Hydrocele

Question 1

Define

Answer 1

• The excessive collection of serous fluid within the tunica vaginalis

Question 2

WHat are the two types?

Answer 2

There are 2 types of hydroceles: communicating and non-communicating (simple).

In communicating hydroceles, a patent processus vaginalis connects the peritoneum with the tunica vaginalis, which allows peritoneal fluid to flow freely between both structures. If the connection is large, abdominal contents (bowel, bladder, or omentum) may enter the groin, and this complication is termed an inguinal hernia.

A non-communicating or simple hydrocele occurs when the processus vaginalis is closed and more fluid is being produced by the tunica vaginalis than is being absorbed.

Question 3

Explain the aetiology

Answer 3

• Congenital
• Idiopathic
• Tumour
• Infection
• Trauma
• Underlying testicular torsion
• Testicular appendage

Question 4

WHat are the risk factors/ associations?

Answer 4

o	Indirect inguinal hernias in children 
o	Epididymo-orchitis 
o	Filariasis (in countries of high prevalence)
o	Male
o	Prematurity
o	Low birth weight

Question 5

Epidemiology

Answer 5

• VERY COMMON in CHILDREN in the first year of life and in many cases associated with indirect inguinal hernias
• Common in older men

Question 6

What are the presenting symptoms?

Answer 6

• Scrotal swelling
• Usually ASYMPTOMATIC
• Patients may complain of pain or urinary symptoms due to the underlying cause

Question 7

What are the signs?

Answer 7

• Scrotal swelling
• It is possible to get above the swelling
• Transilluminates
• Increase in intra-abdominal pressure makes the mass increase, mass smaller in the morning than evening
• Difficult to separate the swelling from the testicle

Question 8

What are the appropriate investigations?

Answer 8

Usually a CLINICAL diagnosis
•	Ultrasound - exclude tumour 
•	Urine - dipstick and MSU for infection 
•	Blood - markers of testicular tumours:
o	alpha-fetoprotein 
o	beta-HCG
o	Lactate dehydrogenase