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Basics

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Author:

Jessica L.Osterman


Description!!navigator!!

Etiology!!navigator!!

Pediatric Considerations
  • Congenital in 6% of newborn boys
  • Usually diagnosed in newborn nursery
  • Caused by patent processus vaginalis, a structure that remains patent in 85% of newborns
  • May vary in size owing to position or crying:
    • Patients may present with history of scrotal mass that has resolved
  • Most close by the age of 2 yr

Diagnosis

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Signs and Symptoms!!navigator!!

Painless scrotal swelling with a sensation of pulling, dragging, or heaviness

History

History and exam with special attention to identifying torsion of testicle

Physical Exam

  • Mass may be soft and doughy or firm depending on the amount of fluid present
  • Initial evaluation includes transillumination of affected side (looking for a homogeneous area without internal shadows):
    • This is rapidly being replaced as diagnostic test of choice by bedside US

Essential Workup!!navigator!!

Diagnostic Tests & Interpretation!!navigator!!

Lab

No specific lab testing is indicated unless underlying cause demand s it (UA, AFP, hCG)

Imaging

US is diagnostic and allows visualization of testicular anatomy:

  • Appears as large anechoic fluid-filled space surrounding the anterolateral testicle

Differential Diagnosis!!navigator!!

Treatment

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Initial Stabilization/Therapy!!navigator!!

Stabilization should focus on underlying cause (e.g., trauma)

ED Treatment/Procedures!!navigator!!

Appropriate exam of testicle to exclude primary neoplasm and referral

Medication!!navigator!!

Treat underlying cause

Follow-Up

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Disposition!!navigator!!

Admission Criteria

Patients with secondary hydrocele may need admission for further evaluation of underlying pathology (e.g., neoplasm, trauma)

Discharge Criteria

  • Otherwise healthy patients without comorbid illness may be referred for further evaluation to urologist
  • Hydrocele is usually repaired if cosmesis is a factor or in cases where it causes discomfort
  • Repair can be:
    • Surgical:
      • Aspiration or sclerotherapy are alternatives to open hydrocelectomy
    • Medical:
      • Aspiration of hydrocele contents and sclerotherapy to prevent recurrence
Pediatric Considerations
  • Most hydroceles in infant population will spontaneously resolve by 12 mo of age:
    • Referral and observation are appropriate once diagnosis is made
  • After the age of 12-18 mo, refer for surgical repair as communicating hydroceles usually have hernia that needs repair

Follow-up Recommendations!!navigator!!

Patients should be referred to Urology

Pearls and Pitfalls

The mass may fail to transilluminate due to thickening of the tunica vaginalis

Additional Reading

See Also (Topic, Algorithm, Electronic Media Element)

Codes

ICD9

ICD10

SNOMED