eMedicine Specialties > Emergency Medicine > Genitourinary

Hydrocele: Follow-up

Author: Scott E Rudkin, MD, MBA, RDMS, FAAEM, FACEP, Vice Chair of Emergency Medicine, Assistant Dean of CME, Co-Director of Medical Informatics, Assistant Program Director, Associate Clinical Professor, Department of Emergency Medicine, University of California at Irvine Medical Center
Coauthor(s): A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon
Contributor Information and Disclosures

Updated: Sep 30, 2008

Follow-up

Further Outpatient Care

  • Arrange for quarterly follow-up examinations until a decision for or against surgery is made. Spontaneous closure is unlikely in children older than 1 year.
  • Observe infants with hydrocele for 1-2 years or until definite communication is demonstrated.
  • Watch for a concomitant hernia.

Complications

  • An extremely large hydrocele may impinge on the testicular blood supply. The resulting ischemia can cause testicular atrophy and subsequent impairment of fertility.
  • Hemorrhage into the hydrocele can result from testicular trauma.
  • Incarceration or strangulation of an associated hernia may occur.
  • Surgical complications
    • Accidental injury to the vas deferens can occur during inguinal surgery for hydrocele.
    • Postoperative wound infections occur in 2% of patients undergoing surgery for hydrocele.
    • Postoperative hemorrhagic hydrocele is not uncommon, but it usually resolves spontaneously.
    • Direct injury to the spermatic vessels may occur.

Prognosis

  • The prognosis for congenital hydrocele is excellent.
  • Most congenital cases resolve by the end of the first year of life.
  • Persistent congenital hydrocele is readily corrected surgically.
  • The prognosis of hydrocele presenting later in life depends upon the etiology of the hydrocele. Adult-onset hydrocele is not uncommonly associated with an underlying malignancy.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • In a patient with signs and symptoms of an acute scrotum, the presence of a hydrocele and a finding of positive transilluminance do not rule out a testicular torsion. Immediate definitive tests are indicated to rule out torsion because testicular survival is poor after 4 hours of ischemia.
  • A reasonable search for possible etiologies should be documented.
  • Document a discussion with the patient regarding the need to follow up with a urologist to rule out comorbid conditions (eg, infections, tumors, hernia, circulatory compromise).

Special Concerns

  • Pediatric: Most cases resolve without intervention.
  • Geriatric: Hydroceles in this group rarely resolve without surgical intervention.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Mazen J El-Sayed, MD, to the development and writing of this article.



More on Hydrocele

Overview: Hydrocele
Differential Diagnoses & Workup: Hydrocele
Treatment & Medication: Hydrocele
Follow-up: Hydrocele
References
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References

  1. Bayne A, Paduch D, Skoog SJ. Pressure, fluid and anatomical characteristics of abdominoscrotal hydroceles in infants. J Urol. Oct 2008;180(4 Suppl):1720-3; discussion 1723. [Medline].

  2. Bhosale PR, Patnana M, Viswanathan C, Szklaruk J. The inguinal canal: anatomy and imaging features of common and uncommon masses. Radiographics. May-Jun 2008;28(3):819-35; quiz 913. [Medline].

  3. Blaivas M, Brannam L. Testicular ultrasound. Emerg Med Clin North Am. Aug 2004;22(3):723-48, ix. [Medline].

  4. Jayanthi VR. Adolescent urology. Adolesc Med Clin. Oct 2004;15(3):521-34. [Medline].

  5. Lau ST, Lee YH, Caty MG. Current management of hernias and hydroceles. Semin Pediatr Surg. Feb 2007;16(1):50-7. [Medline].

  6. McAchran SE, Dogra V, Resnick MI. Office urologic ultrasound. Urol Clin North Am. Aug 2005;32(3):337-52, vii.

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Further Reading

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Keywords

defect in tunica vaginalis of scrotum, irritation in tunica vaginalis of scrotum, communicating hydrocele, congenital hydrocele, pediatric hydroceles, indirect inguinal hernias, noncommunicating hydrocele, hydrocele of the cord, late-onset hydroceles, adult hydroceles, ventriculoperitoneal shunts, VP shunts, peritoneal dialysis, renal transplants, chronic hydroceles, secondary hydroceles, painless enlarged scrotum, transillumination, orchitis, epididymitis, tuberculosis, filariasis, testicular torsion, germ cell tumors, tumors of the testicular adnexa, traumatic hydroceles, hemorrhagic hydroceles, exstrophy of the bladder, Ehlers-Danlos syndrome

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Contributor Information and Disclosures

Author

Scott E Rudkin, MD, MBA, RDMS, FAAEM, FACEP, Vice Chair of Emergency Medicine, Assistant Dean of CME, Co-Director of Medical Informatics, Assistant Program Director, Associate Clinical Professor, Department of Emergency Medicine, University of California at Irvine Medical Center
Scott E Rudkin, MD, MBA, RDMS, FAAEM, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon
A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Edward A Michelson, MD, Program Director, Associate Professor, Department of Emergency Medicine, University Hospital Health Systems in Cleveland
Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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