Filarial Hydrocele Workup

Updated: Jan 05, 2021
  • Author: Bradley Fields Schwartz, DO, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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Workup

Laboratory Studies

Laboratory tests and findings in filarial hydrocele are as follows:

  • Complete blood cell count (CBC): Patients with patent filarial infection commonly have marked eosinophilia

  • Serum immunoglobulins: Elevated serum levels of immunoglobulin E (IgE) and immunoglobulin G4 (IgG4) are seen with microfilarial infection

  • Enzyme-linked immunoassay (ELISA): Og4C3 monoclonal antibody–based ELISA provides a quantitative measure of circulating filarial antigen (CFA)

  • Immunochromatographic testing (ICT): Dipstick testing of whole blood with ICT cards, which utilize monoclonal antibody AD.12, is a qualitative test for CFA that is widely used in the field as a screening test for lymphatic filariasis [9, 10]

  • Hydrocele fluid examination: CFA may be detected in hydrocele fluid, [11] and microfilariae may be found on cytology

  • Urine examination: Chyluria may be detected macroscopically, and microfilariae may be detected via microscopic examination of voided urine; proteinuria and hematuria may also be seen with microfilarial infection with renal involvement

  • Peripheral blood examination: Microfilariae may be detected via microscopic examination of peripheral blood; microfilariae demonstrate a circadian pattern that varies by endemic region, necessitating serum sampling that coincides with periods of activity; activity may be provoked with administration of DEC

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Imaging Studies

Lymphatic obstruction can be demonstrated on ultrasonography. Motile adult worms may be seen in symptomatic and subclinical filarial hydroceles. The characteristic movements of adult filarial worms are called the filarial dance sign (FDS) and are a reliable diagnostic finding. Ultrasonography may also be used to monitor response to treatment.

 

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Staging

To guide surgical management, Capuano and Capuano have proposed a standardized clinical classification of filarial hydroceles, based on four criteria [12] :

  • Type – Unilateral versus bilateral

  • Side (left/right)

  • Scrotal enlargement - Rated from I to VI

  • Grade of burial of the penis – Rated from 0 to 4

For size of the scrotum, the rating scale is as follows:

  • Stage I: Smaller than a tennis ball

  • Stage II: Larger than of a tennis ball up and down; the lower pole of the scrotum does not reach halfway down the thigh (between the lower edge of the great trochanter and the upper edge of the patella)

  • Stage III: The lower pole of the scrotum reaches the area between mid-thigh and the knee (upper edge of the patella

  • Stage IV: The lower pole of the scrotum reaches the area between the upper edge of the patella and the lower edge of the knee (tibial tuberosity)

  • Stage V: The lower pole of the scrotum reaches the area between the lower edge of the knee (tibial tuberosity) and the middle of the lower leg

  • Stage VI: The lower pole of the scrotum reaches the area between mid-leg and the ankle (bi-malleolar line)

For burial of the penis, which can be assessed with the patient standing or lying down, the rating scale is as follows:

  • Grade 0: No apparent burial; penis length is within normal limits

  • Grade 1: Partial burial; the length of the visible part of the penis is > 2 cm

  • Grade 2: More important partial burial; the length of the visible part of the penis is < 2 cm

  • Grade 3: Total burial; the prepuce, or the tip of the glans penis if the patient is circumcised, is visible and flush with the surface of the scrotum

  • Grade 4: Total burial; the glans penis is invisible, and the burial cannot be reduced and causes micturition problems

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