Hydrocoele

Hydrocoele is an accumulation of fluid between the layers of the tunica vaginalis leading to a swelling of the scrotum. It can occur in any age but is most common in infants.

Etiology

• Idiopathic
  • Maybe due to impaired reabsorption of fluid by the tunica vaginalis
• Lymphatic filariasis
• Trauma
• Tumour
• Torsion
• Congenital

Communicating hydrocele

• = the hydrocele communicates with the peritoneal cavity
• Due to failed closure of the processus vaginalis
• The fluid in the hydrocele originates from the peritoneal cavity
• Affects infants
• The hydrocele is reducible
  • = the fluid can be “pushed” back into the peritoneal cavity
• Valsalva manoeuvre increases the size of the hydrocele
  • Because peritoneal fluid is forced into the scrotum
• Usually resolves spontaneously within 1 year

Noncommunicating hydrocele

• = the hydrocele does not communicate with the peritoneal cavity
• The hydrocele is not reducible
• Valsalva manoeuvre does not influence the size

Clinical features

• Painless swelling of the affected hemiscrotum

Diagnosis

• Clinical diagnosis
• Positive transillumination
• US
  • Shows hypoechoic fluid

Treatment

• Surgery for most cases
  • Communicating hydrocele which doesn’t resolve within 1 year
  • Unacceptable discomfort
  • Compromised scrotal skin integrity
• Surgical excision of the hydrocele sac
• Sclerotherapy
  • A sclerosing agent is injected into the hydrocele after the fluid has been aspirated
  • The space will be closed, preventing future hydroceles
  • There is a high incidence of recurrence after sclerotherapy