Hydrocele is an abnormal collection of serous fluid in the tunica vaginalis of the testis or within some part of the processus vaginalis. It may be divided into two categories based on the cause: primary or secondary. Primary Hydrocele – the cause is unknown. Secondary Hydrocele – it is secondary to a disease in the testis and or the epididymis.
Primary Hydrocele: there are five known types which are as follows; Vaginal Hydrocele, Encysted Hydrocele of the cord, Infantile Hydrocele, congenital Hydrocele and funicular Hydrocele. Vaginal Hydrocele is the commonest variety. There is no associated disease of the testis or epididymis. The fluid is usually amber in colour. It commonly occurs in middle aged men. It is more common in tropical countries. The patient will complain of a swelling in the scrotum. Slight amount of pain or discomfort may be present. It may be confused with inguinal hernia, haematocele, pyocele, chylocele, filariasis of the scrotum, tumours of the testis. On examination, it is a cystic swelling and is localized only to the scrotum. The testis may be palpated posterior to the vaginal Hydrocele. The most characteristic test is the transillumination test which is always positive as the fluid is clear in a primary Hydrocele.
Complications: Infection, atrophy of the testis, rupture, calcification of the sac, haematocele and hernia of the Hydrocele sac are some of the common complications.
Treatment: Surgical excision is the treatment of choice. In older patients, tapping of the fluid may be done. In infants, it should be left alone as they may disappear spontaneously. However if they persist, surgery might be necessary.
Congenital Hydrocele: In this condition the processus vaginalis remains patent so there is a direct communication of the tunica vaginalis with the peritoneal cavity. The communicating orifice at the deep inguinal ring is too small for the development of a hernia. It is present since birth. When the patient lies horizontal, the Hydrocele vanishes as the fluid drains back into the abdominal cavity. In the erect position it appears again. The swelling is not easily reducible due to narrowness of the deep inguinal ring.
Funicular Hydrocele: It is a condition in which the processus vaginalis remains patent up to the top of the testis where it is shut off from the tunica vaginalis. The swelling is inguinal rather than scrotal. The testis can be felt separately.
Infantile Hydrocele: The tunica vaginalis is continuous with the processus vaginalis which is shut off from the peritoneal cavity at the deep inguinal ring. It forms an inguinoscrotal swelling thus resembling an inguinal hernia. However there is no impulse felt on coughing.
Secondary Hydrocele: It refers to an abnormal collection of fluid into the tunica vaginalis which is associated with diseases of the testis and or the epididymis. Most common causes are acute epididymo-orchitis, chronic epididymo-orchitis, and malignant disease of the testis, trauma, lymphatic obstruction and post herniorrhaphy Hydrocele. It hardly becomes big enough. It is lax and hence palpation of the testis and epididymis is not difficult. In such cases, the cause must be treated in order to get rid of the Hydrocele.
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