What is Hydrocele?

Hydroceles are fluid collections within the tunica vaginalis of the scrotum or along the spermatic cord. These fluid collections may represent persistent developmental connections along the spermatic cord or an imbalance of fluid production versus absorption. Rarely, similar fluid collections can occur along the canal of Nuck in females.
The presence of fluid within the hemiscrotum imparts little clinical impact on the testis. However, determining the cause for the increased fluid, specifically any associated clinically significant pathology, remains the primary concern with regard to hydroceles. Once pathology that is more ominous has been excluded, persistence of the hydrocele or the association of discomfort may indicate the need for surgical intervention.

 

Clinical

Hydroceles typically manifest as a soft nontender fullness within the hemiscrotum. The testis generally is palpable along the posterior aspect of the fluid collection. When the scrotum is investigated with a focused beam of light, the scrotum transilluminates, revealing a homogenous glow, without internal shadows.
The inability to clearly delineate or palpate the testicular structures; the presence of tenderness, fever, or any gastrointestinal symptoms (eg, vomiting, constipation, diarrhea), or the appearance of internal shadows on transillumination should raise the suggestion of a different diagnosis or some additional underlying pathology. A scrotal ultrasound is the next logical step.

Indications for intervention include the following:

* Inability to distinguish from an inguinal hernia
* Failure to resolve spontaneously after an appropriate interval of observation
* Inability to clearly examine testis
* Association of hydroceles with suggestive pathology (eg, torsion, tumor)
* Pain or discomfort
* Male infertility
* Patient desire

Imaging Studies* Ultrasound *

o As noted, sonography itself is rarely indicated for simple hydroceles.
o Furthermore, a reduced inguinal hernia may be missed on ultrasound images. However, ultrasound does provide excellent detail regarding the testicular parenchyma. Spermatoceles can be clearly distinguished from hydroceles on ultrasound images.
o If a testicular tumor is a diagnostic consideration, ultrasound is an excellent screening study.