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Hydrocele in Emergency Medicine

  • Author: Scott E Rudkin, MD, MBA; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Mar 23, 2016
 

Background

A hydrocele is a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum. Hydroceles also may arise in the spermatic cord or the canal of Nuck. A communicating hydrocele is similar to a hernia except that the sac connecting the abdomen to the scrotum or labia majora contains only fluid rather than abdominal contents. A noncommunicating hydrocele is a collection of scrotal fluid that is isolated from the abdomen. Noncommunicating hydroceles are the most common type of hydrocele globally, affecting more than 30 million men and boys[1]

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Pathophysiology

Embryologically, the processus vaginalis is a diverticulum of the peritoneal cavity. It descends with the testes into the scrotum via the inguinal canal around the 28th gestational week with gradual closure through infancy and childhood.[2]

Structurally, hydroceles are classified into 3 principal types:

  • In a communicating (congenital) hydrocele, a patent processus vaginalis permits flow of peritoneal fluid into the scrotum. Indirect inguinal hernias are associated with this type of hydrocele.
  • In a noncommunicating hydrocele, a patent processus vaginalis is present, but no communication with the peritoneal cavity occurs.
  • In a hydrocele of the cord, the closure of the tunica vaginalis is defective. The distal end of the processus vaginalis closes correctly, but the mid portion of the processus remains patent. The proximal end may be open or closed in this type of hydrocele.

Adult hydroceles are usually late-onset (secondary). Late-onset hydroceles may present acutely from local injury, infections, and radiotherapy; they may present chronically from gradual fluid accumulation. Morbidity may result from chronic infection after surgical repair. Hydrocele can adversely affect fertility.

Primary new-onset hydroceles presenting in late childhood and pre-adolescence are often noncommunicating and resemble the adult type hydrocele pathology.[3]

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Epidemiology

Hydrocele is estimated to affect 1% of adult men.

More than 80% of newborn boys have a patent processus vaginalis, but most close spontaneously within 18 months of age. The incidence of hydrocele is rising with the increasing survival rate of premature infants and with increasing use of the peritoneal cavity for ventriculoperitoneal (VP) shunts, dialysis, and renal transplants.

Most hydroceles are congenital and are noted in children aged 1-2 years.

Chronic or secondary hydroceles usually occur in men older than 40 years.

Noncommunicating hydroceles are the most common type of hydrocele globally, affecting more than 30 million men and boys[1]

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Contributor Information and Disclosures
Author

Scott E Rudkin, MD, MBA RDMS, FAAEM, FACEP, Clinical Professor, Department of Emergency Medicine, Associate Chief Medical Information Officer, University of California at Irvine Medical Center

Scott E Rudkin, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

A Antoine Kazzi, MD Deputy Chief of Staff, American University of Beirut Medical Center; Associate Professor, 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.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Additional Contributors

Edward A Michelson, MD Associate Professor, Program Director, Department of Emergency Medicine, University Hospital Health Systems of Cleveland

Edward A Michelson, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

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

References
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  2. Garriga V, Serrano A, Marin A, Medrano S, Roson N, Pruna X. US of the tunica vaginalis testis: anatomic relationships and pathologic conditions. Radiographics. 2009 Nov. 29(7):2017-32. [Medline].

  3. Koutsoumis G, Patoulias I, Kaselas C. Primary new-onset hydroceles presenting in late childhood and pre-adolescent patients resemble the adult type hydrocele pathology. J Pediatr Surg. 2014 Nov. 49 (11):1656-8. [Medline].

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

  5. Metcalfe MJ, Spouge RJ, Spouge DJ, Hoag CC. The use of TPA in combination with alcohol in the treatment of the recurrent complex hydrocele. Can Urol Assoc J. 2014 May. 8 (5-6):E445-8. [Medline].

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  9. Rizvi SA, Ahmad I, Siddiqui MA, Zaheer S, Ahmad K. Role of color Doppler ultrasonography in evaluation of scrotal swellings: pattern of disease in 120 patients with review of literature. Urol J. 2011 Winter. 8(1):60-5. [Medline].

  10. [Guideline] Tekgul S, Riedmiller H, Gerharz E, Hoebeke P, Kocvara R, Nijman R, et al. Hydrocele. Guidelines on paediatric urology. European Association of Urology, European Society for Paediatric Urology. 2009 Mar. [Full Text].

  11. Saka R, Okuyama H, Sasaki T, Nose S, Yoneyama C, Tsukada R. Laparoscopic treatment of pediatric hydrocele and the evaluation of the internal inguinal ring. J Laparoendosc Adv Surg Tech A. 2014 Sep. 24(9):664-8. [Medline].

  12. Lund L, Kloster A, Cao T. The long-term efficacy of hydrocele treatment with aspiration and sclerotherapy with polidocanol compared to placebo: a prospective, double-blind, randomized study. J Urol. 2014 May. 191(5):1347-50. [Medline].

  13. Francis JJ, Levine LA. Aspiration and sclerotherapy: a nonsurgical treatment option for hydroceles. J Urol. 2013 May. 189(5):1725-9. [Medline].

  14. Cimador M, Castagnetti M, De Grazia E. Management of hydrocele in adolescent patients. Nat Rev Urol. 2010 Jul. 7(7):379-85. [Medline].

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

  16. Jahnson S, Sandblom D, Holmäng S. A randomized trial comparing 2 doses of polidocanol sclerotherapy for hydrocele or spermatocele. J Urol. 2011 Oct. 186 (4):1319-23. [Medline].

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

 
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