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Hydrocele is a subject that hits close to home. Although it is swelling of the scrotum that is painless, it can leave a parent feeling helpless and with constant worry (Garzon Maaks, Barber Starr, Brady, Gaylord, Driessnack, & Duderstadt, 2020). This is why education is very important.
Pathophysiology
In the goin or pelvic area, is the inguinal canal. This canal is where the testis descends from the abdomen to the scrotum when the baby is born. In some cases, the processus vaginalis does not close, leaving the canal open, letting the peritoneal fluid pass into the scrotum. In some rare cases, this can happen with trauma, and the canal will open and hydrocele occurs. This can happen at any age (Dugar, Ghandi, Suh, Weissbart, Shenynkin, Smith, Joshi, & Khan, 2017).
Etiology
There are several different types of hydrocele; “primary, secondary communicating, secondary noncommunicating, microbe-induced, inflammatory, iatrogenic, trauma-induced, tumore-induced, canal of Nuck, congenital, and giant” (Dugar et al, 2017).
Primay is idiopathic. It is not known why it exists. Secondary has two types: communicating and noncommunicating. Communicating is when the peritoneal fluid can flow back and forth between the abdomen and the scrotum. Noncommunicating is when fluid has filled the scrotum but the processus vaginalis has closed. A giant hydrocele, which is what my son had, can grow as large as the persons head and will have the penis ‘disappear’ into the swelling. “The fluid in the hydrocele is prone to infection”. Although it can at times correct itself, it should be followed closely (Dugar et al, 2017).
Physical Findings
The most obvious findings are the swelling of the scrotal sac. This is noticeable sometimes immediately after birth. To detect whether the swelling is fluid or solid, the most common diagnostic tool used in office, is to use transillumination of the scrotal sac. If light is visible in the scrotal sac, the swelling is fluid. If it is not, it is a solid and should be evaluated for the presence of a tumor. The inguinal area should be evaluated for a hernia. Inguinal hernia and hydrocele are generally seen together (Dugar et al, 2017).
The best way to give a solid diagnosis, is to use a duplex doppler sonogram. This will show the testis, the blood flow and the area of swelling in the scrotal sac (Dugar et al, 2017). It is important to remember, hydrocele can be congenital and be present even before birth. It is “common in newborns and usually disappears without treatment by age 1” (Mayo Clinic, 2018).
Differential Diagnosis
Differential diagnosis for this condition can be quite worrisome, more than the condition itself. These differential diagnosis include: “lipomatosis of the lower anterior abdominal wall causing hidden penis, saxophone penis, and webbed penis”. Still others are as follows, “testicular torsion, tumor, scrotal edema, orchitis, anasarca” (Dugar et al, 2017).
Management Plan
When you have a newborn or infant that presents with a hydrocele, one should use the least invasive, most conservative management plan, as possible. Especially if there are no complications or little complications. If surgery can be avoided, the hydrocele may resolve by the age of 18 months (Dugar et al, 2017).
Another less invasive procedure is to aspirate the fluid from the scrotal sac to relieve pressure. Once can also sue sclerotherapy. Still, a hydrocelectomy may be needed. This is simply closing the inguinal canal so that the peritoneal fluid cannot flow to the scrotum any longer. Although the canal will be closed, swelling could last for several more months to a full year while the body absorbs the extra fluid (Dugar et al, 2017).
My son was a severe case, he had surgery a the age of 10 weeks old. We watched his scrotum swell until we could no longer see his penis. We were informed surgery was something that couldn’t wait, as his future fertility was at stake. It was scary but surgery was appropriate. Education is important, not just about the condition, but about the possibility of surgery should the situation arise. Emergent surgeries are more frightening for parents. Giving continual education can give slow continual reassurance through the process.
Reference
Dugar, G., Ghandi, J., Suh, Y., Weissbart, S., Shenynkin, Y. R., Smith, N. L., Joshi, G., & Khan,
S. A. (2017). Classifying hydroceles of the pelvis and groin; An overview of etiology,
secondary complications, evaluation, and management. Current Urology, 10(1), 1-4.
Doi:10.1159/000447145
Garzon Maaks, D. L., Barber Starr, N., Brady, M. A., Gaylord, N. M., Driessnack, M., &
Duderstadt, K. G. (2020). Burns’ Pediatric Primary Care (7th ed.). St. Louis, MO: Elsevier
Mayo Clinic. (2018). Hydrocele. Retrieved from
