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Clinical Summary

A hydrocele of the testis refers to a collection of fluid surrounding the testicle. It is caused by fluid collecting between the parietal and visceral layers of the tunica vaginalis. There are two common types of hydroceles: communicating and noncommunicating. Communicating hydroceles lead to a collection of peritoneal fluid around the testes from a failure of the processes vaginalis closing during development. Noncommunicating is from the direct secretion of fluid from the tunica vaginalis. Infants and adolescents generally present with painless scrotal swelling.

Management and Disposition

Diagnosis can often be made clinically through a physical exam and transillumination of the scrotum. If the diagnosis is unclear, a scrotal ultrasound with Doppler should be obtained to differentiate the hydrocele from more concerning pathology. In infants and young children, the management is largely supportive if the hydrocele is asymptomatic. Communicating or noncommunicating hydroceles in patients older than 2 rarely spontaneously resolve and should be referred to a subspecialist for an elective closure.

FIGURE 14.123

Hydrocele. Painless scrotal swelling (A) which transilluminates (B). This patient had an inguinal hernia that was repaired electively. (Photo contributor: Kevin J. Knoop, MD, MS.)

Pearls

  1. Hydroceles in the less than 1 age group do not often require intervention and resolve spontaneously.

  2. Communicating hydroceles increase in size with the Valsalva maneuver (crying in an infant) or during the day due to gravity, unlike noncommunicating hydroceles.

  3. Reactive hydroceles can be painful and erythematous and are likely a secondary finding to a different pathology (epididymitis, testicular torsion, testicular rupture).

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