Hydrocele

Urology

Clinicals - History

Fact Explanation
Swelling in the scrotum Due to abnormal collection of serous fluid within tunica vaginalis. Swelling in the scrotum
Due to abnormal collection of serous fluid within tunica vaginalis.
Pain and discomfort Very rare. If present, is more suggestive of a secondary cause such as a tumour or epididymo-orchitis. Pain and discomfort
Very rare. If present, is more suggestive of a secondary cause such as a tumour or epididymo-orchitis.

Clinicals - Examination

Fact Explanation
Uniformly enlarged scrotum with impalpable testis Swelling is due to abnormal collection of serous fluid within the tunica vaginalis.
The testis is impalpable as it is surrounded by fluid.
An impalpable testis is the cardinal physical sign that distinguishes hydrocele from an epididymal cyst.
But in an encysted hydrocele of the cord the testis and the cord can be palpated separately.
Uniformly enlarged scrotum with impalpable testis
Swelling is due to abnormal collection of serous fluid within the tunica vaginalis.
The testis is impalpable as it is surrounded by fluid.
An impalpable testis is the cardinal physical sign that distinguishes hydrocele from an epididymal cyst.
But in an encysted hydrocele of the cord the testis and the cord can be palpated separately.
Fluctuant Hydrocele fluctuates as it contains fluid. If large enough a fluid thrill may be elicited. Fluctuant
Hydrocele fluctuates as it contains fluid. If large enough a fluid thrill may be elicited.
Transilluminant Because it contains yellow clear fluid.
However, chronic hydroceles tends to transilluminate less due to calcification of sac.
Transilluminant
Because it contains yellow clear fluid.
However, chronic hydroceles tends to transilluminate less due to calcification of sac.
Distinct from superficial inguinal ring Therefore can "get above the mass" on palpation. This helps to differentiate hydrocele from inguinal hernia.
But a congenital hydrocele can extend in to the superficial inguinal ring.
Distinct from superficial inguinal ring
Therefore can "get above the mass" on palpation. This helps to differentiate hydrocele from inguinal hernia.
But a congenital hydrocele can extend in to the superficial inguinal ring.
Composition Can be lax or tense according to the pressure of the contained fluid. Composition
Can be lax or tense according to the pressure of the contained fluid.

Investigations - Diagnosis

Fact Explanation
Ultrasound examination of the scrotum To confirm the hydrocele.
To differentiate between intratesticular lesions such as a testicular carcinoma from extratesticular lesions.
For prenatal diagnosis of congenital hydrocele.
Ultrasound examination of the scrotum
To confirm the hydrocele.
To differentiate between intratesticular lesions such as a testicular carcinoma from extratesticular lesions.
For prenatal diagnosis of congenital hydrocele.
Tumour markers - AFP, beta hCG and LDH levels To exclude testicular carcinoma Tumour markers - AFP, beta hCG and LDH levels
To exclude testicular carcinoma
Diagnostic aspiration SHOULD BE AVOIDED, as it may lead to implantation of malignant cells along the needle tract. Diagnostic aspiration
SHOULD BE AVOIDED, as it may lead to implantation of malignant cells along the needle tract.

Investigations - Management

Fact Explanation
Ultrasound examination of the scrotum To detect formation of hematocele following needle aspiration or to detect recurrent hydrocele. Ultrasound examination of the scrotum
To detect formation of hematocele following needle aspiration or to detect recurrent hydrocele.
ECG Usually required in anyone over the age of 65 or in patients with a history of cardiovascular, pulmonary or anesthetic complications in order to assess their cardiorespiratory reserve. ECG
Usually required in anyone over the age of 65 or in patients with a history of cardiovascular, pulmonary or anesthetic complications in order to assess their cardiorespiratory reserve.
Full blood count To assess the hemoglobin count, as an indicator for fitness for surgery. Full blood count
To assess the hemoglobin count, as an indicator for fitness for surgery.
Urea and electrolytes Usually required in anyone over the age of 65 or in those taking regular diuretics. Urea and electrolytes
Usually required in anyone over the age of 65 or in those taking regular diuretics.

Management - Supportive

Fact Explanation
Assess and optimize co-morbid conditions To reduce surgical and anesthetic complications. Assess and optimize co-morbid conditions
To reduce surgical and anesthetic complications.

Management - Specific

Fact Explanation
Watchful waiting A small hydrocele may require no treatment other than reassurance. Watchful waiting
A small hydrocele may require no treatment other than reassurance.
Cannula drainage This will relieve the symptoms, but tends to re-accumulate. Thus it is suitable for patients who are unfit for scrotal surgery. Cannula drainage
This will relieve the symptoms, but tends to re-accumulate. Thus it is suitable for patients who are unfit for scrotal surgery.
Aspiration followed by sclerotherapy Sclerosants such as phenol, tetracycline or sodium tetradecylsulfate are injected following aspiration. Useful in treating recurrent hydroceles. Aspiration followed by sclerotherapy
Sclerosants such as phenol, tetracycline or sodium tetradecylsulfate are injected following aspiration. Useful in treating recurrent hydroceles.
Surgical Management - Lord's operation Suitable when the sac is reasonably thin walled. Surgical Management - Lord's operation
Suitable when the sac is reasonably thin walled.
Surgical Management - Jaboulay's procedure Evertion of the sac with placement of the testis in a pouch prepared by dissection in the fascial planes of the scrotum. Surgical Management - Jaboulay's procedure
Evertion of the sac with placement of the testis in a pouch prepared by dissection in the fascial planes of the scrotum.

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