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

Varicoele

Varicocoele is an enlarged and tortuous pampiniform plexus in scrotum due to obstruction of the spermatic vein. It's very common (15% of men).

Etiology

Idiopathic
Secondary to diseases which obstruct spermatic vein
- Retroperitoneal mass
- Thrombosis

Clinical features

Typically affects left side
Dull pain
“Bag of worms” appearance
Symptoms improve when lying down
- Only in primary cases

Diagnosis

Clinical
Negative transillumination
Ultrasound

Treatment

Conservative
- For most patients
- Regular follow-up
- Scrotal support
Surgical repair
- Indications
  - Testicular atrophy
  - Infertility
- Ligation of affected venous branches or percutaneous embolization

Complications

May increase the risk of infertility
Testicular atrophy

Spermatocoele

Spermatocele is a swelling located at the upper pole of the epididymis. It's asymptomatic, harmless. It rarely requires treatment.

Inguinal hernia

(Inguinal hernia does not belong to urology, but rather to general surgery. I think it’s important to differentiate hydrocele from it, though.)Inguinal hernia refers to herniation of intraabdominal contents into the inguinal region, causing a mass in the scrotum or groin. It may also cause pain which worsens during physical activity.

It is the most common type of hernia and is mostly a disorder of older men. There are two types, indirect and direct. Indirect is more common of the two and mostly affects male infants and older men. Direct hernia also mostly affects older men.