Causes of painless scrotal swelling in children and adolescents
- Joel S Brenner, MD, MPH
Joel S Brenner, MD, MPH
- Associate Professor, Sports Medicine and Adolescent Medicine
- Eastern Virginia Medical School
- Aderonke Ojo, MD
Aderonke Ojo, MD
- Associate Professor of Pediatric Emergency Medicine
- Baylor College of Medicine
- Section Editors
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The spectrum of conditions that affect the scrotum and its contents ranges from incidental findings to pathologic events that require expeditious diagnosis and treatment (eg, testicular torsion, testicular cancer). The most common causes of painless scrotal swelling in children and adolescents include hydrocele and inguinal hernias that are not incarcerated. Less common causes are varicocele, spermatocele, localized edema from insect bites, nephrotic syndrome (swelling is usually bilateral), and rarely, testicular cancer (table 1). Scrotal swelling and testicular masses should be evaluated promptly.
The clinical presentation, diagnosis, and management of hydrocele, varicocele, spermatocele will be discussed below along with the presentation and diagnosis of testicular cancer. Inguinal hernia, the evaluation of scrotal pain and swelling, and the causes of scrotal pain in children and adolescents are discussed separately. (See "Overview of inguinal hernia in children" and "Evaluation of scrotal pain or swelling in children and adolescents" and "Causes of scrotal pain in children and adolescents".)
A hydrocele is a collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis. Hydroceles may be communicating or noncommunicating.
Communicating hydroceles usually develop as a result of failure of the processus vaginalis to close during development; the fluid around the testis is peritoneal fluid (figure 1 and picture 1) . Noncommunicating hydroceles have no connection to the peritoneum; the fluid comes from the mesothelial lining of the tunica vaginalis (figure 2).
Hydroceles are common in newborns (whether related to delayed closure of a patent processus vaginalis or fluid trapped at the time of testicular descent is not known) . The majority of hydroceles in neonates resolve spontaneously, usually by the first birthday [1,2].
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