Disease of Tunica Vaginalis is Curable

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What is a hydrocele?

A hydrocele is a scrotal collection of clear fluid (“hydro” = water) in a thin walled sack (“cele” = swelling) that also contains the testicle. Less frequently, due to the common embryological background of male and female gonadal structures, female children or women may also experience a hydrocele. In this case, the sack and connection exist in the labia majora (the outermost and larger of the two labial structures). Because of less potential concern for complications in females with hydroceles, this article will focus predominantly on the male gender. A hydrocele may involve either one side (unilateral) or both sides (bilateral) of the scrotum.

What causes hydroceles?

Embryology
Between the 28th and 36th week of gestation, the testes, associated blood vessels and nerves migrate from the upper posterior abdominal wall adjacent to the kidneys to the lower abdominal cavity and through a tunnel (inguinal canal) into the scrotum. As each gonad exits the pelvic region through the inguinal canal into the scrotum, it is preceded by a thinly lined “sack” called the process vaginalis. Once the testes and associated structures have entered the scrotum, the trailing end of the process vaginalis generally closes off, completely isolating the contents of the abdominal cavity and obstructing their passage into the inguinal canal or scrotum. Should this closure be incomplete and the communication narrow, free fluid in the abdominal cavity (peritoneal fluid) may seep into and through the process vaginalis and collect in the scrotum forming a hydrocele. If the connection is larger and a portion of the small intestine migrates out of the abdominal cavity into the inguinal canal and/or scrotum, a hernia has developed.

Hydroceles usually aren’t painful. Typically not harmful, hydroceles may require no treatment. However, if you have scrotal swelling, see your doctor to rule out other causes, such as testicular cancer or other conditions.

What are the physical features and types hydroceles?

A hydrocele is characterized as a non-painful, soft swelling of the scrotum (one or both sides). The overlying skin is not tender or inflamed. There are two types of hydroceles:

communicating, and 
non-communicating.

Communicating hydroceles
Communicating hydroceles are present at birth and occur as a consequence of the failure of the “tail” end of the process vaginalis to completely close off. Peritoneal fluid (free fluid in the abdominal cavity) is thus free to pass into the scrotum in which the process vaginalis surrounds the testicle.

hydrocele-symptoms-healthpad.info

A characteristic feature of communicating hydroceles is their tendency to be relatively small in the morning (having been horizontal during sleep) and increase in size during the day (peritoneal fluid drainage assisted by gravity). Actions which increase intra-abdominal pressure (for example, crying, severe coughing, etc.) will also tend to increase the size of the hydrocele.

Non-communicating hydroceles
Non-communicating hydroceles may also be present at birth or develop as a boy matures. In a non-communicating hydrocele the tail end of the process vaginalis has closed appropriately. The fluid surrounding the testicle is created by the lining cells of the process vaginalis and is unable to either drain or be reabsorbed efficiently and thus accumulates. Since this fluid is walled off, the size of the hydrocele is generally stable and does not reflect intra abdominal pressure.

How are hydroceles diagnosed?

The diagnosis of a hydrocele is generally made clinically. An apt description of a hydrocele surrounding a palpable (something that can be felt) testis would be that of a small water balloon containing a peanut. The differences between communicating and non-communicating hydroceles described above help to support the suspected diagnosis.

[box]A bedside test, transillumination, provides confirmation of the condition.

Transillumination involves placing a small light source (commonly an otoscope – the medical device used to examine the ear) against the swollen scrotum.[/box]

The fluid filled nature of the hydrocele side is distinctly different from the non-involved side of the scrotum. In rare cases either ultrasound or X-ray study of the region may be indicated. In unusual cases where a hydrocele may be a secondary phenomenon to pathologic cause (caused by disease), surgical exploration may be necessary to establish the diagnosis.

What is the treatment for hydroceles?

In 95% of congenital (present at birth) hydroceles, the natural history is one of gradual and complete resolution by one year of age. For those lasting longer than one year or for those non-communicating hydroceles that manifest after the first year, surgical repair is indicated since these rarely resolve spontaneously.

What are other non-tender scrotal swelling conditions?

The differential diagnosis (list of possibilities) of chronic non tender scrotal swellings (besides hydroceles) includes:
Hernia: A hernia involves the introduction of a segment of the small intestine into the inguinal canal. A sign of a hernia in the small intestinal region is swelling in the groin alone, or may also include the scrotum on the same side. Many complain of an “ache” or “sense of fullness” during this time. If the small intestine spontaneously slides back into the abdominal cavity or if a physician reduces it, the patient is generally referred to a surgeon for closure of the inguinal canal as a preventative move to preclude a repeat experience.

If the small intestine is trapped and cannot be reduced, this is a surgical emergency and the patient will be brought to the operating room in order to avoid intestinal swelling and subsequent limiting of blood flow to the region, and consequent possible death of the trapped bowel tissue.

Varicocele: A varicocele represents engorgement of the testicular veins and clinically has been likened to a “bag of worms”. While it is a relatively rare finding in the preadolescent, approximately 20% of late teens and adult men have been found to have a varicocele. More common on the left side of the scrotum, the varicocele characteristically “deflates” when the male reclines, and becomes engorged due to gravity when standing.

[box]In the older teen and adult, varicoceles generally require no specific management other than observation.

In a younger male, if the varicocele becomes painful, or there is an associated size decrease in the same sided testicle, evaluation with a doctor specializing in urology conditions (urologist) should be sought.[/box]

Tumor: childhood tumors of the structures contained within the scrotum are more often benign when compared to those of teens and adults. The most common tumor in this latter age range is testicular cancer. As a response to the notoriety of Lance Armstrong’s battle with testicular cancer, the recommendation for monthly self-testicular exams (especially for teens and young adults who have a predisposition for this cancer) has found a more receptive audience than in the past.

Hydrocele At A Glance

While hydroceles may occur in either gender, they are much more common in males.

A hydrocele is a collection of clear fluid in a thin walled sack present in the scrotum.

Hydroceles may be either one sided or occupy both sides.

Hydroceles are painless, soft swellings and may be either present at birth (congenital) or develop later.

A very large majority of hydroceles present at birth resolve spontaneously by one year of age.

Hydroceles that are not congenital or those still present after one year of age generally warrant surgical correction.

There are other conditions that must be considered when evaluating a boy with chronic, non-tender scrotal swelling. These include hernia, varicocele and tumor. Physical examination is very helpful in sorting through these options. Rarely are diagnostic or invasive studies necessary.

Causes

Hydroceles are common in newborn infants.

During normal development, the testicles descend down a tube from the abdomen into the scrotum. Hydroceles result when this tube fails to close. Fluid drains from the abdomen through the open tube. The fluid builds up in the scrotum, where it becomes trapped. This causes the scrotum to become swollen.

hydrocele-causes-healthpad.infoHydroceles normally go away a few months after birth, but their appearance may worry new parents. Occasionally, a hydrocele may be associated with an inguinal hernia.

Hydroceles may also be caused by inflammation or injury of the testicle or epididymis, or by fluid or blood blockage within the spermatic cord. This type of hydrocele is more common in older men.

The main symptom is a painless, swollen testicle , which feels like a water balloon. A hydrocele may occur on one or both sides.

During a physical exam, the doctor usually finds an swollen scrotum that is not tender. Often, the testicle cannot be felt because of the surrounding fluid. The size of the fluid-filled sack can sometimes be increased and decreased by pressure to the abdomen or the scrotum.

If the size of the fluid collection varies, it is more likely to be associated with an inguinal hernia.

Hydroceles can be easily demonstrated by shining a flashlight (transillumination) through the enlarged portion of the scrotum. If the scrotum is full of clear fluid, as in a hydrocele, the scrotum will light up.

An ultrasound may be done to confirm the diagnosis.

Hydroceles are usually not dangerous, and they are usually only treated when they cause discomfort or embarrassment, or if they are large enough to threaten the testicle’s blood supply.

One option is to remove the fluid in the scrotum with a needle, a process called aspiration. However, surgery is generally preferred. Aspiration may be the best alternative for people who have certain surgical risks.

Sclerosing (thickening or hardening) medications may be injected after aspiration to close off the opening. This helps prevent the future build up of fluid.

Hydroceles associated with an inguinal hernia should be repaired surgically as quickly as possible. Hydroceles that do not go away on their own over a period of months should be evaluated for possible surgery. A surgical procedure, called a hydrocelectomy, is often performed to correct a hydrocele.

Generally, a simple hydrocele goes away without surgery. If surgery is necessary, it is a simple procedure for a skilled surgeon, and usually has an excellent outcome.

Complications may occur from hydrocele treatment.

Risks related to hydrocele surgery may include:

  • Blood clots
  • Infection
  • Injury to the scrotal tissue or structures

Risks related to aspiration and sclerosing may include:

  • Infection
  • Fibrosis
  • Mild-to-moderate pain in the scrotal area

Call for an appointment with your health care provider if you have symptoms of hydrocele (to rule out other causes of a testicle lump).

Acute pain in the scrotum or testicles is a surgical emergency. If enlargement of the scrotum is associated with acute pain, seek medical attention immediately.

Hydrocele – Disease Definition, Description for Students
Definition of Hydrocele
A hydrocele is an accumulation of fluid in any sac-like cavity or duct – specifically in the tunica vaginalis testis or along the spermatic cord. The condition is caused by inflammation of the epididymis or testis or by lymphatic or venous obstruction of the cord.

The term hydrocele literally means a sac of water.

Description of Hydrocele
Scrotal malignancies are rare and of unknown etiology. There are, however, a number of benign scrotal conditions that may present as a scrotal mass and must be differentiated from a malignant process.

A hydrocele is a collection of serous fluid between the two layers of the tunica vaginalis which normally surrounds the testis. This is the most common benign cause of scrotal swelling and has been estimated to occur in as many as 1 percent of the adult male population.

Causes and Risk Factors of Hydrocele
In the pediatric age group, it is usually due to a patent processus vaginalis.

In older men, any process that acts to stimulate increased production of serous fluid (e.g., tumor, inflammation, trauma) by the tunica or decreases the resorption of this fluid (e.g., inguinal surgery) by the scrotal lymphatics or venous system will result in the formation of a hydrocele.

Symptoms of Hydrocele
Men who appear at a physician’s office for the evaluation of a scrotal mass are frequently asymptomatic. It is not unusual to elicit an incidental history of scrotal or perineal trauma, which has prompted self-examination and discovery of the mass. The history of frequency, urgency, and dysuria associated with bacteriuria and of painful scrotal swelling suggests an inflammatory cause. There may also be pain in the groin or testicle.

An accurate diagnosis can usually be made solely on the basis of physical findings. A complete examination of the scrotum – consisting of inspection, palpation, and transillumination – is made in every case.

[box]The presence of erythema and edema with loss of the normal scrotal rugae is suggestive of an inflammatory lesion (i.e., epididymitis or epididymo-orchitis).

In the presence of acute epididymitis, the epididymis is exquisitely tender to palpation and, in the absence of orchitis, easily separated from the normal testicle.

Pain is aggravated by standing and should be relieved when the testicle is elevated (Prehn’s sign).[/box]

A smooth, cystic feeling mass completely surrounding the testicle and not involving the spermatic cord is characteristic of a hydrocele. A cystic, non-tender mass arising from the head of the epididymis and distinct from the testicle is characteristic of a spermatocele.

Treatment of Hydrocele
When they are small and asymptomatic, hydroceles, spermatoceles, and varicoceles require no therapy other than reassurance. Indications for intervention include scrotal discomfort or disfigurement due to the sheer size of the mass. Treatment options include needle aspiration, aspiration with injection of a sclerosing agent, and surgical excision.

Simple needle aspiration is seldom therapeutic because the cause of the problem is not addressed and the fluid typically reaccumulates.

Excellent results are possible with either surgical excision or needle aspiration combined with injection of a sclerosing agent. Success rates ranging from 33 to 100 percent have been reported.

When intervention is indicated, surgical excision is perhaps the most effective form of treatment. In surgery, the bulk of the hydrocele sac is cut away, and what remains is turned inside out. As a result, the fluid-secreting surface is now in contact with the inner skin of the scrotum rather than that of the testicle with which it made previous contact. The scrotal tissue blots up any fluid that is secreted, unlike the testicular tissue that cannot absorb fluid.

Simplified Summary Hydrocele (Urology)

A hydrocele is a fluid-filled sac that surrounds a testicle, causing swelling of the scrotum. About one in 10 male infants has a hydrocele at birth, but most hydroceles disappear without treatment within the first year of life. Additionally, men — usually older than 40 — can develop a hydrocele due to inflammation or injury within the scrotum.

Hydroceles usually aren’t painful. Typically not harmful, hydroceles may require no treatment. However, if you have scrotal swelling, see your doctor to rule out other causes, such as testicular cancer or other conditions.
Signs & Symptoms

Usually the only indication of a hydrocele is a painless swelling of one or both testicles.

Summarized Hydrocele Causes, etc

Causes

For baby boys, a hydrocele can develop in the womb a few weeks before birth. At about the eighth month of gestation, the testicles descend from the developing baby’s abdominal cavity into the scrotum. A sac (processus vaginalis) accompanies each testicle, allowing fluid to surround them.

In most cases, the sac closes and the fluid is absorbed. However, if the fluid remains after the sac closes, the condition is known as a noncommunicating hydrocele. Because the sac is closed, fluid can’t flow back into the abdomen. Usually the fluid gets absorbed within a year.

In some cases, however, the sac remains open. With this condition, known as communicating hydrocele, the sac can change size or, if the scrotal sac is compressed, fluid can flow back into the abdomen.

In older males, a hydrocele can develop as a result of inflammation or injury within the scrotum. Inflammation may be the result of infection of the small coiled tube at the back of each testicle (epididymitis) or of the testicle (orchitis).

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Comments

  1. I never could get emotionally close to anyone. I have friends and all that, but I am a narcissist and could never really fell deep emotions such as love. I hate people putting their hands on me. Also, one of my balls is bigger than the other because I have a hydrocele, which is a fluid filled area around the balls. I think that it may make me infertile, even though the doctor said it shouldn’t. I am self-conscious about that. I have never even asked a girl out before because I am too nervous to.

    If I had kids, I would be using them to further my own political goals, not for any other reason.
    I know I will never get a girlfriend and I know I will never have sex, so why should I attempt to get a girlfriend?
    I am too embarrassed to have sex.

    1. Hey, to cure hydrocele, you should do Yoga(on empty stomach) as : 1. Garudasana, 2. Gomukhasana, 3. forward bend (never backward bend) 4. daily 5-10 squats while tightly clamping upper ear bone with fingers (never just squat). 5. very slow kapalbhati, 6. light bahya pranayam.

      This will certainly cure your hydrocele in some days.

      Ayurveda has without surgical natural cure to this problem.

  2. (can someone provide me with a list of some disorders of the reproductive system for males)
    Its my health class & i need to talk about a disorder in a males reproductive system. If you guys KNOW ANY please list them! its due tomarrow!:O please & thank you!

  3. I’d like to discuss with someone, preferably a doctor, about testicular cancer in general. I feel I may be being lied to by a family member about this subject, and I need to know more about the cancer itself and treatments. If there’s anyone out there, whether a doctor or someone who’s had testicular cancer, please help!

  4. I’d like to discuss with someone, preferably a doctor, about testicular cancer in general. I feel I may be being lied to by a family member about this subject, and I need to know more about the cancer itself and treatments. If there’s anyone out there, whether a doctor or someone who’s had testicular cancer, please help!

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