From the Guidelines
A hydrocele is a fluid-filled sac that develops around the testicle, causing swelling in the scrotum, and it occurs when there is an incomplete involution of the processus vaginalis, allowing fluid to accumulate extra-abdominally 1.
Definition and Causes
A hydrocele is characterized by the accumulation of fluid in the thin sheath surrounding the testicle, leading to enlargement of the scrotum on the affected side. This condition can develop due to various factors, including inflammation or injury within the scrotum, or as a result of fluid production exceeding absorption in the membrane surrounding the testicle.
Diagnosis and Evaluation
The diagnosis of a hydrocele can be made using ultrasound (US) of the scrotum, which is the established first-line imaging modality for acute scrotal disease 1. US can help differentiate a hydrocele from other scrotal disorders, such as testicular torsion or epididymitis, by evaluating testicular perfusion and detecting signs of inflammation or ischemia.
Treatment and Management
Most hydroceles do not require treatment unless they cause discomfort or become large enough to be bothersome. When treatment is necessary, a surgical procedure called a hydrocelectomy is performed to remove the hydrocele and prevent recurrence. It is essential to evaluate a hydrocele by a healthcare provider to rule out other causes of scrotal swelling, such as hernias or testicular cancer.
Key Points
- A hydrocele is a fluid-filled sac that develops around the testicle, causing swelling in the scrotum.
- It occurs when there is an incomplete involution of the processus vaginalis, allowing fluid to accumulate extra-abdominally 1.
- Ultrasound (US) is the established first-line imaging modality for acute scrotal disease, including hydroceles 1.
- Most hydroceles do not require treatment unless they cause discomfort or become large enough to be bothersome.
From the Research
Definition of Hydrocele
- A hydrocele is an abnormal collection of serous fluid between the parietal and visceral layers arising from the mesothelial lining of the tunica vaginalis that surrounds the testis and spermatic cord directly 2.
- Hydroceles result from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis 2.
- Hydroceles can be divided into two types: primary and secondary 2.
Causes and Types of Hydroceles
- Understanding the causes and types of hydroceles is useful for accurately diagnosing and treatment strategy 2.
- Hydroceles can be managed by conservative treatment, fluid aspiration, or hydrocelectomy 2.
Diagnosis and Treatment
- The diagnosis should be based on medical history, clinical manifestations, and imaging studies 2.
- Aspiration and sclerotherapy versus hydrocelectomy are two approaches for treatment of hydroceles 3, 4.
- Aspiration and sclerotherapy is a safe and effective treatment alternative for hydrocele and spermatocele for patients wishing to avoid surgery 5.
- Sclerotherapy of hydroceles and spermatoceles with alcohol is an efficient procedure that can be performed without difficulties, cost-effectiveness, with few side effects 6.
Comparison of Treatment Options
- There was no significant difference in clinical cure between sclerotherapy and hydrocelectomy 3, 4.
- Meta-analysis revealed a significant increase in recurrence in the sclerotherapy group compared with the surgical group 3, 4.
- Aspiration and sclerotherapy is an efficient technique with a higher recurrent rate; therefore, it is recommended for patients at high risk for surgery or avoiding surgery 4.