Hydrocoele

From greek.doctor

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