Acquired, or adult, hydroceles are usually idiopathic, but may also be present as a consequence of a primary process such as a tumor, infection, or systemic disease. The visceral and parietal layers of the tunica vaginalis appear to have an imbalance between fluid production and fluid reabsorption.

Treatment is generally indicated for symptomatic relief. Needle aspiration is very effective for temporary relief, but the hydrocele will often recur. Aspiration, accompanied by a sclerosing solution, may sometimes be effective. There are many sclerosing agents. Historically, tetracycline mixed with local anesthetic such as lido-caine was used, but modern authors report using sodium tetradecylsulfate (STDS), phenol, Betadine, and fibrin glue. More definitive treatment is surgical, either via a Lord or Jabouley-type repair, which are a plication or excision of the redundant tunica vaginalis, respectively.

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