eMedicine Specialties > Urology > Common Problems of the Testicle
Hydrocele: Workup
Updated: Apr 1, 2009
Workup
Laboratory Studies
- General
- Few laboratory tests, if any, are warranted specifically for simple hydroceles, communicating or noncommunicating.
- Concomitant medical conditions may be indications for preoperative laboratory studies.
- Laboratory studies may be indicated if the differential diagnoses potentially include other surgical or medical conditions.
- Inguinal hernia
- While laboratory studies are not warranted in routine inguinal herniorrhaphy, a possible incarcerated inguinal hernia may be difficult to distinguish from a hydrocele.
- Failure to clearly transilluminate, palpable bowel at the internal ring during the rectal examination, or an elevated WBC count may favor urgent exploration in this setting.
- Testicular tumor
- Approximately 10% of patients with testicular teratomas may present with a cystic mass that may transilluminate during the physical examination. Similarly, adults with testicular tumors may present with newly onset scrotal swelling.
- If this diagnosis is considered, measuring serum alpha-fetoprotein and human choriogonadotropin levels is indicated to exclude malignant teratomas or other germ cell tumors.
- Epididymitis/orchitis
- Occasionally, a reactive hydrocele occurs in association with underlying testicular infection.
- Urinalysis and urine culture may beneficial. Although urinalysis and/or culture results are positive in only 30% of such cases, a positive culture result may be useful in guiding antimicrobial treatment.
- Symptoms are treated with nonsteroidal anti-inflammatory drugs and scrotal elevation.
Imaging Studies
The radiographic evaluation of hydroceles is controversial. Simple hydroceles do not require radiographic studies. Furthermore, studies such as ultrasonography cannot help reliably distinguish hydroceles from hernias. However, findings from radiographic or ultrasonographic studies can help evaluate for an underlying process, such as a tumor or torsion.
- Ultrasonography
- As noted, ultrasonography itself is rarely indicated for simple hydroceles.
- Furthermore, a reduced inguinal hernia may be missed on sonograms. However, ultrasonography does provide excellent detail of the testicular parenchyma. Spermatoceles can be clearly distinguished from hydroceles on sonograms.
- If a testicular tumor is a diagnostic consideration, ultrasonography is an excellent screening study.
- In addition, testicular atrophy suggesting chronic torsion and a reactive hydrocele can be seen on sonograms.
- Failure to clearly delineate testicular anatomy with palpation indicates the need for further diagnostic imaging such as ultrasonography.
- Duplex ultrasonography
- As with ultrasonography, duplex studies are not warranted in simple hydroceles. However, duplex studies may provide substantial information regarding testicular blood flow when a hydrocele may be associated with chronic torsion.
- Additionally, epididymitis associated with a reactive hydrocele can be distinguished based on findings from duplex scanning, as evidenced by increased epididymal flow.
- Finally, duplex studies may help identify Valsalva-augmented regurgitant flow in patients with varicoceles.
- Plain abdominal radiography
- Plain radiography may be useful for distinguishing an acute hydrocele from an incarcerated hernia.
- Gas overlying the groin may indicate an incarcerated hernia.
Other Tests
- No interventional or invasive diagnostic procedures are recommended in the evaluation of hydroceles.
Diagnostic Procedures
- No interventional or invasive diagnostic procedures are recommended in the evaluation of hydroceles. Specifically, diagnostic aspirations should be avoided.
Histologic Findings
If a hernia is identified along with the hydrocele, the sac may be removed following high ligation and sent for pathological analysis. In this case, the histology findings are consistent with peritoneal lining.
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References
Clarnette TD, Hutson JM. The genitofemoral nerve may link testicular inguinoscrotal descent with congenital inguinal hernia. Aust N Z J Surg. Sep 1996;66(9):612-7. [Medline].
Bloom DA, Wan J, Kay D. Disorders of the male external genitalia and inguinal canal. In: Kelalis PP, King LR, Belman AB, eds. Clinical Pediatric Urology. 3rd ed. Philadelphia, Pa: WB Saunders; 1992:1015-49.
Campbell MF, Walsh PC, Retik AB, eds. Campbell's Urology. 8th ed. W.B. Saunders Company; 2002.
Depue RH. Maternal and gestational factors affecting the risk of cryptorchidism and inguinal hernia. Int J Epidemiol. Sep 1984;13(3):311-8. [Medline].
Hutson JM, Temelcos C. Could inguinal hernia be treated medically?. Med Hypotheses. 2005;64(1):37-40. [Medline].
Kaye R. Treatment of hydroceles by injection of sclerosing agents. N Engl J Med. Oct 28 1982;307(18):1149-50. [Medline].
Lloyd DA, Rintala RJ. Inguinal hernia and hydrocele. In: O'Neill Jr J, Rowe M, Grosfeld J, Fonkalsrud E, Coran A, eds. Pediatric Surgery. 5th ed. St. Louis, Mo: Mosby-Year Book; 1998:1071-86.
Marshall FF. The management of hydroceles. AUA Update Series. Vol 1. Baltimore, Md; American Urological Association; 1982:. 2-7.
Sagar J, Kumar S, Mondal D, Shah DK. Idiopathic infected hydrocele in a toddler: a case report with review. ScientificWorldJournal. 2006;6:2396-8. [Medline].
Further Reading
Keywords
hydrocele, communicating hydrocele, noncommunicating hydrocele, pediatric hydrocele, patent processus vaginalis, scrotal hydrocele, postvaricocelectomy hydrocele, post-varicocelectomy hydrocele, filarial hydrocele, filariasis, iatrogenic hydrocele, posttraumatic hydrocele, post-traumatic hydrocele, reactive hydrocele
