From the Guidelines
Hydroceles are primarily associated with risk factors such as trauma, infection, testicular tumors, inguinal surgery, and congenital abnormalities, with most adult cases being idiopathic and infant cases often resulting from incomplete closure of the processus vaginalis. The management of hydroceles depends on the presence of symptoms and the underlying cause. Key considerations include:
- Asymptomatic hydroceles generally require no treatment and may resolve spontaneously, particularly in infants 1.
- Symptomatic cases causing discomfort, pain, or cosmetic concerns typically require surgical intervention as the definitive treatment.
- Surgical options include hydrocelectomy (removal of the hydrocele sac) and the Lord procedure (plication of the sac), with aspiration with sclerotherapy being an alternative for poor surgical candidates, although it has higher recurrence rates.
- It is essential to evaluate patients for underlying causes like infection or malignancy before initiating treatment, as conditions such as epididymitis can lead to reactive hydrocele development, making diagnosis challenging 1.
- Post-operative care involves scrotal support, pain management, and monitoring for complications such as hematoma, infection, or recurrence.
- The use of contrast-enhanced ultrasound (US) has been explored as a diagnostic tool to assess organ perfusion and microvascularity, potentially aiding in the differentiation between conditions like epididymitis and testicular torsion, although its application in hydrocele diagnosis is less clear 1.
- Surgery is the recommended treatment for symptomatic hydroceles, offering a permanent resolution with low complication rates, but patients should be informed about potential risks including bleeding, infection, chronic pain, and fertility concerns in bilateral cases.
From the Research
Risk Factors for Hydrocele
- The exact risk factors for hydrocele are not explicitly stated in the provided studies, but it can be inferred that various etiologies such as diseases or trauma can contribute to the development of hydrocele 2.
- Hydroceles can be classified into different types, including primary, secondary communicating, secondary noncommunicating, microbe-induced, inflammatory, iatrogenic, trauma-induced, tumor-induced, canal of Nuck, congenital, and giant, each with its own underlying etiology 2.
Management Options for Hydrocele
- Surgical repair is a common treatment for symptomatic hydroceles, but it can be associated with sexual dysfunction in the aging male 3.
- Aspiration and sclerotherapy is a nonsurgical treatment option for hydroceles, which involves injecting a sclerosant into the hydrocele under ultrasound guidance 3, 4, 5.
- Sclerotherapy has been shown to be an effective treatment for hydroceles, with success rates ranging from 76% to 96.5% depending on the type of sclerosant used 3, 4, 5.
- Hydrocelectomy is considered the gold-standard treatment for hydroceles, but it poses an increased risk to patients and a greater burden to the healthcare system 5, 6.
- Aspiration and sclerotherapy may be a valuable alternative to hydrocelectomy, especially for patients who are at high risk for surgery or prefer to avoid surgery 6.
Comparison of Treatment Options
- A systematic review and meta-analysis found no significant difference in clinical cure between sclerotherapy and hydrocelectomy, but a significant increase in recurrence in the sclerotherapy group 6.
- Sclerotherapy may be associated with lower complication rates and healthcare costs compared to hydrocelectomy 3, 5.