HYDROCELE
JAMES MWANGI
INTRODUCTION TO HYDROCELE
■ DEF: Hydrocele is a fluid collection within the tunica vaginalis of
the scrotum or along the spermatic cord
26 September
Human Anatomy James Mwangi K
2022
INTRODUCTION TO HYDROCELE
■ These fluid collections may represent:
– persistent developmental connections along
the spermatic cord
– imbalance of fluid production versus
absorption.
■ In rare cases, similar fluid collections can develop
in females along the canal of Nuck
■ Heaviness, fullness, dragging sensation , cosmetic
problem, radiating pain to back
26 September
Human Anatomy James Mwangi K
2022
Epidemiology
Frequency
■ A patent processus vaginalis is found in 80-90% of term male infants at birth.
■ This frequency rate steadily decreases until age 2 yrs, and plateau at approximately 25-40%.
■ Men have a frequency rate of 20% of the processus vaginalis remaining patent until late in life.
■ Clinically apparent scrotal hydroceles are evident in only 6% of term males beyond the
newborn period.
■ Certain conditions, such as breech presentation, gestational progestin use, and low birth
weight, have been associated with an increased risk of hydroceles.
■ The incidence of hydroceles in men is less well known
26 September
Human Anatomy James Mwangi K
2022
Pathophysiology
■ Excessive production of fluid within sac
■ Defective absorption of fluid
■ Interference with lymphatic drainage
■ Connection with peritoneal cavity via patent
processus vaginalis
Pathophysiology
26 September
Human Anatomy James Mwangi K
2022
Relevant Anatomy ■ The developmental anatomy of the
inguinal canal is responsible for the
genesis of pediatric communicating
hydroceles.
■ As the testis descends from the
posterolateral genitourinary ridge at the
beginning of the 3rd trimester of fetal
gestation, a saclike extension of
peritoneum descends in concert with the
testis.
■ As descent progresses, the sac envelops
the testis and epididymis.
■ The result is a serosal-lined tubular
communication between the abdomen
and the tunica vaginalis of the scrotum.
26 September
Human Anatomy James Mwangi K
2022
• The peritoneum-derived serosal
communication is the processus vaginalis,
and the serosa of the hemiscrotum becomes
the tunica vaginalis.
• At term, or within the first 1-2 years of life, the
processus vaginalis of the spermatic cords
fuse, thereby obliterating the communication
between the abdomen and the scrotum.
• The processus fuses distally as far as the
lower epididymal pole and anteriorly to the
upper epididymal pole. Failure of complete
fusion may result in communicating
hydroceles, indirect inguinal hernias, and the
bell-clapper deformity of abnormal testicular
fixation in the scrotum
26 September
Human Anatomy James Mwangi K
2022
Pathophysiology
26 September
Human Anatomy James Mwangi K
2022
Congenital Hydrocele
26 September
Human Anatomy James Mwangi K
2022
Communicating and Non-Communicating Hydrocele
26 September
Human Anatomy James Mwangi K
2022
Presentation of Hydrocele
■ Typically manifest as a soft non-tender fullness within the hemiscrotum.
■ The testis is generally palpable along the posterior aspect of the fluid
collection.
■ When the scrotum is investigated with a focused beam of light, the scrotum
transilluminates, revealing a homogeneous glow without internal shadows.
■ Hydroceles of the canal of Nuck in female patients:
– typically present as soft, non-tender inguinal or labial swelling.
– Like hemiscrotal hydroceles, labial hydroceles transilluminate readily
26 September
Human Anatomy James Mwangi K
2022
Clinical presentation:
History
■ Patients with hydroceles present with a cystic scrotal mass.
■ A hydrocele that communicates with the peritoneal cavity may increase in size during
the day or with the valsalva maneuver.
■ In contrast, non-communicating hydroceles are not reducible and do not change in
size or shape with crying or straining.
■ Progressive painless swelling on the involved side of the scrotum
■ Sensation of heaviness in scrotum
■ Pain radiating to back (occasionally)
■ Swelling in scrotum or inguinal canal
26 September
Human Anatomy James Mwangi K
2022
Clinical presentation:
Physical
■ Hydroceles typically manifest as a soft non--tender fullness within the hemiscrotum
■ Examination of patients with hydroceles should include palpation of the entire testicular
surface for findings of epididymitis, orchitis, testicular torsion, torsion of the appendix testis
or appendix epididymis, trauma, or tumor as the primary etiology
■ The testis is generally palpable along the posterior aspect of the fluid collection.
■ When the scrotum is investigated with a focused beam of light, the scrotum
transilluminates, revealing a homogenous glow, without internal shadows
■ Demonstrated fluctuation in size (communicating hydrocele)
26 September
Human Anatomy James Mwangi K
2022
DIFFERENTIAL DIAGNOSIS: SCROTAL CYSTIC MASSES
■ Indirect inguinal hernia
■ Epididymis cyst
■ Hydrocele
■ Varicocele
■ Spermatocele
■ Pyocoele
■ Hematocele
DIFFERENTIATION
Palpate cord above YES NO
mass
Transillumination YES NO
Fluctuate YES NO
Fluid thrill YES NO
DIFFERENTIATION
Testis palpable NO YES
Cough impulse NO YES
Reducible NO YES
Bowl sounds NO YES
Indications for intervention in hydroceles
■ Inability to distinguish from an inguinal hernia
■ Failure of the hydrocele to resolve spontaneously after an appropriate interval
of observation
■ Inability to clearly examine testis
■ Association of hydroceles with suggestive pathology (eg, torsion, tumor)
■ Pain or discomfort
■ Male infertility
■ Cosmesis
26 September
Human Anatomy James Mwangi K
2022
TREATMENT
■ Communicating
– Tying off the patent processus vaginalis
■ Primary
– Hydrocelectomy
– Aspiration + injection of sclerosing agent
■ Secondary
– Treat underlying pathology
