Classifying Hydroceles of the Pelvis and Groin: An Overview of Etiology, Secondary Complications, Evaluation, and Management

Abstract

Introduction: A hydrocele is defined as the pathological buildup of serous fluid in the pelvis and groin due to various etiologies such as diseases or trauma. It has distinct clinical manifestations, particularly discomfort and psychosocial distress. Understanding the anatomy, embryology, and physiology associated with hydrocele formation is crucial to understand its onset and progression.

Materials and methods: A MEDLINE^® search was conducted using keywords for the relevant classification of hydrocele and its etiology, complications, sexual barriers, evaluation, and management.

Results: Appropriately classifying the hydrocele as primary, secondary communicating, secondary noncommunicating, microbe-induced, inflammatory, iatrogenic, trauma-induced, tumor-induced, canal of Nuck, congenital, and giant is important for identifying the underlying etiology. Often this process is overlooked when the classification or etiology is too rare. A focused evaluation is important for this, so that timely management can be provided. We comprehensively review the classifications, etiology, and secondary complications of hydrocele. Pitfalls of current diagnostic techniques are explored along with recommended methods for accurate diagnosis and current treatment options.

Conclusion: Due to the range of classifications and etiologies of hydrocele in the pelvis and groin, a deliberate differential diagnosis is essential to avoiding imminent life-threatening complications as well as providing the appropriate treatment.

Keywords: Cystic masses; Hernia; Hydrocele; Incontinence; Infection of hydrocele; Infertility; Scrotal pain; Scrotal swelling; Sexual dysfunction.

Fig. 1

Primary hydrocele. A Hernia of hydrocele, B multiloculated hydrocele, C vaginal hydrocele. Illustrated by Yiji Suh.

Fig. 2

Secondary communicating hydrocele. A Communicating hydrocele, B funicular hydrocele, C bilocular hydrocele (en-bisac), D hydrocele of the hernial sac, E hydrocele secondary to incarcerated hernia, F infantile hydrocele. Illustrated by Yiji Suh.

Fig. 3

Secondary noncommunicating hydrocele. A Noncommunicating hydrocele, B intermittent torsion, C thrombosed varicocele (venous-stasis), D lax hydrocele between the layers of tunica vaginalis, E tense hydrocele between the layers of tunica vaginalis, F hydrocele of lymph varix, G hydrocele of pneumoscrotum, H subtesticular hydrocele, I traumatic hydrocele/hematocele, J encysted hydroceles of spermatic cord. Illustrated by Yiji Suh.

Fig. 4

Microbe-induced hydrocele. A) Parasitic hydrocele, B) elephantiasis hydrocele, C) filarial dance hydrocele, D) pyocele, E) syphilitic hydrocele, F) tuberculous hydrocele. Illustrated by Yiji Suh

Fig. 5

Iatrogenic hydrocele. A Ventriculoperitoneal shunt resulting in hydrocele following migration of the peritoneal shunt, B penile hydrocele post-insertion of penile prosthesis, C reactive hydrocele following migration of penile prosthetic pump. Illustrated by Yiji Suh.

Fig. 6

Tumor-induced hydrocele; T: tumor. A Testicular tumor hydrocele, B epidydimal tumor hydrocele, C spermatic cord tumor hydrocele, D mesothelioma tumors of the tunica vaginalis. Illustrated by Yiji Suh.

Fig. 7

Hydrocele of the canal of Nuck. Illustrated by Yiji Suh.

Fig. 8

Giant hydrocele. Illustrated by Yiji Suh.

Fig. 9

Hydrocele imitations. A Scrotal edema, B bladder diverticulum, C congenital diaphanous distended loop of bowel (mistaken on transillumination), D fat necrosis of the scrotall wall, E mesothelial cysts. Illustrated by Yiji Suh.