Hydrocele Disease

BASICS

DESCRIPTION

Hydrocele is a collection of fluid within the scrotum.

Communicating hydrocele: Associated with a patent processus vaginalis, has associated indirect inguinal hernia
Non-communicating hydrocele: Infantile type - no communication, frequent spontaneous resolutionAdult type - no communication, infrequent resolution
Hydrocele of the cord: Distal portion of processus vaginalis has closed, mid-portion patent and fluid filled, proximal portion may be open or closed
Acute hydrocele: Acute fluid collection resulting from an acute process within the tunica vaginalis
System(s) affected: Reproductive
Genetics: Unknown
Incidence/Prevalence in USA: Estimated to be 1% of adult males; prevalence 1000/100,000
Predominant age: Childhood
Predominant sex: Male only

SIGNS AND SYMPTOMS

Swelling in scrotum or inguinal canal
Demonstrated fluctuation in size (communicating hydrocele)
Usually not painful
Sensation of heaviness in scrotum
Pain radiating to back (occasionally)
Fluid collection in scrotum that transilluminates

CAUSES

Closure of processus vaginalis trapping peritoneal fluid (non-communicating)
Closure of distal processus, trapping fluid in mid portion of processus vaginalis (hydrocele of cord)
Failure of closure of processus vaginalis (communicating hydrocele)
Infection
Tumors
Trauma
Ipsilateral renal transplantation

RISK FACTORS

Ventriculoperitoneal shunt
Exstrophy of the bladder
Ehlers-Danlos syndrome
Peritoneal dialysis

DIAGNOSIS

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Patent processus vaginalis in communicating hydroceles

SPECIAL TESTS

N/A

IMAGING

Abdominal x-ray - may be useful to distinguish incarcerated hernias from hydrocele (rarely needed)
Inguinoscrotal ultrasound - should be able to demonstrate presence of bowel, e.g., distinguish incarcerated hernia in child from a hydrocele of the cord
Testicular nuclear scan or doppler ultrasound - to distinguish testicular torsion

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient surgery
Observation in early infancy until definite communication demonstrated or until 1-2 years of age

GENERAL MEASURES

N/A

SURGICAL MEASURES

Inguinal approach with ligation of processus vaginalis and drainage of hydrocele sac in children. (In hydrocele of cord, sac can be completely removed.)
Scrotal approach with drainage of hydrocele and resection of tunica vaginalis in adults
In adults no therapy is needed unless hydrocele causes discomfort or unless there is a significant underlying cause such as tumor
Jaboulay-Winkelmann procedure (for thick hydrocele sac) - hydrocele sac wrapped posteriorly around cord structures
Lord procedure (for thin hydrocele sac) - radial sutures used to gather hydrocele sac posterior to testis and epididymis
Aspiration of hydrocele should not be done (with possible exception of postoperative hydrocele)

ACTIVITY

Full activity after surgery

DIET

For age

PATIENT EDUCATION

N/A

FOLLOW UP

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS

Postoperative traumatic hydrocele common. Usually resolves spontaneously.
Injury to vas deferens or spermatic vessels
Suture granuloma
Hematoma
Wound infection

EXPECTED COURSE AND PROGNOSIS

Recovery should be rapid and complete

MISCELLANEOUS

ASSOCIATED CONDITIONS

Ehlers-Danlos syndrome
Exstrophy of bladder
Indirect inguinal hernia
Hydrocephalus with ventriculoperitoneal shunt
Peritoneal dialysis

AGE-RELATED FACTORS

Pediatric: In communicating hydrocele consider contralateral inguinal exploration
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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