Hydrocele

Description

A hydrocele is a collection of serous fluid between the parietal and visceral layers of the tunica vaginalis within the scrotum.

• Communicating hydrocele (patent processus vaginalis)
  • Direct communication between the hydrocele sac and the peritoneal cavity
  • Contains peritoneal fluid
  • Almost always with associated indirect inguinal hernia
  • Can fluctuate in size; increase in size when upright or during straining; decreases in size with recumbent position
• Noncommunicating hydrocele (processus vaginalis is not patent)
  • No direct connection between the hydrocele sac and the peritoneal cavity
  • Fluid contained is from the mesothelial lining.
  • Can be isolated to the cord with the distal and proximal portions of the processus vaginalis closed
  • Tend to stay the same size or slowly increase in size over time
• Acute hydrocele: fluid collection resulting from an acute process within the tunica vaginalis, typically involving only the scrotum
• Although this disorder is found nearly exclusively in male patients, there are rare hydroceles into the canal of Nuck in females which result from a fluid collection in an abnormal open pouch of peritoneum extending into the labia majora.
• System(s) affected: urogenital

Pediatric Considerations
Most congenital communicating hydroceles resolve spontaneously by 2 years of age.

Epidemiology

Predominant age: childhood (congenital); adulthood (acquired)

Etiology and Pathophysiology

• Congenital
  • Incomplete closure of the processus vaginalis trapping peritoneal fluid anywhere along the length of the tunica vaginalis
  • Failure of closure of the processus vaginalis maintains a communication to the peritoneal cavity
• Acquired
  • Secondary to inflammation, infection, trauma or obstruction of lymphatic or venous drainage
  • Idiopathic in which hydrocele can develop without any clearly identifiable cause

Risk Factors

• For adult acquired hydroceles:
  • Imbalance of the secretion and reabsorption of fluid from the lining of the tunica vaginalis
  • Infection
  • Tumors
  • Trauma
  • Ipsilateral renal transplantation (due to disruption of the spermatic cord during the procedure)
  • Ventriculoperitoneal shunt
  • Ehlers-Danlos syndrome
  • Peritoneal dialysis
  • History of scrotal surgery (to include varicocelectomy)
• For congenital hydroceles:
  • Exstrophy of the bladder
  • Cloacal exstrophy
  • Prematurity
  • Low birth weight
  • Patent processus vaginalis

Commonly Associated Conditions

For adult acquired hydroceles:

• Testicular tumors
• Scrotal trauma
• Ventriculoperitoneal shunt
• Nephrotic syndrome
• Renal failure with peritoneal dialysis
• Epididymitis or orchitis