Hydrocele

Disease Description (Causes and Symptoms)

• Definition: A hydrocele is a condition in which serous fluid accumulates in the space of the tunica vaginalis surrounding the testis, causing the scrotum to swell.
• Causes/Pathophysiology: In children, it commonly occurs when ascitic fluid moves into the scrotum due to developmental failure of closure of the processus vaginalis, which connects the abdominal cavity and scrotum. In adults, it may occur due to an imbalance between fluid secretion and absorption within the tunica vaginalis or as a complication of inflammation, trauma, tumors, and other conditions.
• Risk factors: Premature birth, low birth weight, family history, undescended testis (abnormal testicular descent), etc.
• Main symptoms: Swelling (mass) in one or both sides of the scrotum, usually without pain; the swelling feels soft and fluctuant when touched. It may become larger when intra-abdominal pressure rises (such as with crying or coughing). Redness and fever are usually absent.
• Examination findings: When light is shone through the scrotum, transillumination may be observed. In the differential diagnosis, inguinal hernia, epididymitis, orchitis, testicular tumor, and other conditions should be considered.

Treatment Methods

• Observation (conservative management): In children, many hydroceles tend to resolve spontaneously between 1 and 24 months of age, so periodic observation is recommended for asymptomatic and small hydroceles.
• Surgical treatment: Surgical treatment (ligation and removal of the processus vaginalis) is standard when the hydrocele persists, causes symptoms, or is accompanied by a hernia. In children, it is treated through an inguinal approach, while in adults, removal through a scrotal incision is commonly performed. Most patients are cured after surgery.
• Procedures/medications: Scrotal puncture (aspiration) is generally not recommended because of the risks of infection, recurrence, and peritonitis. Antibiotics or anti-inflammatory drugs are used only when an infection is present.
• Lifestyle management/precautions: Seek medical attention immediately if pain or redness and fever occur. After surgery, wound care and rest are recommended. Preventive surgery on the opposite side is generally not performed (a patent processus vaginalis on the opposite side has been reported in 5–20% of cases).

Checklist Before an Outpatient Visit (Items to Prepare and Points to Review) — Including Sample Questions

• Items to prepare/bring:
  • A list of current medications and supplements
  • Birth history (whether premature and whether low birth weight) and records of previous surgeries
  • Results of previous tests (scrotal ultrasound, blood tests), if available
  • A record or photographs, if possible, of when symptoms began and how they have changed (changes in size, presence of pain, fever, etc.)
• Items to organize for the medical history:
  • When it was first observed and whether its size changes throughout the day or with activity
  • Presence or absence of pain, fever, or urinary abnormalities
  • Previous pediatric or urology visits and diagnoses
• Materials to show the doctor during the visit:
  • Scrotal photographs (for size comparison) and previous ultrasound results
• Sample questions (questions patients/guardians can ask themselves):
  • "When is surgery necessary?"
  • "Is an additional test (ultrasound) needed right now?"

Examples of General Questions to Ask the Doctor

• What is the prognosis for this condition? How likely is it to resolve spontaneously?
• What are the criteria (timing) for recommending surgery? What warning signs indicate that surgery is needed promptly?
• What are the major complications of surgery, and how likely are they to occur (such as recurrence, vas deferens injury, and testicular atrophy)?
• Are there any conservative management methods worth trying instead of surgery?
• How long is the expected hospital stay and recovery period after surgery?

Examples of Condition-Specific Questions

• How likely is it that our child’s hydrocele will disappear spontaneously within a few months? (For example, please assess this based on the child’s current age and the size of the hydrocele.)
• If surgery is performed, how will the presence of a hernia be confirmed, and how will the surgical plan change if a hernia is present?

Additional reference: If the diagnosis is uncertain, or if pain, fever, rapid enlargement, or marked asymmetry of one testis occurs, an ultrasound examination and prompt evaluation are necessary. The decision regarding treatment or surgery should be made in consultation with the treating doctor after considering the patient’s age, presence or absence of symptoms, changes in size, and accompanying conditions.