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

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.

Management of nonpalpable testicular tumors.

OBJECTIVES: To report our series of nonpalpable testicular tumors with a review of published studies. Radical orchiectomy remains the reference standard in the treatment of a solid testicular mass. Testis-sparing surgery has recently been advocated for a select group of patients with nonpalpable tumors. METHODS: Between 1998 and 2002, a nonpalpable testicular mass was discovered in 9 patients. Ultrasonography was performed for infertility evaluation (5 patients), testicular pain (3 patients), and retroperitoneal lymphadenopathy (1 patient). RESULTS: Radical orchiectomy was performed in 7 of 9 patients and testis-sparing surgery with microsurgical excision of tumor in 1 patient. One patient decided against surgery. A benign testicular tumor was found in 6 and a malignant tumor in 2 of the 8 patients. CONCLUSIONS: A high incidence of benign nonpalpable tumor and an advanced microsurgical technique justifies organ-sparing surgery as an alternative for radical orchiectomy in a select group of patients. Testicular preservation in patients with a malignant nonpalpable testicular tumor is a feasible, but still controversial, approach.