Hydrocele in Emergency Medicine

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

Background

A hydrocele is a collection of serous fluid that results from a defect or irritation in the tunica vaginalis of the scrotum. Hydroceles also may arise in the spermatic cord or the canal of Nuck. A communicating hydrocele is similar to a hernia except that the sac connecting the abdomen to the scrotum or labia majora contains only fluid rather than abdominal contents. A noncommunicating hydrocele is a collection of scrotal fluid that is isolated from the abdomen. Noncommunicating hydroceles are the most common type of hydrocele globally, affecting more than 30 million men and boys [1]

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Pathophysiology

Embryologically, the processus vaginalis is a diverticulum of the peritoneal cavity. It descends with the testes into the scrotum via the inguinal canal around the 28th gestational week with gradual closure through infancy and childhood. [2]

Structurally, hydroceles are classified into 3 principal types:

  • In a communicating (congenital) hydrocele, a patent processus vaginalis permits flow of peritoneal fluid into the scrotum. Indirect inguinal hernias are associated with this type of hydrocele.
  • In a noncommunicating hydrocele, a patent processus vaginalis is present, but no communication with the peritoneal cavity occurs.
  • In a hydrocele of the cord, the closure of the tunica vaginalis is defective. The distal end of the processus vaginalis closes correctly, but the mid portion of the processus remains patent. The proximal end may be open or closed in this type of hydrocele.

Adult hydroceles are usually late-onset (secondary). Late-onset hydroceles may present acutely from local injury, infections, and radiotherapy; they may present chronically from gradual fluid accumulation. Morbidity may result from chronic infection after surgical repair. Hydrocele can adversely affect fertility.

Primary new-onset hydroceles presenting in late childhood and pre-adolescence are often noncommunicating and resemble the adult type hydrocele pathology. [3]

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Epidemiology

Hydrocele is estimated to affect 1% of adult men.

More than 80% of newborn boys have a patent processus vaginalis, but most close spontaneously within 18 months of age. The incidence of hydrocele is rising with the increasing survival rate of premature infants and with increasing use of the peritoneal cavity for ventriculoperitoneal (VP) shunts, dialysis, and renal transplants.

Most hydroceles are congenital and are noted in children aged 1-2 years.

Chronic or secondary hydroceles usually occur in men older than 40 years.

Noncommunicating hydroceles are the most common type of hydrocele globally, affecting more than 30 million men and boys [1]

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