Hydrocele

Hydrocele is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

A collection of fluid between the parietal and visceral layers of the tunica vaginalis within the scrotum

  • Communicating hydrocele (patent processus vaginalis)
    • Direct communication with the peritoneal cavity
    • Contains peritoneal fluid
    • Almost always with associated indirect inguinal hernia
    • Decreases in size with recumbent position
  • Noncommunicating hydrocele (The processus vaginalis is not patent.)
    • No direct connection to 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
  • System(s) affected: urogenital

Pediatric Considerations
In a communicating hydrocele, consider contralateral inguinal exploration to rule out an occult indirect hernia.

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 maintaining 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

Risk Factors

  • Ventriculoperitoneal shunt
  • Exstrophy of the bladder
  • Cloacal exstrophy
  • Ehlers-Danlos syndrome
  • Peritoneal dialysis

Commonly Associated Conditions

  • Testicular tumors
  • Scrotal trauma
  • Ventriculoperitoneal shunt
  • Nephrotic syndrome
  • Renal failure with peritoneal dialysis

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