A hydrocele is the accumulation of fluids around the testicle, within the tunica vaginalis or processus vaginalis.
- Communicating hydrocele: fluid passing from peritoneal cavity into patent processus vaginalis
- Noncommunicating hydrocele: fluid confined within the processus vaginalis (hydrocele of the cord) or tunica vaginalis
- Abdominal-scrotal hydrocele: fluid collection within processus vaginalis, extending into retroperitoneum
- Reactive hydrocele (noncommunicating): accumulation of fluid within tunica vaginalis caused by infection, trauma, or other inflammatory conditions
- 2–5% of male neonates have hydrocele.
- Male more common than female
- Female: “cyst” or “hydrocele” in the canal of Nuck; may be communicating or noncommunicating
- Right more common than left
- Majority asymptomatic
- Simple (noncommunicating): commonly seen at birth, frequently bilateral, may be large
- Majority spontaneously resolve in 12 to 24 months.
- Persistent hydroceles beyond 24 months and those presenting after birth more likely to be communicating
- Age >12 years old: majority noncommunicating
- Adolescent/adult hydroceles are generally acquired (reactive) and idiopathic in origin.
- Similar to inguinal hernia
- Prematurity, low birth weight, gestational progestin use, connective tissue anomalies, cystic fibrosis, cryptorchidism, posterior urethral valves, and other syndromic disorders
- Trauma or infection
- Lymphatic obstruction (i.e., varicocelectomy, filariasis, pelvic radiation, malignancy)
- Communicating hydrocele can become indirect inguinal hernia, with potential for incarceration.
- Noncommunicating hydrocele generally thought to be low clinical concern.
- Potential damage in large, tense hydroceles
- Raised intrascrotal temperature can cause potential testicular harm.
- Tense hydrocele may cause pressure atrophy.
- Increased resistive index observed in subcapsular artery and absent testicular diastolic flow indicate risk for permanent damage.
- Communicating hydrocele similar to indirect inguinal hernia (defined by contents entering through patent processus vaginalis: peritoneal fluid versus fat or visceral organ)
- In testicular descent, lip of peritoneum descends with testicle, the processus vaginalis, and covers testicle, tunica vaginalis.
- Patent processus in girls (canal of Nuck) related to descent of round ligament to labia, female equivalent of gubernaculum
- Related to delayed closure of processus vaginalis
- Complete closure on both side in 18% of newborns
- 40% close in first 2 months of life
- 60% close by 2 years
- Patent processus vaginalis commonly associated with undescended testicles
- Adult autopsy data demonstrate 15–30% patent.
- Reactive (acquired) hydrocele is imbalance between fluid production and absorption.
- Majority are idiopathic.
- Defective lymphatic drainage
- Aspirated fluid similar protein content to lymphatic fluid
- Result of inflammation from trauma, testicular torsion, torsion of testicular appendage, epididymo-orchitis
- Postvaricocelectomy second most common cause
- Majority are idiopathic.
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