Updated: 2/12/2018

Hydrocele

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  • hydroceleA 6-month old boy is brought to the pediatrician’s office for evaluation of a “lump” in his genital area. His birth history is unremarkable and he has been feeding and eating well. His parents report no other concerns. On physical exam, there is a tense and non-tender mass in the scrotum. The transillumination test is positive. The parents are counseled about his condition and reassured that this will most likely resolve spontaneously.
Introduction
  • Clinical definition
    • swelling in scrotum due to fluid accumulation between parietal and visceral layers of tunica vaginalis
    • communicating hydroceles
      • incomplete closure of processus vaginalis
      • account for most cases of hydroceles in infants and children
    • non-communicating hydroceles
      • complete closure of processus vaginalis
      • most often idiopathic
      • account for all cases of adult hydroceles
  • Epidemiology
    • incidence
      • 1% of adult men
      • 1-4.7% of male infants
  • Etiology
    • adults and adolescents
      • trauma
      • infection
        • acute epididymitis
        • mumps
      • tumor
        • mesothelioma
        • 10% of testicular tumors present with hydrocele
    • infants and children (congenital)
      • incomplete obliteration of processus vaginalis
  • Prognosis
    • natural history of disease
      • congenital hydrocele usually resolves spontaneously by 1 year of age
Presentation
  • Symptoms
    • painless bulge of genitals
  • Physical exam
    • scrotum
      • nontender
      • tense
      • fluid-filled
      • enlarged
    • scrotum transilluminates
      • positive transillumination test
Imaging
  • Ultrasound
    • indications
      • only if diagnosis is uncertain or suspicion for tumor
Differential
  • Varicocele
    • “bag of worms”
Treatment
  • Conservative
    • monitoring
      • indications
        • monitor for 6-9 months for small noncommunicating hydrocele in adults
        • monitor until after 1 year of age for communicating hydrocele in infants
  • Operative
    • surgical hydrocelectomy
      • indications
        • if hydrocele does not self-resolve
Complications
  • Testicular damage
  • Subfertility
 
 
 

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Questions (1)

(M1.RP.13.23) A 6-month-old male presents with a painless, enlarged left scrotum. After examining the patient, you suspect this enlargement is secondary to serous fluid entering and accumulating in the scrotum through a patent processus vaginalis. Which of the following would be the most useful next step in confirming the diagnosis of this patient’s condition? Tested Concept

QID: 101241
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Measurement of AFP and hCG levels

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Transillumination test followed by scrotal ultrasound

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Evaluation of cremasteric reflex on physical exam

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Measurement of serum testosterone levels

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Standard urinalysis

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