Hydrocoele

Question 1

Define hydrocoele

Answer 1

Collection of serous fluid in the tunica around the testes or along the spermatic cord

May occur in females along the canal of Nuck

Question 2

Aetiology of hydrocoele

Answer 2

Patent process vaginalis
Most paediatric cases are congenital, and resolve within the first year of life

Non-communicating (no communication to the abdominal cavity):
- Minor trauma
- Infection
- Testicular torsion
- Epididymitis
- Varicocele operation
- Testicular tumour

Communicating (passage of peritoneal fluid to the scrotum):
- Increased intra-abdominal fluid or pressure (due to shunts, peritoneal dialysis, or ascites)
- Patent processus vaginalis
- Connective tissue disorders
- Filariasis (as a result of lymphatic obstruction)

10% of testicular malignancies are thought to present with hydrocoeles

Question 3

Risk factors for hydrocoele

Answer 3

Male
Infants:
- <6 months of age
- Prematurity and low birth weight
- Testes descend relatively late
Increased intraperitoneal fluid or pressure e.g. shunts, peritoneal dialysis, ascites)
Inflammation or injury within the scrotum
Testicular cancer
Connective tissue disorders
Varicocelectomy | Filariasis | maternal exposure to polybrominate biphenyl

Question 4

Symptoms of hydrocoele

Answer 4

Scrotal mass
- Enlargement following e.g. coughing, straining, crying, raising arms
- Variation during the day i.e. smaller in the morning than in the evening
- Gradually increasing in size
- Feels heavy

Question 5

Differentials for hydrocoele

Answer 5

Inguinal hernia
Varicocoele
Testicular torsion
Epididymitis
Testicular cancer

Question 6

Signs of hydrocoele on examination

Answer 6

Scrotal mass with:
Transillumination
Enlargement following e.g. coughing, straining, crying, raising arms
Fluctuant consistency
Skin not separate from lump, but not tethered*
- Fluid collects around the front and sides of the testicle (testicle cannot be felt separately) and can extend upwards in the spermatic cord.
Dull on percussion
Difficult to palpate the testes

Question 7

Investigations for hydrocoele

Answer 7

Clinical diagnosis

US: confirms presence or absence of normal/abnormal testis

Question 8

Management for hydrocoele

Answer 8

Neonatal: observation (most spontaneously resolve by 12 months)
- Persisting >1 year → surgical correction to reduce the risk of inguinal hernia

Adults - Jaboulay repair: Incision and scrunch up to release fluid (remains in the scrotum)

Question 9

Complications of hydrocoeles

Answer 9

Indirect inguinal hernia
Lower extremity oedema
Testicular atrophy
Hydronephrosis
Infertility (bilateral) post-surgery

Question 10

Prognosis for hydrocoeles

Answer 10

Majority of non-communicating hydrocoeles resolve within the first 2 years of life
Persistence of a hydrocele beyond 2 years of age may be an indication for surgical correction
Incidence of testicular damage during hydrocele repair has been reported to be low (0.3%)
2% of patients develop a recurrent inguinal hernia within 5 years of surgery (occurs if the processus vaginalis is not adequately dissected) and ligated