A hydrocele is a scrotal enlargement caused by fluid accumulation in the thin layer surrounding one or both the testes. Hydrocele is commonly found in newborns and gets typically cured on its own by the age of one. A hydrocele can develop in older boys and adult men due to scrotal inflammation or injury.
A hydrocele rarely causes complications and may not require any treatment. However, scrotal swelling must be assessed by a clinical practitioner to rule out other harmful causes mimicking the condition.
Causes of Hydrocele
- Congenital defects in newborns
- Post-herniorrhaphy complication (a nerve pain experienced after hernia surgery)
- Filariasis caused by Wuchereria bancrofti, tuberculosis, syphilis
- Trauma and inflammation
Signs Or Symptoms of Hydrocele
- Painless swelling in one or both the scrotum
- In adults, heaviness and discomfort due to swelling
- Pain in highly inflamed scrotum
- Diurnal changes in swelling
Possible Treatment of Hydrocele
- Most cases of hydrocele require no treatment and get resolved spontaneously with the remedy of primary aetiology.
- Complicated and symptomatic hydrocele is treated by surgical intervention. There are two types of surgery performed:
- Excision and eversion
- Those who have contraindications for surgery may undergo aspiration of accumulated fluid. After taking out the fluid, a sclerosant (shrinking agent) is injected. However, the fluid may re-accumulate within a short period.
Risk Factors of Hydrocele
Most cases of hydrocele are congenital, related to the following risk factors:
- Low birth weight Gestational use of progestin
However, later in life, the following risk factors influence the development of hydrocele
- Injury to the scrotum Infection (including Sexually transmitted infections, STIs), and inflammation.
A physician may conduct a physical examination to check the change in the swelling on pressure or may see the collection of fluid by illuminating the scrotum with a shining light. Laboratory studies in the form of Serum alpha-fetoprotein and human chorionic gonadotropin (hCG) urinalysis can be performed to rule out differential diagnoses such as testicular tumours or Epididymitis/Orchitis. Additionally, imaging studies using ultrasonography or Duplex ultrasonography can be performed to evaluate testicular tumours, spermatocele, testicular atrophy, and aberrant blood flow in the testis.
No such preventive measures are useful to prevent congenital hydrocele. However, hydrocele in adults can be prevented by avoiding injury, such as wearing an athletic cup during contact sports.
Types of Hydrocele
This type of condition makes contact with the fluids in the abdominal cavity. The anomalies of the vaginal processes (blind-ended invagination of the abdominal wall during foetal development) causes a communicative hydrocele. In such circumstances, the possibility of hydrocele and hernia formation increases.
In this type of condition, even after the closure of the inguinal canal, some excess fluid remains in the scrotum surrounding the testicle. This disease may persist from birth or appears later in life for no apparent cause.
Some schools of literature classify hydrocele into Primary (obliteration of the communication between the abdomen and scrotum) and Secondary (arising due to infection such as filaria, tuberculosis, syphilis, etc. or trauma).
- Varicocele Spermatocele Inguinal hernia Epididymal cyst Testicular tumour Scrotal edema Epididymitis/Orchitis Epididymo-orchitis
- A high percentage (approximately 80 to 90 percent) of term infants possess such defects at birth. However, this reduces to approximately one-third or less at two years of age.
- The same persists in adult life at a frequency of 20%.
- Only 6% of these require clinical attention due to complications.
Infantile hydrocele is expected to get resolved on its own. Moreover, hydroceles that require surgical intervention can be repaired without any postoperative complications by an expert surgeon. Prognosis of adult hydrocele depends on the extent and severity of the underlying infection or injury.
Quality of life is generally not impacted due to hydrocele. However, complicated conditions require management, else leading to severe complications such as infection, atrophy, hernia, accumulation of blood, rupture, etc.
The testicles normally descend into the scrotum from the abdominal cavity in the developmental stage of a foetus. Each testicle is accompanied by a sac that allows fluid to surround the testicles. Each sac normally shuts, and the fluid is absorbed.
After the sac closes, the fluid may remain entrapped (noncommunicating hydrocele). Within the first year of life, the fluid usually is progressively absorbed. However, the sac does occasionally remain open (communicating hydrocele). Fluid might flow back into the abdomen if the sac changes size or if the scrotal sac is squeezed. Inguinal hernia is frequently linked with communicating hydroceles. In adults, the major pathology is inflammatory swelling.
Complications from this condition depend on underlying pathology and management of the condition. Some possible complications are as follows:
- Pyocele (purulent fluid accumulation)
- Haematocele (accumulation of blood)
- Atrophy of testes
- Hernia of hydrocele
- Infertility (cessation of spermatogenesis due to increased blood pressure arising from edema)
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