First one with correct answer with justification win.

 

[size=20px]A 15-year old boy has noted right scrotal swelling for four months. He is asymptomatic and otherwise healthy. Examination reveals a large transilluminating fluid collection which cannot be reduced.

 

The best next step in management of this adolescent with a hydrocele is

 

A right inguinal exploration.

 

B diagnostic laparoscopy.

 

C scrotal ultrasound.

 

D needle aspiration.

 

E needle aspiration and sclerotherapy.[/size]

correct answer

C scrotal ultrasound

 

Hydrocele is defined as an abnormal collection of serous fluid in the potential space between the parietal and visceral layers of the tunica vaginalis. A hydrocele in an infant which persists outside the newborn period suggests the presence of an indirect inguinal hernia. Hydrocele in adolescent males are usually not associated with a hernia - most are acquired and are idiopathic. In one study, nearly 90% of boys over age 12 presenting with a scrotal hydrocele did not have an associated hernia.

 

The second most common cause of hydrocele is seen after adolescent varicocele ligation with a 10% incidence. In this setting, observation or an attempt at aspiration is reasonable.

 

The pathogenesis of adolescent hydrocele is thought to be an imbalance in the normal process of fluid production and reabsorption. Since 15% of testicular neoplasms are associated with a reactive hydrocele an ultrasound is indicated.

 

Needle aspiration of an idiopathic hydrocele is unlikely to result in long term resolution. Sclerosing agents are contraindicated. The treatment of choice is an open hydrocelectomy via a scrotal incision.