Fluid collections within the tunica

vaginalis of the scrotum or a long

spermaticcord.
Persistent developmental connections a
long the spermatic cord or Imbalance of
fluid produc versus absorption.
Little risk of clinical consequence.

Pathophysiology
Proc. Vaginalis is a diverticulum of the
peritoneal cavity.
It descends with the testis into the scrotum
(28th gestational week).

Principal types of hydrocele

A communicating (congenital) hydrocele.
A noncommunicating hydrocele.

Adult hydrocele (secondary)

Because of local injury, infections,
radiotheraphy.
Hydrocele can adversely affect fertility.

Incidence
> 80% new born boys have a patent
processus vaginalis.
Most close spontaneusly within 18 months
of age.
Hydrocele is rising with the increasing
survival rate of premature infants.
Estimated to affect 1% of adult men.

History
Asymptomatic/subclinical
Ouset, duration 4 severity of signs and
symptoms.
Identify any relevant GU :
Trauma
Exercise
System illnesses

A painless enlarge scrotum

 A sensation of heaviness or dragging.

Mild discomfort radiating along the
inguinal area to the mind partions of the
back.
Pain ? acute epididymal infection.
The size may decrease or increate,
depend on position.

Phisical
Hydroceles are located superior and
anterior to the testis.
Contrast to spermatoceles.
Bilateral in 7 10% of cases.
Associated with hernia.
The size and the palpable consistency of
hydroceles can vary with position.

Transillumination
A light source shines brightly through a
hydrpcele.
Not diagnostic hydrocele ?
This procedure is not reliable for final
diagnosis.

Differentials

Orchitis
Testicular torsion
Indirect inguinal hernia
Traumatic injury to the testical

Laboratory
CBC an inflamatory process.
Urinalysis proteinuria/pyuria.

Imaging
Simple hydroceles
radiographic studies.
Ultrasound

do

not

require

To identify abnormalities in the testis

Doppler ultrasound flow study

Abdominal X-Ray
An acute hydrocele or incarcerated hernia

Treatment
Hydrocele aspiration :
Not recommended
High rate recurrence
A risk of infection

Medical theraphy :
Asymptomatic adults with isolated non
communicating hydroceles

Surgical Theraphy
Can be divided into 2 approaches
I. An inguinal approach with ligation of the
proc. Vaginalis.
The procedure of choice for pediatric
hydrocele
II. Scrotal approach with excision or eversion
and suturing of the tunica vaginalis.
For chronic non communicanting
hydroceles.

Complication
Injury to spermatic care structures (1 - 3%
of inguinal approaches).
Recurrence (after inguinal approaches,
and resolves within several mounths).
Bledding/scrotal hematuria.
Ilioinguinal/genito femoral nerve injury
(inguinal approaches)
Wound infection.