eMedicine Specialties > Emergency Medicine > Genitourinary

Hydrocele: Treatment & Medication

Author: Scott E Rudkin, MD, MBA, RDMS, FAAEM, FACEP, Associate Clinical Professor; Assistant Dean, Continuing Medical Education; Vice Chair, Director of Medical Informatics, 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: Nov 25, 2009

Treatment

Emergency Department Care

  • Differentiating between a hydrocele and an acute scrotum (eg, testicular torsion, strangulated hernia) is important.2
  • 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.2

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
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References

  1. Garriga V, Serrano A, Marin A, Medrano S, Roson N, Pruna X. US of the Tunica Vaginalis Testis: Anatomic Relationships and Pathologic Conditions. Radiographics. November-December 2009;29(7):2017-2032. [Medline].

  2. [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. Mar 2009;[Full Text].

  3. 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].

  4. 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].

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

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

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

  8. 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

hydrocele, hydrocele causes, hydrocele symptoms, hydrocele treatment, defect in tunica vaginalis of scrotum, communicating hydrocele, congenital hydrocele, pediatric hydroceles, indirect inguinal hernias, noncommunicating hydrocele, painless enlarged scrotum

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Contributor Information and Disclosures

Author

Scott E Rudkin, MD, MBA, RDMS, FAAEM, FACEP, Associate Clinical Professor; Assistant Dean, Continuing Medical Education; Vice Chair, Director of Medical Informatics, 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: eMedicine Salary Employment

Managing Editor

Richard H 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 H 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

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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