Hydrocele testis
| Hydrocele testis | |
|---|---|
| Specialty | Urology  |
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, tumor or varicocele's surgery,[1] but the cause is generally unknown.
Hydrocele normally is seen in infant boys, as enlarged scrotum. In infant girls it appears as enlarged 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 will vary greatly in size which are normally painless and harmless. Large hydroceles will cause discomfort because of their size. As the fluid of a hydrocele is transparent, light shone through the hydrocelic region will be visible from the other side. This phenomenon is called transillumination. However, as the fluid continues to accumulate and the scrotum further enlarges, more discomfort can be expected. 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.
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 sack 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.[2]
If the hydrocele is not surgically removed, it may continue to grow. The hydrocele fluid can be aspirated. This procedure 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]
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]
Popular media
Jason Bateman in The Change-Up features hydrocele testes,[6] despite the term is not used, stating "One of Dave's balls feels like two balls — it's like you have three balls, you have a bouquet of balls".
In the British comedy series Peep Show, there are numerous references to the unusual appearance of the character Dave Mitchell's character's testicles; it is eventually revealed that this is due to a 'large hydrocele.'
References
- ^ C, Esposito. "Incidence and management of hydrocele following varicocele surgery in children". Pubmed. US National Library of Medicine. Retrieved 19 May 2015.
- ^ 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
- ^ 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.
- ^ 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.
- ^ 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.
- ^ Debbie Michaud. "HyThe Change-Up is a lot funnier than you'd think".