urology,

Hydrocele

May 10, 2020

Key facts

  • Hydrocele is a collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord.
  • Principally patients complain of scrotal swelling and fullness
  • Divided into congenital and non-congenital hydrocele

History taking

  • Look for risk factors
    • Premature and low birth weight
    • Infants <6 months of age
    • Infants whose testes descend relatively late
    • Increased intraperitoneal fluid or pressure
    • Testicular cancer
    • Connective tissue disorder
  • Enlargement of scrotal mass following activity
  • Variation in scrotal mass during the day

Examination

  • Non-tender
  • Easily transilluminated
  • Cremasteric reflect preserved
  • Often be able to get above it

Investigations

  • Usually clinical diagnosis
  • US if ?secondary cause

Differential diagnosis

  • Inguinal hernia
  • Testicular cancer
  • Epididymitis
  • Epididymo-orchitis
  • Scrotal oedema

Management

  • Congenital hydrocele
    • Repair if does not resolve by 2 years
    • Adolescent: surgery and/or aspiration
  • Non-congenital
    • USS to look for secondary cause
    • Reassurance and scrotal support if asymptomatic