A hydrocele is a collection of fluid within the tunica vaginalis, a sealed pouch of membrane that surrounds the testes.
Originally, the tunica vaginalis is part of the peritoneal membrane. During fetal development it becomes separated from the peritoneal membrane and remains in the scrotum, partially covering each testicle.
Simple Hydrocele
Simple hydroceles are common, occurring in 5-10% of newborn males. They occurs where fluid is trapped in the tunica vaginalis. Usually, the fluid gets reabsorbed over time and the hydrocele disappears.
Communicating Hydrocele
Communicating hydroceles occur where the tunica vaginalis around the testicle remains connected to the peritoneal cavity via a pathway called the processus vaginalis. Fluid can travel from the peritoneal cavity to the hydrocele, allowing the hydrocele to fluctuate in size.
Examination
Hydroceles cause a soft, smooth, non-tender swelling around one of the testes.
The hydrocele will transilluminate when holding a pen torch flat against the scrotum. The entire lump will light up.
Differential Diagnosis
The key differential diagnoses of a scrotal or inguinal swelling in a neonate are:
- Hydrocele (common)
- Undescended testes (common)
- Inguinal hernia (common)
- Testicular torsion (rare)
- Haematoma (rare)
- Tumours (rare)
Management
Ultrasound can confirm the diagnosis and exclude other causes.
Simple hydroceles will usually resolve spontaneously within 1-2 years without any lasting effects.
Communicating hydroceles may be treated with a surgical operation to remove or ligate the connection between the peritoneal cavity and the hydrocele (the processus vaginalis).
Last updated April 2025
Now, head over to members.zerotofinals.com and test your knowledge of this content. Testing yourself helps identify what you missed and strengthens your understanding and retention.
