The presence of fluid within the hemiscrotum has little clinical impact on the testis. However, determining the cause for the increased fluid, specifically any associated clinically significant pathology, remains the primary concern with regard to hydroceles. Once pathology that is more ominous has been excluded, persistence of the hydrocele or associated discomfort may indicate the need for surgical intervention.
With communicating hydroceles, simple Valsalva maneuvers probably account for the classic variation in size during day-sleep cycles. Nonetheless, with the incidence of patent processus so great, why children with clinically apparent hydroceles are relatively few remains somewhat inexplicable. Chronically increased intra-abdominal pressure (eg, as in chronic lung disease) or increased abdominal fluid production (eg, children with ventriculoperitoneal shunts) probably warrants early surgical intervention.
Hydroceles typically manifest as a soft nontender fullness within the hemiscrotum. The testis is generally palpable along the posterior aspect of the fluid collection. When the scrotum is investigated with a focused beam of light, the scrotum transilluminates, revealing a homogeneous glow without internal shadows.
Noncommunicating hydroceles
Pathophysiology
History of the Procedure
Noncommunicating hydroceles may result from increased fluid production or impaired fluid absorption. A sudden onset of scrotal hydrocele in older children has been noted after viral illnesses. In such cases, viral-mediated serositis may account for the net increased fluid production. Posttraumatic hydroceles likely occur secondary to increased serosal fluid production due to underlying inflammation. Although rare in the United States, filarial infestations are a classic cause of the decreased lymphatic fluid absorption resulting in hydroceles.
Communicating hydroceles
The description of the abdominal cavity parietes to the tunica vaginales is attributed to Galen in 176 AD. However, the clear description of the inguinal anatomy and its relationship to groin hernias and hydroceles was not recorded until the 19th century.
The pathophysiology of hydroceles requires an imbalance of scrotal fluid production and absorption. This imbalance can be divided further into exogenous fluid sources or intrinsic fluid production.
Presentation
Problem
