Chapter 1
Hydrocele
In my earlier years as family doctor, I had many middle-aged men who came to consult me with a large swelling in one scrotum.
They had typically hydroceles which are fluid filled scrotums.
These were easily identified by the transillumination of the swollen scrotum when a torch light was shone against the skin of the scrotum.
The fluid could be seen as well as the testis inside.
Treatment was by careful aspiration of the fluid out of the scrotal sac.
Usually a light yellow liquid was aspirated.
After the aspiration the scrotal sac had shrunk and the scrotal skin became wrinkled.
The weight of the swollen scrotum was gone and the patient was able to walk properly instead of wide legged.
However recurrence is very common and aspiration may have to be done several times before it may finally not recur.
A diuretic in older men sometimes reduced the recurrence.
In persistent cases surgical resection of the sac may be necessary.
Nowadays most patients will be referred to an Urologist or Surgeon.
What is a hydrocele?
A hydrocele is a medical disorder where there is abnormal collection of fluid within the sac in the scrotum (remnants of the processus vaginalis)
A hydrocele is a fluid-filled swollen sac usually occurring in one scrotum.
There are various forms of hydroceles.
A. Simple hydrocele:
a. There is collection of fluid within the tunica vaginalis.
b. It affects 1-2% of male neonates.
c. A congenital, simple hydrocele usually disappears within the first 1-2 years of life.
Causes in older boys and men are:
1. Trauma,
2. Epididymo-orchitis,
3. Testicular torsion,
4. Hernia,
5. Varicocele,
6. Testicular tumor.
Hydroceles in older boys and men may also be due to generalized edema, such as nephrotic syndrome or heart failure.
B. Communicating hydrocele:
Persistence of the processus vaginalis permits peritoneal fluid to communicate easily with the scrotal sac.
These hydroceles are congenital but may first manifest in older boys and men as a result of raised intra-abdominal pressure, continuous peritoneal dialysis or fluid overload.
C. Hydrocele of the cord:
The processus vaginalis closes in segments, keeping fluid within the spermatic cord.
D. Abdomino-scrotal hydrocele:
Uncommonly a large hydrocele lies across the internal ring, with both inguino-scrotal and intra-abdominal lobes.
What are the causes of Hydrocele?
Causes
Hydroceles are frequent in newborn infants.
During a baby’s development in the womb, the testicles move down from the abdomen through a tract into the scrotum.
Hydroceles occur when this tract does not close.
Fluid drains from the abdomen through the open tract.
It gets trapped in the scrotum.
This causes the scrotum to become bigger.
Most hydroceles will disappear in a short time after birth.
Occasionally, a hydrocele may occur with an inguinal hernia.
Hydroceles may also be caused by:
1. Buildup of the normal fluid around the testicle.
This may occur because the body produces a larger amount of the fluid than needed or it does not flow away well.
This type of hydrocele is more frequent in older men.
2. Inflammation or injury of the testicle or epididymis
Hydroceles need to be fully investigated if there is any suspicion of an underlying cause.
3. In children, most hydroceles are the communicating type, in which patency of the processus vaginalis permits peritoneal fluid to flow into the scrotum.
4. Non-communicating hydroceles are caused by excessive fluid production within the tunica vaginalis.
Medically apparent scrotal hydroceles are evident in 6% of term males beyond the newborn period.
Most pediatric hydroceles are congenital but rarer causes are malignancy and infection.
TABLE OF CONTENT
Introduction
Chapter 1 Hydrocele
Chapter 2 Causes
Chapter 3 Symptoms
Chapter 4 Diagnosis
Chapter 5 Treatment
Chapter 6 Pro
