Hydrocele (Pediatric, Testicular) (cont.)

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.

The differential diagnosis (list of possibilities) of chronic non tender scrotal swellings (besides hydroceles) includes:

Hernia: A hernia involves the introduction of a segment of the small intestine into the inguinal canal. A sign of a hernia in the small intestinal region is swelling in the groin alone, or may also include the scrotum on the same side. Many complain of an "ache" or "sense of fullness" during this time. If the small intestine spontaneously slides back into the abdominal cavity or if a physician reduces it, the patient is generally referred to a surgeon for closure of the inguinal canal as a preventative move to preclude a repeat experience.

If the small intestine is trapped and cannot be reduced, this is a surgical emergency and the patient will be brought to the operating room in order to avoid intestinal swelling and subsequent limiting of blood flow to the region, and consequent possible death of the trapped bowel tissue.

Varicocele: A varicocele represents engorgement of the testicular veins and clinically has been likened to a "bag of worms". While it is a relatively rare finding in the preadolescent, approximately 20% of late teens and adult men have been found to have a varicocele. More common on the left side of the scrotum, the varicocele characteristically "deflates" when the male reclines, and becomes engorged due to gravity when standing.

In the older teen and adult, varicoceles generally require no specific management other than observation. In a younger male, if the varicocele becomes painful, or there is an associated size decrease in the same sided testicle, evaluation with a doctor specializing in urology conditions (urologist) should be sought.

Tumor: childhood tumors of the structures contained within the scrotum are more often benign when compared to those of teens and adults. The most common tumor in this latter age range is testicular cancer. As a response to the notoriety of Lance Armstrong's battle with testicular cancer, the recommendation for monthly self-testicular exams (especially for teens and young adults who have a predisposition for this cancer) has found a more receptive audience than in the past.

Source: MedicineNet.com
http://www.medicinenet.com/hydrocele_pediatric_testicular/article.htm