Hydrocele testis

Hydrocele testis
Classification and external resources
The right testis, exposed by laying open the tunica vaginalis. (Tunica vaginalis is labeled at upper right.)
ICD-10	N43.0-N43.3
ICD-9	603
DiseasesDB	6137
eMedicine	emerg/256 med/2778 ped/1037
MeSH	D006848

A hydrocele testis is an accumulation of clear fluid in the tunica vaginalis, the most internal of membranes containing a testicle. A primary hydrocele causes a painless enlargement in the scrotum on the affected side and is thought to be due to the defective absorption of fluid secreted between the two layers of the tunica vaginalis (investing membrane). A secondary hydrocele is secondary to either inflammation or a neoplasm in the testis.

A hydrocele usually occurs on one side, but can also affect both sides. The accumulation can be a marker of physical trauma, infection or tumor, but the cause is generally unknown.

Hydrocele normally is seen in infant boys, as enlarged scrotum. In infant girls it appears as enlarge labia. However, hydrocele is more common in boys than girls. There is a greater chance of infertility if the hydrocele does not show itself until the child has reached adulthood. The younger the patient is when the hydrocele is found and treated, the lesser the chances of infertility. Some beg to differ on infertility due to hydrocele, but the majority agree upon the chances of infertility due to hydrocele is highly likely, unless the patient is an infant or child of pre-teen age.

Cause

During embryogenesis, the testis descends through the inguinal canal, drawing a diverticulum of peritoneum into the scrotum as it descends. This peritoneal tissue is known as the processus vaginalis. Normally, the communication between the processus vaginalis and the peritoneum is obliterated, and the tunica vaginalis is the tissue that remains overlying the testis and the epididymis. Congenital hydrocele results when the processus vaginalis remains patent, allowing fluid from the peritoneum to accumulate in the scrotum.

Symptoms

A hydrocele feels like a small fluid-filled balloon inside the scrotum. It is smooth, and is mainly in front of the testis. Hydroceles vary greatly in size. Hydroceles are normally painless and harmless. Large hydroceles cause discomfort because of their size. As the fluid of a hydrocele is transparent, light shone through a hydrocelic region will be visible from the other side. This phenomenon is called transillumination. However , as the testicle continues to grow, a male can expect more pain. Sometimes the pain can be in both testicles, as pressure from enlarged one to regular one can cause additional pain to normal testicle. It has also been found to decrease a mans sex drive and makes them less active for fear of enlarging mass.

Symptoms of a hydrocele can easily be distinguished from testicular cancer, as a hydrocele is soft and fluidy, where a testicular cancer feels hard and rough.

Through diagnostic ultrasound the accumulation of fluids can be diagnosed correctly.

Treatment

The accumulation should generally be removed surgically. The procedure is called hydrocelectomy. There are two surgical techniques available for hydrocelectomy.

Hydrocelectomy with Excision of the Hydrocele Sac: Incision of the hydrocele sac after complete mobilization of the hydrocele. Partial resection of the hydrocele sac, leaving a margin of 1–2 cm. Care is taken not to injure testicular vessels, epididymis or ductus deferens. The edge of the hydrocele sac is oversewn for haemostasis (von Bergmann's technique) or the edges are sewn together behind the spermatic cord (Winkelmann's or Jaboulay's technique). Hydrocele surgery with excision of the hydrocele sas is useful for large or thick-walled hydroceles and multilocular hydroceles.

Hydrocele Surgery with Plication of the Hydrocele Sac:

The hydrocele is opened with a small skin incision without further preparation. The hydrocele sac is reduced (plicated) by suture Hydrocele surgery: Lord's technique. The plication technique is suitable for medium-sized and thin-walled hydroceles. The advantage of the plication technique is the minimized dissection with a reduced complication rate.^[1]

If the hydrocele is not surgically removed, it may continue to grow. The hydrocele fluid can be aspirated, the procedure is less invasive but recurrence rates are high.^[2] Sclerotherapy, the injection of a solution following aspiration of the hydrocele fluid may increase success rates.^[3] In many patients, the procedure of aspiration and sclerotherapy is repeated as the hydrocele recurs.^[4]

Fertility

A hydrocele testis is not generally thought to affect fertility. However, it may be indicative of other factors that may affect fertility.^{[citation needed]}

References