Hydrocele testis

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Hydrocele testis
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The right testis, exposed by laying open the tunica vaginalis. (Tunica vaginalis is labeled at upper right.)
Specialty Urology

A hydrocele testis is an accumulation of clear fluid within the cavum vaginale, the potential space between the layers of the tunica vaginalis of the testicle. It is the most common form of hydrocele and is often referred to simply as a "hydrocele". A primary hydrocele testis 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.

Contents

A hydrocele testis usually occurs on one side, but can also affect both sides. The accumulation can be a marker of physical trauma, infection, tumor or varicocele surgery, [1] but the cause is generally unknown. Indirect inguinal hernia indicates increased risk of hydrocele testis.

Signs and symptoms

A hydrocele testis as it outwardly presents in an adult male Male Hydrocele Testis.jpg
A hydrocele testis as it outwardly presents in an adult male

A hydrocele testis feels like a small fluid-filled balloon inside the scrotum. It is smooth, and is mainly in front of the testis. Hydrocele testes vary greatly in size and are typically painless and harmless. However, as the fluid continues to accumulate and the scrotum further enlarges, more discomfort can be expected. Large hydroceles will cause discomfort because of their size. Sometimes pain can be in both testicles as pressure from the enlarged area puts pressure against the unaffected area which can cause discomfort to the normal testicle. It has also been found to decrease a man's sex drive and makes him less active for fear of enlarging the mass. As the fluid of a hydrocele testis is transparent, light shone through the hydrocelic region will be visible from the other side. This phenomenon is called transillumination.[ citation needed ]

Symptoms of a hydrocele testis can easily be distinguished from testicular cancer, as a hydrocele is soft and fluid-filled, whereas testicular cancer feels hard and rough.[ citation needed ]

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 ]

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 testis results when the processus vaginalis remains, allowing fluid from the peritoneum to accumulate in the scrotum.[ citation needed ]

Diagnosis

Scrotal ultrasound of a 10 cm large hydrocele testis, with anechoic (dark) fluid surrounding the testicle. Ultrasonography of hydrocele.jpg
Scrotal ultrasound of a 10 cm large hydrocele testis, with anechoic (dark) fluid surrounding the testicle.
Communicating hydrocele testis, caused by the failure of the processus vaginalis closure. Ultrasound Scan ND 0124155309 1600360.png
Communicating hydrocele testis, caused by the failure of the processus vaginalis closure.

Through diagnostic ultrasound the accumulation of fluids can be diagnosed correctly.[ citation needed ]

Treatment

The fluid accumulation can be drained by aspiration, but this may be only temporary. A more permanent alternative is a surgical procedure, generally, an outpatient ambulatory (same-day) procedure, called a hydrocelectomy. There are two surgical techniques available for hydrocelectomy.[ citation needed ]

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 hemostasis (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 sac is useful for large or thick-walled hydroceles and multilocular hydroceles.[ citation needed ]
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. [2]

If the hydrocele is not surgically removed, it may continue to grow. The hydrocele fluid can be aspirated. This procedure can be done in a urologist's office or clinic and is less invasive, but recurrence rates are high. [3] Sclerotherapy, the injection of a solution following aspiration of the hydrocele fluid may increase success rates. [4] In many patients, the procedure of aspiration and sclerotherapy is repeated as the hydrocele recurs. [5]

Related Research Articles

<span class="mw-page-title-main">Testicle</span> Internal organ in the male reproductive system

A testicle or testis is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testosterone. Testosterone release is controlled by the anterior pituitary luteinizing hormone, whereas sperm production is controlled both by the anterior pituitary follicle-stimulating hormone and gonadal testosterone.

<span class="mw-page-title-main">Testicular torsion</span> Medical condition

Testicular torsion occurs when the spermatic cord twists, cutting off the blood supply to the testicle. The most common symptom in children is sudden, severe testicular pain. The testicle may be higher than usual in the scrotum and vomiting may occur. In newborns, pain is often absent and instead the scrotum may become discolored or the testicle may disappear from its usual place.

<span class="mw-page-title-main">Spermatic cord</span> Structure in the human male reproductive system

The spermatic cord is the cord-like structure in males formed by the vas deferens and surrounding tissue that runs from the deep inguinal ring down to each testicle. Its serosal covering, the tunica vaginalis, is an extension of the peritoneum that passes through the transversalis fascia. Each testicle develops in the lower thoracic and upper lumbar region and migrates into the scrotum. During its descent it carries along with it the vas deferens, its vessels, nerves etc. There is one on each side.

<span class="mw-page-title-main">Orchiopexy</span> Surgery to fix a testicle into the scrotum

Orchiopexy is a surgery to move and/or permanently fix a testicle into the scrotum. While orchiopexy typically describes the operation to surgically correct an undescended testicle, it is also used to resolve testicular torsion.

<span class="mw-page-title-main">Inguinal hernia</span> Medical condition in which contents of the abdominal cavity protrude through the inguinal canal

An inguinal hernia or groin hernia, is a hernia (protrusion) of abdominal cavity contents through the inguinal canal. Symptoms, which may include pain or discomfort especially with or following coughing, exercise, or bowel movements, are absent in about a third of patients. Symptoms often get worse throughout the day and improve when lying down. A bulging area may occur that becomes larger when bearing down. Inguinal hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the intestine is blocked. This usually produces severe pain and tenderness of the area.

<span class="mw-page-title-main">Spermatocele</span> Medical condition

Spermatocele is a fluid-filled cyst that develops in the epididymis. The fluid is usually a clear or milky white color and may contain sperm. Spermatoceles are typically filled with spermatozoa and they can vary in size from several millimeters to many centimeters. Small spermatoceles are relatively common, occurring in an estimated 30 percent of males. They are generally not painful. However, some people may experience discomfort such as a dull pain in the scrotum from larger spermatoceles. They are not cancerous, nor do they cause an increased risk of testicular cancer. Additionally, unlike varicoceles, they do not reduce fertility.

<span class="mw-page-title-main">Polyorchidism</span> Medical condition

Polyorchidism is the incidence of more than two testicles. It is a very rare congenital disorder, with fewer than 200 cases reported in medical literature and six cases in veterinary literature.

<span class="mw-page-title-main">Hydrocele</span> Accumulation of fluid in a body cavity

A hydrocele is an accumulation of serous fluid in a body cavity. A hydrocele testis, the most common form of hydrocele, is the accumulation of fluids around a testicle. It is often caused by fluid collecting within a layer wrapped around the testicle, called the tunica vaginalis, which is derived from peritoneum. Provided there is no hernia present, it goes away without treatment in the first year. Although hydroceles usually develop in males, rare instances have been described in females in the Canal of Nuck.

<span class="mw-page-title-main">Varicocele</span> Medical condition

A varicocele is an abnormal enlargement of the pampiniform venous plexus in the male scrotum; the female equivalent of painful swelling to the embryologically identical pampiniform venous plexus is called pelvic compression syndrome. This plexus of veins drains blood from the testicles back to the heart. The vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Varicoceles occur in around 15% to 20% of all men. The incidence of varicocele increase with age.

<span class="mw-page-title-main">Hematocele</span> Medical condition

A hematocele is a collections of blood in a body cavity or potential space. The term most commonly refers to the collection of blood in the tunica vaginalis around the testes, known as a scrotal hematocele. Hematoceles can also occur in the abdominal cavity and other body cavities. Hematoceles are rare, making them harder to diagnose and treat. They are very common especially as slowly growing masses in the scrotum usually in men older than 50 years.

<span class="mw-page-title-main">Testicular pain</span> Medical condition

Testicular pain, also known as scrotal pain, occurs when part or all of either one or both testicles hurt. Pain in the scrotum is also often included. Testicular pain may be of sudden onset or of long duration.

Transillumination is the technique of sample illumination by transmission of light through the sample. Transillumination is used in a variety of methods of imaging.

<span class="mw-page-title-main">Tunica vaginalis</span> Pouch of serous membrane that covers the testes

The tunica vaginalis is the pouch of serous membrane that covers the testes. It is derived from the vaginal process of the peritoneum, which in the fetus precedes the descent of the testes from the abdomen into the scrotum.

<span class="mw-page-title-main">Appendix of testis</span>

The appendix testis is a vestigial remnant of the Müllerian duct, present on the upper pole of the testis and attached to the tunica vaginalis. It is present about 90% of the time.

<span class="mw-page-title-main">Testicular vein</span>

The testicular vein, the male gonadal vein, carries deoxygenated blood from its corresponding testis to the inferior vena cava or one of its tributaries. It is the male equivalent of the ovarian vein, and is the venous counterpart of the testicular artery.

<span class="mw-page-title-main">Vaginal process</span> An embryonic developmental outpouching of the parietal peritoneum

The vaginal process is an embryonic developmental outpouching of the parietal peritoneum. It is present from around the 12th week of gestation, and commences as a peritoneal outpouching.

<span class="mw-page-title-main">Scrotum</span> Anatomical male reproductive structure

The scrotum or scrotal sac is an anatomical male reproductive structure located at the base of the penis that consists of a suspended dual-chambered sac of skin and smooth muscle. It is present in most terrestrial male mammals. The scrotum contains the external spermatic fascia, testes, epididymis, and ductus deferens. It is a distention of the perineum and carries some abdominal tissues into its cavity including the testicular artery, testicular vein, and pampiniform plexus. The perineal raphe is a small, vertical, slightly raised ridge of scrotal skin under which is found the scrotal septum. It appears as a thin longitudinal line that runs front to back over the entire scrotum. In humans and some other mammals the scrotum becomes covered with pubic hair at puberty. The scrotum will usually tighten during penile erection and when exposed to cold temperatures. One testis is typically lower than the other to avoid compression in the event of an impact.

Vasoepididymostomy or epididymovasostomy is a surgery by which vasectomies are reversed. It involves connection of the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy.

<span class="mw-page-title-main">Scrotal ultrasound</span> Medical ultrasound examination of the scrotum.

Scrotalultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.

Aspasia was an ancient Greek, Athenian physician who concentrated on obstetrics and gynecology. During this time period in ancient Greece, women did not have access to higher education, so they found themselves restrained to common housekeeping roles. The ancient Greeks viewed medicine as a divine science that came as a gift from the gods, so they did not allow women or slaves to become educated in medicine. It wasn’t until Greek historian Xenophon, who helped create a piece of local legislation in Athens stating, that women should have the social role of protecting their family’s health, creating the path towards medico-philosophy. It wasn’t until the Roman Emperor Julius Caesar, who ordered that all women who were educated in medicine should be granted special privileges, that women could gain citizenship and be relieved from almost all taxes.After the proclamation from Julius Caesar, women began to adopt new roles in medicine as physicians, midwives, surgeons, druggists, herb collectors, nurses, therapists and wet nurses. It was during this time when Aspasia became such an impressive physician who made many valuable discoveries on the medico-philosophical knowledge, challenging the sex barrier in ancient Greece.

References

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  2. Ku u.a. 2001 KU, J. H.; KIM, M. E.; LEE, N. K.; PARK, Y. H.:The excisional, plication and internal drainage techniques: a comparison of the results for idiopathic hydrocele.In: BJU Int 87 (2001), Nr. 1, S. 82–4
  3. Fracchia, JA; Armenakas, NA; Kohan, AD (1998). "Cost-effective hydrocele ablation". The Journal of Urology. 159 (3): 864–7. doi:10.1016/S0022-5347(01)63755-8. PMID   9474170.
  4. Beiko, DT; Kim, D; Morales, A (2003). "Aspiration and sclerotherapy versus hydrocelectomy for treatment of hydroceles". Urology. 61 (4): 708–12. doi:10.1016/S0090-4295(02)02430-5. PMID   12670550.
  5. Shan, CJ; Lucon, AM; Arap, S. (2003). "A Comparative study of sclerotherapy with phenol and surgical treatment for hydrocele". J Urol. 169 (3): 1056–9. doi:10.1097/01.ju.0000052680.03705.40. PMID   12576845.