hydrocele

Introduction

A fluid-filled sack along the spermatic cord within the scrotum.

Etiology

• failure of the testicular tract from the abdomen into the scrotum to close during development
• testicular inflammation or injury
• epididymitis
• blockage within the spermatic cord
• may be associated with inguinal hernia

Epidemiology

• common in newborn infants
• MKSAP20 sites a case in a 37 year old man

Pathology

• during development, the testes descend from the abdomen into the scrotum
• when the tract of the testes fails to close, fluid may drain from the abdomen into the scrotum
• thus drainage of abdominal fluid into the scrotum results in a swollen scrotum
• fluid collection between the layers of the tunica vaginalis

Clinical manifestations

• painless, swollen scrotum (may be painful]
• unilateral or bilateral
• transillumination through fluid filled scrotum

Diagnostic procedures

• ultrasound

Management

• congenital hydroceles generally resolve within a few months
• transillumination
  • if mass transilluminates
    • it is either a hydrocele or spermatocele*
    • generally asymptomatic
    • may cause discomfort if large
    • surgical excision
    • aspiration not useful because of recurrence
    • ultrasound not necessary
  • if mass does not transilluminate
    • ultrasound of mass
    • referral to urology
• asymptomatic transilluminating hydroceles generally do not require treatment
• pain control as needed

More general terms

• abnormal morphologic structure (malformation)
• male genital disease

Additional terms

• scrotal pain/mass (testicular pain, testicular torsion)
• varicocele; cirsocele; pampinocele