HYDROCELE

Hydrocele

Definition: Collection of fluid between the parietal and visceral layers

of the tunica vaginalis
 Communicating hydrocele: a patent processus vaginalis extending
beyond the internal inguinal ring containing peritoneal fluid alone, which
extends to the testis, with fluid within the tunica vaginalis
• Hydrocele of the spermatic cord: fluid contained within a segment of
patent processus vaginalis with obliterated processus distally and
proximally
 Scrotal hydrocele: fluid contained within the tunica vaginalis sur-
rounding the testis without communication proximally
 Abdominoscrotal hydrocele: a large scrotal hydrocele that extends
proximally across the internal inguinal ring into the abdomen without
communication with the peritoneum
 Diagnosis

• Signs and symptoms: The scrotal hydrocele may be seen as a chronic or

acute scrotal swelling after an inflammatory, infectious, or traumatic event.
The hydrocele size is typically stable but may decrease over time. The
hydrocele of the spermatic cord is also usually painless and variable in
size. It may be confused for the testis because of its round-oval shape.
• Physical examination: Scrotal hydroceles may elicit a blue hue through the
scrotal skin. Normal cord structures are palpable superior to the hydrocele
but may be difficult to distinguish if it extends up to or across
(abdominoscrotal) the internal ring, in which case abdominal examination
should reveal a ballotable mass. The hydrocele fluid surrounding the
testicle should transilluminate; however, neonatal bowel may also
transilluminate. The testis should be palpable within a soft scrotal
hydrocele but may be difficult to discern within a tense hydrocele.
 Diagnosis

• If the diagnosis is that of a hydrocele, there will be no

history of reducibility and no associated symptoms; the
swelling is translucent, smooth and usually not tender.
• If there are any doubts about the character of an
intrascrotal mass, scrotal US should be performed and has
nearly 100% sensitivity in detecting intrascrotal lesions.
• Doppler US studies help to distinguish hydroceles from
varicocele and testicular torsion, although these
conditions may also be accompanied by a hydrocele.
 Management

• In the majority of infants, surgical treatment of hydrocele is not indicated

within the first twelve months because of the tendency for spontaneous
resolution
• Little risk is taken by initial observation as progression to hernia is rare
and does not result in incarceration.
• Early surgery is indicated if there is suspicion of a concomitant inguinal
hernia or underlying testicular pathology.
• Persistence of a simple scrotal hydrocele beyond twelve months of age
may be an indication for surgical correction.
• Delaying surgery may reduce the number of procedures necessary without
increasing morbidity.
 Management

• The question of contralateral disease should be addressed by both

history and physical examination at the time of initial consultation
• In late-onset hydrocele, suggestive of a non-communicating hydrocele,
there is a reasonable chance of spontaneous resolution (75%) and
expectant management of six to nine months is recommended
• In the paediatric age group, the operation consists of ligation of patent
processus vaginalis via inguinal incision and the distal stump is left
open, whereas in hydrocele of the cord the cystic mass is excised or
unroofed
• The scrotal approach (Lord or Jaboulay technique) is used in the
treatment of a secondary non-communicating hydrocele.