Hydrocele in Emergency Medicine Treatment & Management

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

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]

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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.

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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]

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