J I N U J A N E T V A R G H E S E

G R O U P : I V

Y E A R : V

T B I L I S I S T A T E M E D I C A L U N I V E R S I T Y

HYDROCELE

INTRODUCTION

Hydrocele is an abnormal fluid collection in the scrotum between the visceral and parietal areas of the tunica vaginalis.

in infants is usually the result of incomplete closure of the processus vaginalis. It may or may not be associated with inguinal hernia. In older boys and men it may be idiopathic but more likely to be secondary to another pathologic process in the scrotum or adjacent structures

CAUSES

For baby boys, a hydrocele can develop in the womb. Normally, the testicles descend from the developing baby's abdominal cavity into the scrotum. A sac (processus vaginalis) accompanies each testicle, allowing fluid to surround the testicles.In most cases, each sac closes and the fluid is absorbed. However, if the fluid remains after the sac closes, the condition is known as a NONCOMMUNICATING HYDROCELE. Because the sac is closed, fluid can't flow back into the abdomen. Usually the fluid gets absorbed within a year.In some cases, however, the sac remains open. With this condition, known as COMMUNICATING HYDROCELE, the sac can change size or, if the scrotal sac is compressed, fluid can flow back into the abdomen.In older males, a hydrocele can develop as a result of inflammation or injury within the scrotum. Inflammation may be the result of infection of the small coiled tube at the back of each testicle (epididymitis) or of the testicle.

Risk factors

Most hydroceles are present at birth (congenital), and babies who are born prematurely have a higher risk of having a hydrocele.

Risk factors for developing a hydrocele later in life include:

Scrotal injury

Infection, including sexually transmitted infections

EPIDEMIOLOGY

SexHernias are 6 times more common in boys than in girls.Bowel incarceration is more common in females than in males.In females, an ovary or fallopian tube incarcerates more frequently than bowel. Therefore, the overall incidence of bowel strangulation is lower in females than in males.AgeThe incidence of PPV decreases with age. In newborns, 80%-94% have a PPV. Hernias are 20 times more common in premature infants who weigh less than 1500 g than in babies born at term.

SIGNS & SYMPTOMS

A bulge in the groin or scrotal enlargement is the classic presentation of hernia or communicating hydrocele.

Pain is generally not a prominent feature but may occur if a hydrocele expands quickly; tension in the wall may cause milder pain. Severe pain raises concern about a strangulated hernia. Very rarely, a hydrocele may become infected and cause pain.

Frequently, parents report an intermittent bulge. The bulge may reduce at night in the supine position. A history of vomiting, colicky abdominal pain, or constipation suggests bowel obstruction, which may occur with an incarcerated or strangulated hernia.

PHYSICAL ASSESSMENT

The exam may reveal an enlarged scrotum that isn't tender to the touch. Pressure to the abdomen or scrotum may enlarge or shrink the fluid-filled sac, which may indicate an associated inguinal hernia.

Because the fluid in a hydrocele usually is clear, your doctor may shine a light through the scrotum (transillumination). With a hydrocele, the light will outline the testicle, indicating that clear fluid surrounds it.

If the hydrocele is caused by inflammation, blood and urine tests may help determine whether there is an infection, such as epididymitis.

The fluid surrounding the testicle may keep the testicle from being felt. In that case, ultrasound imaging test is done. This test can rule out a hernia, testicular tumor or other cause of scrotal swelling.

Laboratory Studies

Laboratory evaluation is generally not essential to the evaluation of hydroceles and hernias.

Leukocytosis may be a sign of a strangulated hernia.

Leukocytosis with a higher percentage of neutrophils suggests an infectious and/or inflammatory process (eg, epididymo-orchitis).

Imaging Studies

Simple hydroceles do not require radiographic studies. Findings from radiographic or ultrasonographic studies can help evaluate for an underlying process, such as a tumor or torsion.

As with ultrasonography, duplex studies are not warranted in simple hydroceles. However, duplex studies may provide substantial information regarding testicular blood flow when a hydrocelemay be associated with chronic torsion.

TREATMENT

Hydroceles usually improve without any treatment within the first year of life. An operation is usually only advised if the hydrocele persists after 12-18 months of age.

The operation for a hydrocele involves making a very small cut in the lower tummy (abdomen) or the scrotum. The fluid is then drained from around the testicle (testis). The passage between the abdomen and the scrotum will also be sealed off so the fluid cannot reform in the future. This is a minor operation and is performed as a day case, so does not usually involve an overnight stay in the hospital.

There are no long-term effects of having a hydrocele. Having a hydrocele does not affect the testicles (testes) or a boy's fertility in the future.

Potential Complications from Surgery

Complications from surgery are very rare, but are more likely if the child has previous groin surgery. Possible risks include infection, bleeding recurrence, pulling up of the testicle, and injury to the testicle or its ducts.