Hydrocele
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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
- Although this disorder is found nearly exclusively in male patients, there is a rare hydrocele into the canal of Nuck in females which results 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 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 (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
Commonly Associated Conditions
- For adult-acquired hydroceles:
- Testicular tumors
- Scrotal trauma
- Ventriculoperitoneal shunt
- Nephrotic syndrome
- Renal failure with peritoneal dialysis
-- To view the remaining sections of this topic, please log in or purchase a subscription --
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
- Although this disorder is found nearly exclusively in male patients, there is a rare hydrocele into the canal of Nuck in females which results 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 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 (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
Commonly Associated Conditions
- For adult-acquired hydroceles:
- Testicular tumors
- Scrotal trauma
- Ventriculoperitoneal shunt
- Nephrotic syndrome
- Renal failure with peritoneal dialysis
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