From the Guidelines
Hydroceles are typically diagnosed and managed based on clinical presentation, with ultrasound (US) being the established first-line imaging modality for scrotal evaluation, as it can accurately diagnose most scrotal disorders, including hydroceles, when combined with clinical history and physical examination 1.
Key Points to Consider
- Hydroceles are fluid-filled sacs that develop around the testicle, causing painless swelling of the scrotum.
- Most hydroceles don't require treatment unless they cause discomfort or are large enough to cause embarrassment.
- For symptomatic hydroceles, surgical correction (hydrocelectomy) is the definitive treatment, as it provides a permanent solution with minimal risk of recurrence.
- Ultrasound (US) is essential in diagnosing hydroceles and differentiating them from other scrotal pathologies, such as epididymitis or testicular torsion, which may present with similar symptoms but require different management approaches 1.
Diagnostic Approach
- Clinical history and physical examination are crucial in the initial assessment of a patient with a suspected hydrocele.
- Ultrasound (US) is used to confirm the diagnosis and rule out other causes of scrotal swelling, such as testicular tumors or hernias.
- The use of color Doppler US can help differentiate hydroceles from conditions like epididymitis, which is characterized by increased blood flow due to inflammation 1.
Management Options
- Surgical correction (hydrocelectomy) is the preferred treatment for symptomatic hydroceles, as it offers a permanent solution with minimal risk of recurrence.
- Needle aspiration can provide temporary relief for elderly or high-risk patients, but recurrence is common.
- It's essential to distinguish hydroceles from other scrotal swellings, as they may require different treatments, and to manage them accordingly to improve patient outcomes and quality of life.
From the Research
Definition and Causes of Hydrocele
- 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, 3.
- Hydroceles can be divided into two types: primary and secondary 2.
Diagnosis of Hydrocele
- The diagnosis should be based on medical history, clinical manifestations, and imaging studies 2.
- Scrotal ultrasonography is mandatory in nonpalpable testicles to rule out a subtending testicular solid mass requiring inguinal exploration 3.
Treatment Options for Hydrocele
- Hydroceles can be managed by conservative treatment, fluid aspiration, or hydrocelectomy 2, 3.
- Aspiration and sclerotherapy with doxycycline is an effective and safe nonsurgical treatment option for hydrocele correction, with a success rate of 84% 4.
- Sclerotherapy is an alternative treatment for hydroceles that involves injecting a sclerosant into the hydrocele under ultrasound guidance, with various sclerosants used including polidocanol, phenol, and STS 5.
- Phenol had the highest clinical success rate of 96.5% among the sclerosants used for hydrocele sclerotherapy 5.
Comparison of Treatment Outcomes
- Hydrocelectomy is a more effective method in completely curing hydroceles, but it comes with more complications 5.
- Sclerotherapy is a valuable alternative for treating hydroceles, with advantages including lower healthcare costs and burden to patients 5.
- Aspiration and sclerotherapy have a role in treating symptomatic hydroceles, especially in patients who are not fit for surgery, with cure rates of 76% after a single injection and 94% after multiple treatments 6.