Hydrocele

Author: Dr. Subrahmanyam Karuturi, MD

Dr.Subrahmanyam Karuturi is a Passionate Physician & Founder of Doctors Hangout & Indian Patient Foundation. Follow Dr. Subrahmanyam Karuturi on Google+, Facebook, Twitter, Web.

Definition

• A hydrocele is an accumulation of fluid in the tunica vaginalis

Epidemiology

• In India, 69% of hydroceles could be assigned to be of filarial origin

Etiology

• Infants & Children : Congenital. Often associated with inguinal hernia
• Adults : Infection, tumor, or trauma. Epididymitis is associated with reactive hydrocele. In tropical climates, filariasis is commonly assocaited with hydrocele.

Clinical Features

• Symptoms : Scrotal enlargement, Scrotal discomfort or heaviness radiating to the inguinal region, Back pain
• Signs : Smooth, nontender, transillumination of the scrotum confirms the fluid-filled nature of the mass, It is important to palpate the testis, because some young men develop a hydrocele in association with a testis tumor.
• Types
  • Communicating - Is a small inguinal hernia in which fluid, but not peritoneal structures, traverses the processus vaginalis. Varies in size throughout the day and palpation of a thickened cord above the testicle on the affected side
  • Noncommunicating - Processus vaginalis was obliterated during development

Diagnosis

• Scrotal ultrasound - Maybe associated with onset of epididymitis, testicular tumor, trauma, and torsion of a testicular appendage
• An inguinal hernia/hydrocele is likely if compression of the fluid-filled mass completely reduces the hydrocele.

Differential Diagnosis

• Testicular tumor
• Spermatocele
• Inguinoscrotal hernia
• Varicocele
• Epididymitis

Treatment

• Indications for intervention in Hydrocele - Inability to distinguish from an inguinal hernia, Failure of the hydrocele to resolve spontaneously after an appropriate interval of observation, Inability to clearly examine testis, Association of hydroceles with suggestive pathology (eg, torsion, tumor), Pain or discomfort, Male infertility, Patient desire
• Congenital hydroceles - Resolve by 12 months of age following reabsorption of the hydrocele fluid
• Asymptomatic hydroceles - No treatment if asymptomatic and testis is believed to be normal.
• Surgery
  • If hydrocele is tense and large
  • Communicating hydroceles should be repaired in the same manner as an indirect hernia
  • The indications for repair of a noncommunicating hydrocele include failure to resolve and increase in size to one that is large and tense.
  • Surgical correction is similar to a herniorrhaphy - Through an inguinal incision, the spermatic cord is identified, the hydrocele fluid is drained, and a high ligation of the processus vaginalis is performed.

Prognosis

• Inguinal repairs of communicating hydroceles are exceedingly successful, with a less than 1% recurrence rate.

References

• Shenoy RK, Sandhya K, Suma TK, Kumarasami VA. Preliminary study of filariasis related acute adenolymphangitis with special reference to precipitation factor and treatment modalities. Southeast Asian J Trop Med Public Health 1995;26:301.
• Elder JD: Disorders and anomalies of the scrotal contents. In: Kliegman RM, et al ed. Nelson textbook of pediatrics, ed 19. Philadelphia: Saunders; 2011.
• Chang YT, Lee JY, Wang JY, Chiou CS, Chang CC. Hydrocele of the spermatic cord in infants and children: its particular characteristics. Urology. Jul 2010;76(1):82-6.
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• Campbell MF, Walsh PC, Retik AB, eds. Campbell's Urology. 8^th ed. W.B. Saunders Company; 2002.
• Lloyd DA, Rintala RJ. Inguinal hernia and hydrocele. In: O'Neill Jr J, Rowe M, Grosfeld J, Fonkalsrud E, Coran A, eds. Pediatric Surgery. 5^th ed. St. Louis, Mo: Mosby-Year Book; 1998:1071-86.
• Marshall FF. The management of hydroceles. AUA Update Series. Vol 1. Baltimore, Md; American Urological Association; 1982:. 2-7.
• Barteczko KJ, Jacob MI: The testicular descent in human: origin, development and fate of the gubernaculum Hunteri, processus vaginalis peritonei, and gonadal ligaments. Adv Anat Embryol Cell Biol 2000; 156:III-X.1–98
• Bayne A, Paduch D, Skoog SJ: Pressure, fluid and anatomical characteristics of abdominoscrotal hydroceles in infants. J Urol 2008; 180:1720-1723.discussion 1723
• Ben-Meir D, Deshpande A, Hutson JM: Re-exploration of the acute scrotum. BJU Int 2006; 97:364-366.