II. Pathophysiology

  1. Collection of peritoneal fluid sorrounding Testicle
    1. Fluid collects 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 occurs
      4. 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, Undescended Testicle
  3. Types: Adults
    1. Non-Communicating Hydrocele
      1. Imbalance in secretion vs absorption of tunica
      2. Results from inflammatory reaction (typically idiopathic)
        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

III. 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

IV. Signs

  1. Nontender Scrotal Swelling anterior to Testis and cord
  2. Translucent fluid on transillumination (allows light transmission)
  3. Scrotal Swelling is not reducible (unlike Inguinal Hernia)
  4. Overlying scrotal skin may have bluish tint

V. Differential Diagnosis

VI. Imaging: Scrotal Ultrasound Indications (Adults)

  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)

VII. Management

  1. Infant
    1. See Communicating Hydrocele
  2. Adult (Non-Communicating Hydrocele)
    1. Aspirate fluid - may help to better palpate Testicle for masses
    2. Surgery indicated only for:
      1. Discomfort from bulky mass
      2. Tense Hydrocele leading to Testicle atrophy

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Related Studies

Ontology: Testicular Hydrocele (C1720771)

Definition (MSH) Accumulation of serous fluid between the layers of membrane (tunica vaginalis) covering the TESTIS in the SCROTUM.
Concepts Disease or Syndrome (T047)
MSH D006848
ICD9 603.9, 603
ICD10 N43.3
SnomedCT 155912008, 197982005, 386152007, 55434001, 26614003
English Hydrocele, unspecified, Hydrocele, Scrotal, Hydrocele, Testicular, Hydrocele, Vaginal, Hydroceles, Scrotal, Hydroceles, Testicular, Hydroceles, Vaginal, Scrotal Hydroceles, Scrotal Hydrocele, Testicular Hydroceles, Testicular Hydrocele, Vaginal Hydroceles, Vaginal Hydrocele, hydrocele, hydrocele of male genital organs, testicular hydrocele (diagnosis), hydrocele (physical finding), hydrocele of male genital organs (diagnosis), testicular hydrocele, Hydrocele NOS, Testicular Hydrocele [Disease/Finding], hydrocele testicle, hydrocele testis, testicle hydrocele, testis hydrocele, hydrocele testicles, Hydrocele NOS (disorder), Hydrocele, Hydrocele of testis, Hydrocele (disorder), Hydrocele (morphologic abnormality), Hydrocele of testis (disorder), Hydrocoele, Hydrocele, NOS
Dutch niet-gespecificeerde hydrokèle, Hydrocele, Hydrokle, niet gespecificeerdn, hydrokèle
French Hydrocèle, non précisée, Hydrocèle vaginal, Hydrocèle testiculaire, Hydrocèle
German Hydrozele, umspezifisch, Hydrozele testis, Hydrocele testis, Wasserbruch des Hodens, Hydrocele vaginalis, Hydrozele vaginalis, Hydrozele, nicht naeher bezeichnet, Hydrozele
Italian Idrocele non specificato, Idrocele testicolare, Idrocele vaginale, Idrocele
Portuguese Hidrocele NE, Hidrocele Testicular, Hidrocelo
Spanish Hidrocele no especificado, Hidrocele Testicular, hidrocele, SAI, hidrocele, SAI (trastorno), hidrocele (anomalía morfológica), hidrocele (trastorno), hidrocele del testículo (trastorno), hidrocele del testículo, hidrocele testicular, hidrocele, Hidrocele
Swedish Vattenbråck
Finnish Kivesvesikohju
Czech hydrokéla, Hydrokéla, blíže neurčená, Hydrokéla
Japanese 精索水瘤, 精巣水瘤, 睾丸水瘤, 精索水腫, 水瘤-陰嚢, インノウスイリュウ, 陰嚢水瘤、詳細不明, インノウスイリュウショウサイフメイ, 陰嚢水腫, 陰嚢水瘤
Korean 상세불명의 음낭수류
Polish Wodniak jądra
Hungarian Hydrocele, Hydrocele, nem meghatározott
Norwegian Vannbrokk i pungen, Hydrocele testis