The term hydrocele refers to the Greek word hydro; water and cele; comes from the words tumor. Hydrocele, also known as water hernia, is the swelling of the scrotum as a result of the accumulation of more fluid than normal in the membranes surrounding the testicles. Normally, 0.5 -1 ml between the testis and these membranes to ensure the lubricity of the testicle. While there is liquid, this liquid amount in the hydrocele is 100–200 ml. sometimes even larger volumes.
Congenital (Congenital) Hydrocele:
In the mother’s womb, the testicle is located in the abdomen, and from the 14th week of pregnancy, it moves towards the lower parts of the abdomen and then descends into the scrotum. During this descent, the peritoneum (peritoneum), which is dragged together, descends with the testicle in the style of a glove finger. After a while, this sac closes and becomes a filamentous structure, if this vesicle is not closed, the intra-abdominal fluid passes through this opening and causes swelling in the scrotum around the testicle.This is called hydrocele, if the opening is large, the intra-abdominal organs may sag from here and form a hernia. If the hydrocele is limited to the membranes surrounding the testicle, it is called testicular hydrocele, if it is limited to a cystic structure along the testicular cord, it is called cord hydrocele or cord cyst. Congenital hydrocele occurs in about 6 percent of newborn males. Most of the neonatal hydroceles are congenital, but it should be kept in mind that tumor, infection or circulatory disorders may cause hydrocele during this period.
2 types of hydrocele are observed in newborn age
Communicating hydrocele (associated hydrocele); While it means that the abdominal membrane descending into the scrotum is completely open,
In non-communicating hydroceles, this means that the abdominal part of the membrane is abnormally closed and peritoneal fluid is trapped in the scrotum.
Hydrocele occurs in about 1 percent of adult men and usually over the age of 40.
In adult men and older people, hydrocele may occur due to trauma to the scrotum, inflammatory diseases of the testicle and its appendages, testicular tumors, varicocele surgeries and after radiotherapy. Unilateral hydrocele occurs in 70 percent of kidney transplant patients. Testicular torsion (sudden rotation of the testicle around itself) can cause reactive hydrocele in 20 percent of patients and mask testicular torsion requiring immediate intervention.
The diagnosis of hydrocele can be easily made by history and physical examination. Many hydroceles do not cause any complaints. Patients’ consultation to the physician is usually due to painless swelling in the scrotum. The patient may feel heaviness and fullness in the scrotum. Rarely, they may experience mild discomfort in the groin area and pain that hits the lumbar region. Pain usually does not occur, if any, it may be due to the accompanying acute epididymis infection. In congenital hydrocele, it is typical for the swelling of the scrotum to disappear in the morning and become apparent later in the day. Fever, chills, nausea, vomiting are generally not seen in simple hydroceles.
In the examination of the scrotum, the hydrocele is observed in the upper anterior part of the testicle. 7–10 percent is bilateral. Especially right-sided hydroceles are usually associated with inguinal hernia. If there is no infection, there is no redness or color change in the scrotum. When light is shed on the scrotum in a dark room, if the cause of swelling is hydrocele, it is translucent. In congenital hydrocele, swelling becomes apparent when the child stands up or cries, and disappears during examination or when lying down.
Inguinal-scrotal ultrasonography can be performed to confirm the diagnosis, it is effective in showing whether there is abnormalities in the testicles and appendages (especially testicular tumors), complex cystic masses, spermatoceles, or co-hernia. Testicular color Doppler ultrasonography is used to show blood flow in the testicle and should be absolutely performed, especially if testicular torsion is suspected.