History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include male sex, prematurity and low birth weight, infants <6 months of age, infants whose testes descend relatively late, increased intraperitoneal fluid or pressure, inflammation or injury within the scrotum, and connective tissue disorders.

scrotal mass

The mass is likely to be soft if the communication is large or tense if it is small. It may be restricted to the scrotum or it may extend into the inguinal canal.

transillumination

Because of the fluid, most hydroceles are easily transilluminated when a focused beam of light is shone on the scrotum.

enlargement of scrotal mass following activity

Increasing intra-abdominal pressure makes the peritoneal fluid flow into the scrotal sac. Therefore, the mass increases in size with activities such as coughing, straining, crying, or raising the arms.​​[7]​​

variation in scrotal mass during the day

Increasing intra-abdominal pressure makes the peritoneal fluid flow into the scrotal sac. Therefore, the size of the mass will be smaller in the morning than in the evening and after lying down.

Risk factors

strong

male sex

Approximately 85% of patients with paediatric hydroceles or hernias are male.[8] In girls, hydrocele of the canal of Nuck is rare.

prematurity and low birth weight

The incidence of hydroceles and hernias in newborns is 20-fold higher in those with a birth weight <1500 g than in those weighing >1500 g, with an incidence of 16% reported in those weighing <1500 g.​[24][25]​​

Prematurity and low birth weight are also risk factors for bilateral hydroceles.

infants <6 months of age

Approximately 30% of all paediatric hydroceles and hernias occur in infants <6 months of age.[7]

infants whose testes descend relatively late

These infants often have hydroceles.

increased intraperitoneal fluid or pressure

Communicating hydroceles or hernias may occur following increased intra-abdominal fluid or pressure (e.g., following shunts, peritoneal dialysis, or ascites) if there is a patent processus vaginalis.​​[6][8][21]​ This is especially a risk for contralateral symptomatic hernia/hydrocele.[26]

inflammation or injury within the scrotum

Non-communicating hydroceles can arise after minor trauma, infection, testicular torsion, or epididymitis.

testicular cancer

Approximately 10% of testicular malignancies are thought to present with hydroceles.[7]

connective tissue disorders

These patients have a high risk of communicating hydroceles.[6] They also have a higher risk of recurrence after surgery for the communicating hydroceles.

weak

varicocelectomy

Hydrocele is the most common complication of varicocelectomy. Depending on the technique of repair, up to 20% of patients develop a hydrocele; however, with some highly specialised microsurgical techniques, the occurrence rate can be decreased to <1%.[15][16][17]​​

filariasis

The tropical parasitic infection filariasis can cause hydroceles as a result of lymphatic obstruction.[18]

maternal exposure to polybrominated biphenyl

Intrauterine exposure to polybrominated biphenyl, a brominated flame retardant and endocrine disruptor, has been found to increase the risk of hydrocele/hernia.[12]

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