Alexander D Doudt1, John E Kehoe1, Romeo C Ignacio2, Matthew S Christman3. 1. Department of Urology, Naval Medical Center San Diego, San Diego, CA. 2. Department of Pediatric Surgery, Naval Medical Center San Diego, San Diego, CA. 3. Department of Urology, Naval Medical Center San Diego, San Diego, CA. Electronic address: Matthew.S.Christman3.mil@mail.mil.
Abstract
BACKGROUND: Abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by a fluid-filled mass with inguinoscrotal and abdominal components. Controversy exists regarding the best management. We conducted a systematic review of the literature with special interest in presentation, management and outcomes. METHODS: A search was conducted of the MEDLINE/PubMed, Embase, Ovid, Web of Science and Scopus databases. Two authors independently extracted data and assessed the risk of bias in each study. RESULTS: We found 18 case series that met selection criteria, describing 116 patients with 146 hydroceles. Unilateral ASH was found in 59% of cases with almost even distribution between left and right-sided hydroceles. Ipsilateral undescended testicle, testicular dysmorphism, and contralateral pathology (inguinal hernia) often accompanied ASH. Management was always surgical. The most common approaches were inguinal (67.2%), combined laparoscopic + inguinal (11.2%), and scrotal (10.3%). Complications were poorly reported, but were generally minor. There were a decreased number of complications with the scrotal approach because of avoidance of a difficult inguinal dissection. CONCLUSIONS: ASH is a rare entity treated most commonly via an inguinal approach. However, consideration should be given to combining with an extraperitoneal or laparoscopic approach given coexisting pathology, or to the scrotal approach for reducing morbidity. Published by Elsevier Inc.
BACKGROUND: Abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by a fluid-filled mass with inguinoscrotal and abdominal components. Controversy exists regarding the best management. We conducted a systematic review of the literature with special interest in presentation, management and outcomes. METHODS: A search was conducted of the MEDLINE/PubMed, Embase, Ovid, Web of Science and Scopus databases. Two authors independently extracted data and assessed the risk of bias in each study. RESULTS: We found 18 case series that met selection criteria, describing 116 patients with 146 hydroceles. Unilateral ASH was found in 59% of cases with almost even distribution between left and right-sided hydroceles. Ipsilateral undescended testicle, testicular dysmorphism, and contralateral pathology (inguinal hernia) often accompanied ASH. Management was always surgical. The most common approaches were inguinal (67.2%), combined laparoscopic + inguinal (11.2%), and scrotal (10.3%). Complications were poorly reported, but were generally minor. There were a decreased number of complications with the scrotal approach because of avoidance of a difficult inguinal dissection. CONCLUSIONS: ASH is a rare entity treated most commonly via an inguinal approach. However, consideration should be given to combining with an extraperitoneal or laparoscopic approach given coexisting pathology, or to the scrotal approach for reducing morbidity. Published by Elsevier Inc.