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Hydrocele

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Topic updated on 08/22/17 9:10pm

Snapshot
  • A 6-year-old boy presents to the pediatrician’s office for a well-child visit. He has no complaints and enjoys going to school. He is tracking along well on his weight and height chart at the 60% percentile. His parents have no concerns. On physical exam, the physician notices a tense and non-tender mass in the scrotum. The mass transilluminates when light is shone through it. His physician recommends waiting 6 months before deciding whether or not to proceed with a surgical correction.
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
      • indication
        • if hydrocele does not self-resolve during monitoring (see above)
  • Non-operative
    • aspiration and sclerotherapy
      • indications
        • for patients wanting a less invasive option
Complications
  • Testicular damage
  • Subfertility



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Qbank (1 Questions)

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(M2.RL.23) A 1-day-old male infant born by normal spontaneous vaginal delivery was found to have a scrotal mass on physical examination. The mass transilluminates and confirms the attending physician's suspicion of hydrocele. How long should the physician recommend that the parents wait before the hydrocele is reassessed? Topic Review Topic

1. 1 day
2. 1 week
3. 1 month
4. 6 months
5. 1 year

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