eMedicine Specialties > Emergency Medicine > Genitourinary

Hydrocele: Treatment & Medication

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

Treatment

Emergency Department Care

  • Differentiating between a hydrocele and an acute scrotum (eg, testicular torsion, strangulated hernia) is important.
  • As many as 50% of acute scrotum cases are initially misdiagnosed.
  • Transillumination is not diagnostic and cannot rule out an acute scrotum.
  • Ultrasound anatomic imaging with Doppler evaluation of testicular blood flow is indicated when an acute scrotum is suspected, as follows:
    • A traumatic hemorrhage into a hydrocele or testes
    • A testicular torsion with or without a secondary hydrocele
    • An ischemic testicle
  • In children, hydrocele is treated through inguinal incisions with high ligation of the patent processus vaginalis and excision of the distal sac.

Consultations

  • Immediately consult a urologist if testicular torsion is found or suspected.
  • A urologic follow-up examination is required if any testicular pathology is involved.
  • A general surgery evaluation is indicated for patients with a tense hydrocele that threatens to embarrass scrotal circulation. Surgical evaluation is also indicated for hydrocele producing a large and bulky mass that is unsightly or uncomfortable.

More on Hydrocele

Overview: Hydrocele
Differential Diagnoses & Workup: Hydrocele
Treatment & Medication: Hydrocele
Follow-up: Hydrocele
References
[ CLOSE WINDOW ]

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.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.