Testes

Hydrocele

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Hydrocele

  • Pathophysiology
  1. Collection of peritoneal fluid sorrounding Testicle
    1. Between visceral and parietal tunica vaginalis
  2. Types: Infants
    1. Non-Communicating Hydrocele
      1. Hydrocele fluid accumulates in-utero prior to closure of tunica vaginalis
      2. Prior to birth tunica vaginalis closes
      3. After delivery, no further fluid accumulation and the fluid is gradually resorbed by 18-24 months
    2. Communicating Hydrocele
      1. Incomplete obliteration of processus vaginalis
      2. Open communication between peritoneum and tunica vaginalis
      3. Closes spontaneously in the first year of life in most cases
      4. Persistent opening allows for Indirect Inguinal Hernia
  3. Types: Adults
    1. Non-Communicating Hydrocele
      1. Imbalance in secretion vs absorption of tunica
      2. Results from inflammatory reaction
        1. Injury (may result in hematocele, blood collection, which does not transilluminate)
        2. Infection (e.g. Filariasis causes lymphatic obstruction)
        3. Testicular tumor
        4. Testicular Torsion
  • Symptoms
  1. Painless scrotal swelling
  2. Small and soft on arising in the morning
  3. Becomes large and tense as the day progresses
  4. Large amounts of fluid may interfere with intercourse
  • Signs
  1. Nontender scrotal swelling anterior to Testis and cord
  2. Translucent fluid on transillumination
  3. Overlying scrotal skin may have bluish tint
  1. Raised suspicion for testicular tumor
    1. New onset Hydrocele
    2. Hydrocele that Hemorrhages after only mild Trauma
    3. Right sided Hydrocele (90% are on left)
  • Management
  1. Infant
    1. See Communicating Hydrocele
  2. Adult (Non-Communicating Hydrocele)
    1. Aspirate fluid - may help better palpate Testicle
    2. Surgery indicated only for:
      1. Discomfort from bulky mass
      2. Tense Hydrocele leading to Testicle atrophy