Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hydrocele in Emergency Medicine Treatment & Management

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

Emergency Department Care

Differentiating between a hydrocele and an acute scrotum (eg, testicular torsion, strangulated hernia) is important.[10]

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.[10]

Next

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.

Previous
Next

Medical Care

Surgical removal of hydroceles is the gold standard of care. However, high success rates (85-96%) have been reported with a combination of aspiration and sclerotherapy. Reports of effective agents include polidcocanol, phenol, tetracycline ethanolamine oleate, sodium tetradecyl sulfate (STS), and alcohol. Complication rates have been reported to be as high as 50%.[11, 12, 13, 14, 15, 16]

Previous
 
 
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
  1. Beard JH, Ohene-Yeboah M, devries CR, Schecter WP, Debas HT, Donkor P, et al. Hernia and Hydrocele. 2015 Apr 02. [Medline].

  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].

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

  7. Crawford P, Crop JA. Evaluation of scrotal masses. Am Fam Physician. 2014 May 1. 89(9):723-7. [Medline].

  8. Palmer LS. Hernias and hydroceles. Pediatr Rev. 2013 Oct. 34(10):457-64; quiz 464. [Medline].

  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.

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.