Hydrocele - Disorders of the male genital system

Hydrocele

Definition

Collection of fluid within the coverings of the testes.

Incidence/prevalence

Common.

Age

Congenital hydroceles occur in childhood, secondary are more common age 20–40 years.

Aetiology

Most hydroceles are idiopathic but may occur secondary to trauma, infection or neoplasm.

Pathophysiology

Fluid accumulates between the two layers (parietal and visceral) of the tunica vaginalis. It is thought to occur due to imbalance of secretion/reabsorption of peritoneal fluid from these layers. Congenital hydrocele is caused by the persistence of the processus vaginalis and can be associated with herniation of abdominal contents into the sac.

Clinical features

Patients present with an increase in the size of the testis or a swelling in the scrotum, which can be massive before becoming uncomfortable. Idiopathic hydroceles generally develop very slowly, whereas secondary hydroceles develop rapidly. Usually the hydrocele covers the testis, so that it is difficult to palpate. In the upper part of the swelling, a normal spermatic cord should be palpable (this differentiates a hydrocele from an inguinal hernia). A simple hydrocele transilluminates well, but if there is blood (a haematocele) or it is chronic and the wall is thickened, it does not.

Investigations

If there is any doubt an ultrasound scan confirms the diagnosis and is useful to exclude an underlying testicular tumour.

Management

1.     Any secondary cause should be identified and treated.

2.     Treatment is by surgical excision or plication of the sac. Aspiration should not be attempted as there is a risk of infection and bleeding.

3.     If the hydrocele fluid becomes infected or contains blood, incision and drainage of pus are necessary, and examination of the scrotal contents to exclude an underlying tumour may be performed at that time.