Hydrocele is Greek for water bag, and means the accumulation of fluid in the testicle skin or along the sperm ducts. It may be a developmental disorder or imbalance between the formation and removal of liquids. By itself hydrocele is not a big problem, however , it is necessary to investigate its cause in order not to misidentify a serious disease that had caused it.
Age
Congenital hydrocele usually manifests at age of 1-2 years, and chronic/secondary in men older than 40.
Gender
Hydrocele the disease of men. Extremely rarely it appears in women as a similar collection of fluid along the canal of Nuck.
Cause
There are numerous causes of hydrocele. In children, the majority of hydrocele are of communicating type in which there is communication between the scrotum and the abdominal cavity.
In the fetal period, the testes are located in the abdominal cavity and normally descend through the inguinal canal into the scrotum during the 7th to 9th month of fetal life. Before the testis begins to descend, in the third month of pregnancy a vaginal pouch develops, so-called tunica vaginalis (processus vaginalis peritonei) that also passes through the inguinal canal and is already closed before birth at its upper end . If it remains open, the scrotum is filled with fluid from the abdominal cavity, especially during straining, and hydrocele occurs.
In non-communicating type of hydrocele, due to a number of known or unknown causes, an imbalance occurs between the creation and absorption of liquids and its accumulation.
Possible causes of non-communicating hydrocele are:
- Inflammation of testes or epididymis (orchitis, epididymitis)
- Tuberculosis
- Tropical infections, e.g. filariasis
- Torsion of the testis causes reactive hydrocele in 20% of cases
- Testicular tumor
- Trauma, especially if bleeding occurs
- In 70% of cases after kidney transplantation
- Radiation therapy
- Bladder exstrophy
- Ehlers-Danlos syndrome
- Change in type or volume of abdominal fluid, e.g. in patients on peritoneal dialysis with ventriculoperitoneal shunt (with hydrocephalus)
- Removal of lymph nodes
- Idiopathic retroperitoneal fibrosis (Ormond ‘s disease)
Types
In addition to communicating and non-communicating, hydroceles can be divided into primary and secondary.
Primary or idiopathic hydrocele was not created as a result of some disease of testicles and its cause is unknown. Its forms are:
- Hydrocele of vaginal membrane – it is located around testicles so it is difficult to touch
- Congenital (communicating) hydrocele – appears due to processus vaginalis, and has an opening to the abdominal cavity
- Hydrocele in children – located approximately around testicles and continues to internal inguinal ring, but does not communicate with the abdominal cavity
- Hydrocele of sperm ducts
A secondary hydrocele occurs as an accompanying phenomenon of a disease, most commonly with tumors or inflammation of the testicles and/or epididymis. Other possible causes are already listed.
Symptoms
Most of hydroceles are without symptoms. Usually they appear as painless scrotal swelling. Patients sometimes describe the feeling of heaviness or pulling the scrotum and mild feeling of discomfort in testicular region. Hydrocele is usually painless, so if there is pain it usually indicates inflammation of the epididymis. Hydrocele can be reduced in the lying position, and increased upon standing. In relation to the testicle it is located up and forward. In 70-10% of cases is on both sides. It is often associated with a hernia, often on the right side.
Diagnosis
An examination confirms the suspicion of hydrocele. Ultrasound can prove it. Additional tests are testicular scintigraphy and radiological examination. Laboratory analysis of blood and urine tests proves the inflammation. Aspiration of hydrocele (fluid sampling with needle and syringe) reveals a clear liquid. It cannot be a therapeutic procedure because the fluid builds up again very quickly, and there is a risk of introducing infection.
The most important thing to do is to exclude the existence of torsion of testicles.
In childhood, the hydrocele often disappears spontaneously, and if it does not occur a surgical procedure to close the vaginal extension and to remove the extended sack where liquid was accumulated is needed.
Procedure for secondary hydrocele depends on the cause – it is necessary to heal the underlying disease. If the hydrocele is large and threatening to compromise the circulation in the scrotum it should be resolved surgically.
Complications
Possible complications are endangering circulation in the scrotum due to pressure from large amounts of fluid in hydrocele and consequent testicular atrophy and infertility. Bleeding in hydrocele is result of a trauma. The intestinal convolutions can get stuck in hydrocele if there is a hernia.
Complications of surgical treatment are rare, but may include bleeding, infection, anaesthesia complication , accidental vascular and sperm duct injuries.
Prognosis
Congenital hydrocele have an excellent prognosis, most of them disappearing within the first year. Permanent congenital hydrocele are successfully treated by surgical intervention.
Prognosis of secondary hydrocele depends on its cause.