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Non-communicating hydroceles may also be present at birth or develop as a boy matures. In a non-communicating hydrocele the tail end of the process vaginalis has closed appropriately. The fluid surrounding the testicle is created by the lining cells of the process vaginalis and is unable to either drain or be reabsorbed efficiently and thus accumulates. Since this fluid is walled off, the size of the hydrocele is generally stable and does not reflect intra abdominal pressure.
How are hydroceles diagnosed?
The diagnosis of a hydrocele is generally made clinically. An apt description of a hydrocele surrounding a palpable (something that can be felt) testis would be that of a small water balloon containing a peanut. The differences between communicating and non-communicating hydroceles described above help to support the suspected diagnosis.
A bedside test, transillumination, provides confirmation of the condition. Transillumination involves placing a small light source (commonly an otoscope - the medical device used to examine the ear) against the swollen scrotum. The fluid filled nature of the hydrocele side is distinctly different from the non-involved side of the scrotum. In rare cases either ultrasound or X-ray study of the region may be indicated. In unusual cases where a hydrocele may be a secondary phenomenon to pathologic cause (caused by disease), surgical exploration may be necessary to establish the diagnosis.
What is the treatment for hydroceles?
In 95% of congenital (present at birth) hydroceles, the natural history is one of gradual and complete resolution by one year of age. For those lasting longer than one year or for those non-communicating hydroceles that manifest after the first year, surgical repair is indicated since these rarely resolve spontaneously.