HYDROCELE

DEFINITION A hydrocele is a fluid-filled sac surrounding a testicle that results in swelling of the scrotum, the loose bag of s in underneath the !enis" #! to $% !ercent of male infants ha&e a hydrocele at birth, but most hydroceles disa!!ear without treatment within the first year of life" Additionally, adult men can de&elo! a hydrocele due to inflammation or in'ury within the scrotum" Hydroceles usually aren(t !ainful" )y!ically not harmful, hydroceles may re*uire no treatment" Howe&er, if you ha&e scrotal swelling, see your doctor to rule out other causes, such as testicular cancer or other conditions" Pathophysiology During fetal de&elo!ment, an e+tension of the !eritoneum migrates distally through the inguinal canal with the gubernaculum in the first trimester" ,ormally, this thin membrane that e+tends through the inguinal canal and descends into the scrotum -!rocessus &aginalis. is obliterated !ro+imally at the internal inguinal ring, and the distal !ortion forms the tunica &aginalis" /n the ma'ority of cases, the !rocessus &aginalis closes within the first year of life" /f it is not obliterated at the internal ring, it is referred to as a !atent !rocessus &aginalis, and the tunica &aginalis communicates with the !eritoneum, so that !eritoneal fluid flows freely between both structures and a communicating hydrocele forms" /f the communication is large enough, intra-abdominal structures, such as intestine, omentum, bladder, or genital contents, may be found in the inguinal canal, and this com!lication is nown as an indirect inguinal hernia" 0hile the !rocessus &aginalis forms in both se+es in the first trimester, it does not enlarge in females" Hydrocele of the canal of ,uc is rare and results from the failure of the !rocessus &aginalis to close, which causes fluid to accumulate within the inguinal canal" A non-communicating or sim!le hydrocele occurs in cases where the !rocessus &aginalis is obliterated and secretion e+ceeds absor!tion of fluid from the tunica &aginalis" An abdominoscrotal hydrocele is a sim!le hydrocele that enlarges through the inguinal canal resulting in an abdominal com!onent" A hydrocele of the s!ermatic cord is the result of segmental closure of

the !rocessus &aginalis" /t is loculated and usually does not communicate with the !eritoneal ca&ity"

Causes Hydroceles are common in newborn infants" During normal de&elo!ment, the testicles descend down a tube from the abdomen into the scrotum" Hydroceles result when this tube fails to close" 1luid drains from the abdomen through the o!en tube" )he fluid builds u! in the scrotum, where it becomes tra!!ed" )his causes the scrotum to become swollen" Hydroceles normally go away a few months after birth, but their a!!earance may worry new !arents" Occasionally, a hydrocele may be associated with an inguinal hernia" Hydroceles may also be caused by inflammation or in'ury of the testicle or e!ididymis, or by fluid or blood bloc age within the s!ermatic cord" )his ty!e of hydrocele is more common in older men" Symptoms )he main sym!tom is a !ainless, swollen testicle , which feels li e a water balloon" A hydrocele may occur on one or both sides" Diagnosis )he diagnosis of a hydrocele is generally made clinically" An a!t descri!tion of a hydrocele surrounding a !al!able -something that can be felt. testis would be that of a small water balloon containing a !eanut" )he differences between communicating and non-communicating hydroceles described abo&e hel! to su!!ort the sus!ected diagnosis" A bedside test, transillumination, !ro&ides confirmation of the condition" )ransillumination in&ol&es !lacing a small light source -commonly an otosco!e - the medical de&ice used to e+amine the ear. against the swollen scrotum" )he fluid filled nature of the hydrocele side is distinctly different from the non-in&ol&ed side of the scrotum" /n rare cases either ultrasound or 2-ray study of the region may be indicated" /n unusual cases where a hydrocele may be a secondary !henomenon to !athologic cause -caused by disease., surgical e+!loration may be necessary to establish the diagnosis" " Treatment Hydroceles are usually not dangerous, and they are usually only treated when they cause discomfort or embarrassment, or if they are large enough to threaten the testicle(s blood su!!ly" One o!tion is to remo&e the fluid in the scrotum with a needle, a !rocess called as!iration" Howe&er, surgery is generally !referred" As!iration may be the best alternati&e for !eo!le who ha&e certain surgical ris s" 3clerosing -thic ening or hardening. medications may be in'ected after as!iration to close off the o!ening" )his hel!s !re&ent the future build u! of fluid" Hydroceles associated with an inguinal hernia should be re!aired surgically as *uic ly as !ossible" Hydroceles that do not go away on their own o&er a !eriod of months should be e&aluated for !ossible surgery" A surgical !rocedure, called a hydrocelectomy, is often !erformed to correct a hydrocele"