From the Guidelines
A hydrocele is a condition where fluid accumulates in the scrotum, surrounding a testicle, causing swelling, typically resulting from incomplete involution of the processus vaginalis 1.
Causes and Mechanism
- The processus vaginalis is an extension of the peritoneal lining that surrounds the testis as it descends from its intra-abdominal location through the inguinal canal 1.
- Normally, the processus vaginalis obliterates and involutes, leaving no communication between the intra-abdominal peritoneal cavity and the extra-abdominal inguinal canal and scrotum 1.
- However, incomplete involution results in a patent processus vaginalis (PPV), through which fluid can travel and accumulate extra-abdominally as a hydrocele 1.
Clinical Implications
- Hydroceles can be associated with other conditions, such as indirect inguinal hernias, where intra-abdominal structures such as bowel may herniate through the patent processus vaginalis 1.
- The relation of the processus vaginalis with testicular descent is thought to explain why more than 90% of pediatric inguinal hernias are diagnosed in boys 1.
- It is essential to consult a healthcare professional for proper diagnosis and treatment, as hydroceles can be a sign of an underlying issue, such as an injury, infection, or tumor.
From the Research
Definition of Hydrocele
- Hydrocele is an abnormal collection of serous fluid between the parietal and visceral layers arising from the mesothelial lining of the tunica vaginalis that surrounds the testis and spermatic cord directly 2.
- It is defined as an abnormal collection of serous fluid in the potential space between the parietal and visceral layers of the tunica vaginalis 3, 4.
- Hydrocele is one of the most common causes of scrotal swellings, resulting from fluid accumulation within the tunica vaginalis, a remnant of the peritoneum covering the testicle 5.
Causes and Types of Hydrocele
- Hydroceles result from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis 2.
- Hydroceles can be divided into two types: primary and secondary 2.
- In adolescents, hydrocele is acquired and is idiopathic in origin, with the pathogenesis thought to be an imbalance in the normal process of fluid production and reabsorption 3.
- The second most common cause of hydrocele in adolescents is varicocelectomy, with the risk of hydrocele formation higher with non-artery-sparing procedures or those performed without microsurgical aid 3.
Diagnosis and Management of Hydrocele
- The diagnosis of hydrocele should be based on medical history, clinical manifestations, and imaging studies 2.
- Scrotal ultrasonography is mandatory in nonpalpable testicles to rule out a subtending testicular solid mass requiring inguinal exploration 3.
- Hydroceles can be managed by conservative treatment, fluid aspiration, or hydrocelectomy 2, 3.
- Open hydrocelectomy via a scrotal incision is the standard treatment of idiopathic hydroceles 3.