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Updated: Feb 12 2018


  • Snaphot
    • A 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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