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Hydrocele

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Topic updated on 08/22/17 9:13pm

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  • hydroceleA 6-month old boy is brought to the pediatrician’s office for evaluation of a “lump” in his genital area. His birth history is unremarkable and he has been feeding and eating well. His parents report no other concerns. On physical exam, there is a tense and non-tender mass in the scrotum. The transillumination test is positive. The parents are counseled about his condition and reassured that this will most likely resolve spontaneously.
Introduction
  • Clinical definition
    • swelling in scrotum due to fluid accumulation between parietal and visceral layers of tunica vaginalis
    • communicating hydroceles
      • incomplete closure of processus vaginalis
      • account for most cases of hydroceles in infants and children
    • non-communicating hydroceles
      • complete closure of processus vaginalis
      • most often idiopathic
      • account for all cases of adult hydroceles
  • Epidemiology
    • incidence
      • 1% of adult men
      • 1-4.7% of male infants
  • Etiology
    • adults and adolescents
      • trauma
      • infection
        • acute epididymitis
        • mumps
      • tumor
        • mesothelioma
        • 10% of testicular tumors present with hydrocele
    • infants and children (congenital)
      • incomplete obliteration of processus vaginalis
  • Prognosis
    • natural history of disease
      • congenital hydrocele usually resolves spontaneously by 1 year of age
Presentation
  • Symptoms
    • painless bulge of genitals
  • Physical exam
    • scrotum
      • nontender
      • tense
      • fluid-filled
      • enlarged
    • scrotum transilluminates
      • positive transillumination test
Imaging
  • Ultrasound
    • indications
      • only if diagnosis is uncertain or suspicion for tumor
Differential
  • Varicocele
    • “bag of worms”
Treatment
  • Conservative
    • monitoring
      • indications
        • monitor for 6-9 months for small noncommunicating hydrocele in adults
        • monitor until after 1 year of age for communicating hydrocele in infants
  • Operative
    • surgical hydrocelectomy
      • indications
        • if hydrocele does not self-resolve
Complications
  • Testicular damage
  • Subfertility
 
 


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Qbank (1 Questions)

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(M1.RP.23) A 6-month-old male presents with a painless, enlarged left scrotum. After examining the patient, you suspect this enlargement is secondary to serous fluid entering and accumulating in the scrotum through a patent processus vaginalis. Which of the following would be the most useful next step in confirming the diagnosis of this patient’s condition? Topic Review Topic

1. Measurement of AFP and hCG levels
2. Transillumination test followed by scrotal ultrasound
3. Evaluation of cremasteric reflex on physical exam
4. Measurement of serum testosterone levels
5. Standard urinalysis

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