Hydrocele

Description

• Most common cause of painless scrotal swelling
• Classified as congenital or acquired (secondary):
  • Congenital result from a patent process vaginalis and communication between tunica vaginalis and peritoneal cavity:
    • Normally occurs spontaneously and most are closed by 2 yr of age
  • Acquired occur secondary to interscrotal infection, neoplasm, inguinal or scrotal surgery, or regional or systemic disease
• Communicating hydrocele:
  • Patent processus vaginalis
  • Scrotum fills and empties with peritoneal fluid depending on body position and intraperitoneal pressures
• Noncommunicating hydrocele:
  • Due to production of serous fluid by a disease process or impaired absorption within the scrotum itself

Etiology

• Imbalance between production and resorption of fluid within the space between tunica vaginalis and tunica albuginea
• Disease processes causing adult noncommunicating hydrocele include:
  • Epididymitis
  • Hypoalbuminemia
  • TB
  • Trauma
  • Mumps
  • Spermatic vein ligation
  • In developing world, hydrocele is primarily caused by infections such as Wuchereria bancrofti or Loa Loa (filariasis is the cause of most hydroceles worldwide)
  • Rarely malignancy (first-degree testicular neoplasm or lymphoma)
• Rare etiology is the abdominoscrotal hydrocele that may cause hydroureter or unilateral limb edema owing to compression:
  • US reveals single sac extending from scrotum into abdominal cavity via the deep inguinal ring

• Congenital in 6% of newborn boys
• Usually diagnosed in newborn nursery
• Caused by patent processus vaginalis, a structure that remains patent in 85% of newborns
• May vary in size owing to position or crying:
  • Patients may present with history of scrotal mass that has resolved
• Most close by the age of 2 yr