U9 Hydrocele

Pathophysiology

There are three categories of hydroceles: in an interactive hydrocele, a clear processus vaginalis allows flow of peritoneal fluid inside the scrotum. This type of hydrocele is consequently linked to secondary inguinal hernias.

In a non-interactive hydrocele, a clear processus vaginalis exists, but there is no communication with the peritoneal cavity befalls (Pachl, De & Jawaheer, 2014). 

In a cord hydrocele, the tip of the tunica vaginalis is sub-standard. Processus vaginalis distal end correctly closes, however the mid part of the processus remains clear. Either the proximal end may be closed or opened, in this hydrocele (Palmer, & Palmer, 2014).  

In adolescents, hydroceles are usually in their second stage of growth, where they only grow but they do not affect the patient. In this stage the patient can only experience swelling on the testis, however it may not be painful at all. It may be caused by an acute scrotum injury, or may result after birth hence remaining resistant until adolescent stage (Brook et al, 2009).

Epidemiology

Over 80% of new-born male babies tend to have a clear processus vaginalis, which translates into the number of adolescents affected by the condition. In most children, hydroceles disappear with time, thus making the rate of adolescents with the disease to be low. However, in adolescent stage, the hydrocele may become very large to the point of being seen, then a surgery may be needed to terminate the hydrocele (Pachl, De & Jawaheer, 2014). In case of treatment, the required surgical repair is known as definitive management. Different methods of performing surgical hydrocelectomy may include removal of the hydrocele or otherwise, plication of the hydrocele wall. A surgery may however not be essential if the scrotum does not become large. Medications may be administered to the patient, thus leading to the removal of the hydrocele (Brook et al, 2009).

Physical Exam Findings

A physical examination is essential for assessing the sternness of pain through observing the patient prior to the beginning of the examination (Brook et al, 2009). Some of the factors which can be examined prior to the physical examination include the following: if the patient is under a lot of pain, if the patient socializes easily with friends and family and, if the patient is able to ambulate without any form of discomfort (Palmer, & Palmer, 2014). Physical examination requires a whole abdominal examination to be undertaken, with specific attention given to border the inflammation of the bladder enlargement (Pachl, De & Jawaheer, 2014). The inguinal region should then be observed in order to look for any forms of hernias or otherwise any form of swelling.

Differential diagnoses and rationale      

There are different differential diagnoses of hydrocele depending on the type or area affected (Brook et al, 2009). In testicular cancer, solid hard masses which are not trans-illuminated are evident. Nonetheless, tumours may be surrounded by hydroceles which might be reactive, hence making them transilluminated. In epididymitis, the patient experiences pain clinically while the scrotum becomes tender and the changes in the local inflammatory can be noticed (Pachl, De & Jawaheer, 2014).  

Management Plan  

The diagnosis is tested through looking for tenderness around the enlarged scrotum (Brook et al, 2009). This is usually done through applying pressure on both the abdomen and the scrotum hence looking for inguinal hernia. Urine and blood tests should also be conducted in order to determine if the there is an infection like epididymitis. Ultra sound may also be necessary for treating hernia, or even other causative agents of scrotal swelling (Pachl, De & Jawaheer, 2014).    

Hydrocele in adolescents may be treated through a surgery, whereby the surgery can be performed through or on an outpatient basis during regional and general anaesthesia (Brook et al, 2009).  An incision is basically made in either the lower abdomen or through the scrotum in order to remove the hydrocele (Pachl, De & Jawaheer, 2014). After the surgery, a tube is necessary for draining the fluid, thus the patient is required to dress in bulk. The patient might need both ice packs and scrotal support strap to reduce the pain.

 

 

 

 

References

Pachl, M., De, L. H. M. N., & In Jawaheer, G. (2014). Key clinical topics in paediatric surgery.

Brook, C. G. D., Clayton, P. E., Brown, R. S., & Wiley InterScience (Online service). (2009). Brook's clinical pediatric endocrinology. Chichester, UK: Wiley-Blackwell.

In Palmer, L. S., & In Palmer, J. S. (2014). Pediatric and adolescent urologic imaging.