Hydrocele in Emergency Medicine Follow-up

Updated: Mar 23, 2016
  • Author: Scott E Rudkin, MD, MBA, RDMS, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Follow-up

Further Outpatient Care

Arrange for quarterly follow-up examinations until a decision for or against surgery is made. Spontaneous closure is unlikely in children older than 1 year. Observe infants with hydrocele for 1-2 years or until definite communication is demonstrated. Watch for a concomitant hernia.

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Complications

An extremely large hydrocele may impinge on the testicular blood supply. The resulting ischemia can cause testicular atrophy and subsequent impairment of fertility.

Hemorrhage into the hydrocele can result from testicular trauma.

Incarceration or strangulation of an associated hernia may occur.

Surgical complications include the following:

  • Accidental injury to the vas deferens can occur during inguinal surgery for hydrocele.
  • Postoperative wound infections occur in 2% of patients undergoing surgery for hydrocele.
  • Postoperative hemorrhagic hydrocele is not uncommon, but it usually resolves spontaneously.
  • Direct injury to the spermatic vessels may occur.
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Prognosis

The prognosis for congenital hydrocele is excellent.

Most congenital cases resolve by the end of the first year of life.

Persistent congenital hydrocele is readily corrected surgically. One study assessed the safety and efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) for hydrocele in comparison with that of open repair (OR). LPEC was found to be a safe and effective procedure for treating hydrocele. Among a total of 69 patients, 40 underwent LPEC, and 29 underwent OR. There were no significant differences in the length of operation/anesthesia and complications. No recurrences were observed in either group. [11]

Polidocanol was shown, in a Danish study, to be an effective treatment for hydrocele testis in 77 men, 36 of whom were initially given polidocanol and 41 of whom were initially given placebo. Depending on hydrocele testis size (< 100 ml, 100-200 ml, and >200 ml), the patients were treated with 1, 3 or 4 ml polidocanol after aspiration. The overall success rate of treatment in the polidocanol group was 89%. Recurrence after the first treatment was seen in 16 (44%) patients from the treated group and in 32 (78%) from the placebo group. Both groups were then given polidocanol after recurrence. Recurrence after re-treatment with polidocanol in the treated group was 4 out of 14 patients (25%); in the former placebo group, recurrence after re-treatment with polidocanol was 14 out of 32 (44%). [12]

Hydrocele aspiration and sclerotherapy with doxycycline was successful in correcting 84% of simple nonseptated hydroceles with a single treatment. According to the authors of this study, this success rate is similar to the reported success rate for hydrocelectomy. In this study, 29 patients (mean age, 52.8 years) presenting with 32 nonseptated hydroceles underwent hydrocele aspiration and sclerotherapy with doxycycline. Of the hydroceles, 27 (84%) were successfully treated with a single aspiration and sclerotherapy procedure. Of those patients in whom hydrocele aspiration and sclerotherapy failed, 1 had hydrocele successfully resolved with a second aspiration and sclerotherapy treatment, 3 did not have success with a second procedure and underwent hydrocelectomy, and 1 wanted immediate surgical correction. [13]

The prognosis of hydrocele presenting later in life depends upon the etiology of the hydrocele. Adult-onset hydrocele is not uncommonly associated with an underlying malignancy.

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Patient Education

Emphasize the importance of timely follow-up care.

For patient education resources, see the Men's Health Center, as well as Understanding the Male Anatomy.

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