2021

Hydrocele

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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 the 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
  • 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
  • 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
  • Studies
  • Differential
    • Varicocele
      • “bag of worms”
  • Diagnosis
  • 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
  • Prognosis
    • natural history of disease
      • congenital hydrocele usually resolves spontaneously by 1 year of age
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