Introduction
A hydrocele describes the accumulation of fluid within the tunica vaginalis. This results in a scrotal swelling.
Classification
Hydroceles can be divided into communicating and non-communicating:
- communicating: caused by patency of the processus vaginalis allowing peritoneal fluid to drain down into the scrotum. Communicating hydroceles are common in newborn males (clinically apparent in 5-10%) and usually resolve within the first few months of life
- non-communicating: caused by excessive fluid production within the tunica vaginalis
Epidemiology
- Incidence: 230.00 cases per 100,000 person-years
- Most commonly see in infants
| Condition | Relative incidence |
|---|---|
| Hydrocele | 1 |
| Epididymo-orchitis | 0.87 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Aetiology
Hydroceles may develop secondary to:
- epididymo-orchitis
- testicular torsion
- testicular tumours
Clinical features
Features
- soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle
- the swelling is confined to the scrotum, you can get 'above' the mass on examination
- transilluminates with a pen torch
- the testis may be difficult to palpate if the hydrocele is large
Investigations
Diagnosis may be clinical but ultrasound is required if there is any doubt about the diagnosis or if the underlying testis cannot be palpated.
Management
Management
- infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
- in adults a conservative approach may be taken depending on the severity of the presentation. Further investigation (e.g. ultrasound) is usually warranted however to exclude any underlying cause such as a tumour