II. Pathophysiology
- Collection of peritoneal fluid sorrounding Testicle
- Fluid collects between visceral and parietal tunica vaginalis
- Types: Infants
- Non-Communicating Hydrocele
- Hydrocele fluid accumulates in-utero prior to closure of tunica vaginalis
- Prior to birth tunica vaginalis closes
- After delivery, no further fluid accumulation occurs
- Fluid is gradually resorbed by 18-24 months
- Communicating Hydrocele
- Incomplete obliteration of processus vaginalis
- Open communication between peritoneum and tunica vaginalis
- Closes spontaneously in the first year of life in most cases
- Persistent opening allows for Indirect Inguinal Hernia, Undescended Testicle
- Non-Communicating Hydrocele
- Types: Adults
- Non-Communicating Hydrocele
- Imbalance in secretion vs absorption of tunica
- Results from inflammatory reaction (typically idiopathic)
- Injury (may result in hematocele, blood collection, which does not transilluminate)
- Infection (e.g. Filariasis causes lymphatic obstruction)
- Testicular Tumor
- Testicular Torsion
- Non-Communicating Hydrocele
III. Symptoms
- Painless Scrotal Swelling
- Small and soft on arising in the morning
- Becomes large and tense as the day progresses
- Large amounts of fluid may interfere with intercourse
IV. Signs
- Nontender Scrotal Swelling anterior to Testis and cord
- Translucent fluid on transillumination (allows light transmission)
- Scrotal Swelling is not reducible (unlike Inguinal Hernia)
- Overlying scrotal skin may have bluish tint
V. Differential Diagnosis
- See Scrotal Swelling
VI. Imaging: Scrotal Ultrasound Indications (Adults)
- Raised suspicion for Testicular Tumor
- New onset Hydrocele
- Hydrocele that Hemorrhages after only mild Trauma
- Right sided Hydrocele (90% are on left)
VII. Management
- Infant
- Adult (Non-Communicating Hydrocele)