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Management of hydrocele in adolescent patients

Abstract

Hydrocele is defined as an abnormal collection of serous fluid in the potential space between the parietal and visceral layers of the tunica vaginalis. In the majority of affected adolescents, hydrocele is acquired and is idiopathic in origin. The pathogenesis of idiopathic hydrocele is thought to be an imbalance in the normal process of fluid production and reabsorption. The diagnosis is usually clinical. Taking a thorough history is essential to rule out any fluctuation in size, which is an indication of a patent processus vaginalis. Scrotal ultrasonography is mandatory in nonpalpable testicles to rule out a subtending testicular solid mass requiring inguinal exploration. Otherwise, open hydrocelectomy via a scrotal incision is the standard treatment of idiopathic hydroceles. The second most common cause of hydrocele in adolescents is varicocelectomy. The risk of hydrocele formation is higher with non-artery-sparing procedures or those performed without microsurgical aid, and in surgery requiring cord dissection. If hydrocele occurs after varicocelectomy, initial management should include observation with or without hydrocele aspiration. Large persistent hydroceles are best served by open hydrocelectomy.

Key Points

  • Hydrocele in adolescents is most often idiopathic and seldom owing to a persistently patent processus vaginalis

  • Varicocelectomy is the second most common cause of hydrocele in adolescents in developed countries; prevalence varies according to surgical technique

  • The diagnosis of hydrocele is generally clinical, but idiopathic cases with a nonpalpable testicle should undergo scrotal ultrasonography to rule out a subtending solid testicular mass

  • Open hydrocelectomy via scrotal incision is the standard approach for idiopathic hydrocele in adolescents

  • Observation should be the initial approach in postvaricocelectomy hydrocele, unless the hydrocele is very large and tense

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Figure 1: Excision hydrocelectomy: delivery of the vaginal sac.
Figure 2: Excision hydrocelectomy: fluid removal.
Figure 3: Excision hydrocelectomy: tunica vaginalis resection.
Figure 4: Excision hydrocelectomy: closing up.

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Cimador, M., Castagnetti, M. & De Grazia, E. Management of hydrocele in adolescent patients. Nat Rev Urol 7, 379–385 (2010). https://doi.org/10.1038/nrurol.2010.80

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