Hydrocele
Basics
Description
A hydrocele is a collection of fluid between the parietal and visceral layers of the tunica vaginalis within the scrotum.
- Communicating hydrocele (patent processus vaginalis)
- Direct communication between the hydrocele sac and the peritoneal cavity
- Contains peritoneal fluid
- Almost always with associated indirect inguinal hernia
- Decreases in size with recumbent position
- Noncommunicating hydrocele (processus vaginalis is not patent)
- No direct connection between the hydrocele sac and the peritoneal cavity
- Fluid contained is from the mesothelial lining.
- Can be isolated to the cord with the distal and proximal portions of the processus vaginalis closed
- Acute hydrocele: fluid collection resulting from an acute process within the tunica vaginalis, typically involving only the scrotum
- Although this disorder is found nearly exclusively in male patients, there are rare hydroceles into the canal of Nuck in females which result from a fluid collection in an abnormal open pouch of peritoneum extending into the labia majora.
- System(s) affected: urogenital
Pediatric Considerations
Most congenital communicating hydroceles resolve spontaneously by 2 years of age.
Epidemiology
Predominant age: childhood
Incidence
Estimated at 0.7–4.7% of male infants
Prevalence
- 1,000/100,000
- Estimated at 1% of adult men
Etiology and Pathophysiology
- Incomplete closure of the processus vaginalis trapping peritoneal fluid anywhere along the length of the tunica vaginalis
- Failure of closure of the processus vaginalis maintains a communication to the peritoneal cavity.
- Imbalance of the secretion and reabsorption of fluid from the lining of the tunica vaginalis
- Infection
- Tumors
- Trauma
- Ipsilateral renal transplantation (due to disruption of the spermatic cord during the procedure)
Risk Factors
- For adult acquired hydroceles:
- Ventriculoperitoneal shunt
- Ehlers-Danlos syndrome
- Peritoneal dialysis
- History of scrotal surgery (to include varicocelectomy)
- For congenital hydroceles:
- Exstrophy of the bladder
- Cloacal exstrophy
General Prevention
None
Commonly Associated Conditions
For adult acquired hydroceles:
- Testicular tumors
- Scrotal trauma
- Ventriculoperitoneal shunt
- Nephrotic syndrome
- Renal failure with peritoneal dialysis
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Citation
Domino, Frank J., et al., editors. "Hydrocele." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116289/0/Hydrocele.
Hydrocele. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116289/0/Hydrocele. Accessed October 13, 2024.
Hydrocele. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116289/0/Hydrocele
Hydrocele [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 October 13]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116289/0/Hydrocele.
* Article titles in AMA citation format should be in sentence-case
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T1 - Hydrocele
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