Those most at risk of hydrocele are infants and adults over the age of 40.The causes of hydrocele vary according to age.
In children, the condition is due to failure of the peritoneal vaginal duct to close . In adults, it may depend on: a reopening of the vaginal peritoneal duct, an inflammation of the testicles , the presence of water retention in the lower limbs or a testicular tumor .
Typically, a hydrocele causes testicular swelling. More rarely, it can cause pain and redness in the scrotum , and/or a feeling of pressure at the base of the penis .
Physical examination and history are essential for a correct diagnosis.
Treatment varies according to the severity of the symptoms.
Brief Anatomical Review Of The Male Genital System
The basic elements of the male reproductive system are:
- The testicles or didymi . Contained in the scrotum are the male gonads . Their job is to produce sperm cells and the important hormone testosterone .
- The prostate and seminal vesicles . The prostate is the gland that produces semen . The seminal fluid, in addition to collecting the spermatozoa (sperm), also provides for their nutrition. Two in number, the seminal vesicles produce a liquid similar to seminal fluid.
- The epididymis and vas deferens of each testicle . The epididymis and the vas deferens are the channels that connect the testicles to the seminal vesicles and the prostate, and which introduce sperm into the latter.
- The urethra . The urethra is a small tube that begins at the level of the bladder , runs through the penis and is used for the expulsion of urine and semen.
- The expulsion of urine and semen occurs through the urinary meatus, located on the glans penis .
- The penis . The penis is the male reproductive organ and the last part of the urinary tract . Thanks to its particular anatomical structure, it allows the passage of sperm from men to women.
What Is Hydrocele?
A hydrocele is an abnormal accumulation of clear fluid in the scrotum, all around the testicle or testicles.
It represents one of the main causes of a condition, which, in common parlance, is called a swollen testicle .
Most cases of hydrocele occur at birth (1 to 10 out of 100 newborns are affected) and in men over the age of 40.
In infants, hydrocele is due to failure of the duct connecting the abdomen to the scrotum ( peritoneal-vaginal duct ) to allow descent of the testicles into the scrotal sac. The patency of the peritoneal-vaginal duct allows the peritoneal fluid to freely reach the site where the testicles are housed.
In adult men, however, hydrocele can have an idiopathic origin or be the consequence of:
- The reopening of the peritoneal-vaginal duct;
- An inflammation of the testicles, secondary to an injury or an infection (for example tuberculosis , syphilis or epididymitis );
- The presence of water retention, at the level of the lower limbs;
- Testicular cancer (very rarely).
Meaning of idiopathic
the term idiopathic , associated with the name of a pathology, indicates that the latter has arisen for unknown or unidentifiable reasons.
Symptoms, Signs And Complications
Typically, a hydrocele is responsible for testicular swelling , involving one or both testicles.
The extent of the swelling varies from patient to patient and depends, above all, on the triggering causes.
Sometimes, in addition to testicular swelling, the presence of hydrocele can cause: pain in the testicles, redness in the scrotum and a sense of pressure at the base of the penis.
Some individuals with hydroceles have more intense symptoms in the afternoon or evening than in the morning.
If the underlying causes of the hydrocele lack particular clinical significance, the resulting condition is harmless and does not interfere with either sexual function or fertility.
If, on the other hand, the causes of the hydrocele are clinically very relevant (eg: testicular cancer, serious infections, etc.), the resulting condition can have unpleasant complications, including altered sexual function and/or reduced sperm production.
When To See A Doctor?
Any male individual who notices that he has a swollen testicle (or a parent who notices swelling of his or her child’s testicles) should contact their doctor immediately, for further investigation of the situation.
The timeliness of the diagnosis is very important; if, in fact, the swelling was connected to a serious condition, a late diagnosis could be the cause of unpleasant consequences.
List Of Conditions Which, Like Hydrocele, Typically Result In Testicular Swelling:
- Cyst of the epididymis
- Inguinal hernia
- Epididymitis and/or orchitis
- Testicular torsion
Usually, the diagnostic work-up for identifying a hydrocele begins with a careful physical examination and a thorough history. Then, follow up with a urine test and a blood test , to understand whether or not an infection is present. Finally, it ends with a scrotal ultrasound , which corresponds to the most reliable evaluation.
PHYSICAL EXAMINATION AND ANAMNESIS
The physical examination is the set of diagnostic manoeuvres, carried out by the doctor, to verify the presence or absence, in the patient, of the indicative signs of an anomalous condition.
The anamnesis is the collection and critical study of the symptoms and facts of medical interest reported by the patient or his family members (NB: family members are involved, above all, when the patient is very young).
Scrotal ultrasound is a sufficiently comprehensive and completely harmless diagnostic imaging test.
For its realization, an ultrasound probe is needed, which, resting on the male patient’s scrotum, projects its internal organs and tissues onto a monitor.
If performed in the presence of testicular swelling, scrotal ultrasound (or ultrasound of the scrotum) allows us to grasp the exact dimensions and, above all, the nature of the swelling.
On an ultrasound examination , a hydrocele appears as a clear fluid buildup.
If other oddities emerge, such as clusters of solid content, it is possible that the testicular anomaly in progress is more serious (eg: testicular cancer).
Hydroceles in very young children tend to disappear spontaneously, without any particular treatment. Typically, healing times consist of about 12 months, no more.
If hydroceles in very young children do not go away on their own or tend to get worse rather than better, doctors may decide that surgery is needed. The surgery in question consists of a drainage operation of the liquid present.
Shifting attention to hydrocele in adult men, it is important to specify right away that the treatment of the condition depends on the symptoms.
A hydrocele in adults with insignificant symptoms does not require specific treatment, as it tends to resolve spontaneously within 6 months. In these situations, there is a spontaneous reabsorption of the liquid present inside the scrotum.
Conversely, a hydrocele in adults with significant symptoms may require needle aspiration of the liquid present in the scrotum or, in the most serious cases, a surgical procedure known as hydrocelectomy.
ASPIRATION OF THE LIQUID BY NEEDLE
Doctors opt for fluid aspiration when the hydrocele is of medium size and responsible for annoying symptoms.
Aspiration is a therapeutic option with its advantages and disadvantages.
The main advantage consists in the reduced invasiveness; the most important disadvantage, on the other hand, consists in the non-negligible possibility of the hydrocele reappearing.
Hydrocelectomy is an operation performed in the presence of large and very painful cases of hydrocele.
This operation involves general or local anesthesia, the practice of an incision in the scrotum or lower abdomen and the drainage, through the aforementioned incision, of the abnormal fluid present in the scrotum.
At the end of the drainage, the surgeon closes the incision with stitches.
If performed under general anesthesia, hydrocelectomy requires hospitalization of the patient for at least one day.
The hydrocelectomy operation is effective; however it does not rule out the possibility that the hydrocele may recur in the future.