The term hydrocele comes from the Greek hydro; water and cele from the word; tumor. Hydrocele, also known as water hernia among the people, 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 of fluid is present between the testis and these membranes in order to ensure the lubrication of the testis. While there is fluid present normally, this amount of fluid in hydrocele can get up to 100–200 ml. Sometimes it can even reach much larger volumes.
Types of hydrocele
Congenital (Congenital) Hydrocele: When the baby is in mother's womb, the baby’s testes are 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 sack called the scrotum. During this descent, the peritoneum, which is dragged together, descends with the testis till the scrotum like a finger in a glove. After a while, this sack closes and becomes a filamentous structure. If this sac does not close, the intra-abdominal fluid will pass through this opening and accumulate in the scrotum around the testis and cause swelling. If the hydrocele is limited to the membranes surrounding the testis, it is called testicular hydrocele, and 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 boys. Most neonatal hydroceles are congenital, but it should not be forgotten that tumors, infections or circulatory disorders may also lead to development of hydrocele.
Two types of hydrocele are observed in the newborn periods.
Communicating hydrocele (associated hydrocele); While it means that the peritoneum descending to the scrotum is completely open,
In non-communicating type hydroceles, this means that the abdominal part of the membrane is closed abnormally and the peritoneal fluid is trapped within the scrotum.
Adult hydrocele: Hydrocele occurs in about 1 percent of adult men and usually seen in men over the age of 40.
In adult men and older people, hydrocele may occur due to trauma to the scrotum, inflammatory diseases of the testis and its appendages, testicular tumors, varicocele surgeries and potentially after radiotherapy. Unilateral hydrocele occurs in 70 percent of kidney transplant patients. Testicular torsion (sudden rotation of the testis) may cause reactive hydrocele in 20 percent of patients and may mask testicular torsion that requires immediate intervention.
Hydrocele diagnosis: The diagnosis of hydrocele can be achieved easily by history taking and physical examination. Many hydrocele patients do not report any complaints, patients usually apply to the doctor because of 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 discomfort from the pain in the lumbar region. Pain usually does not occur, if any, may be due to the accompanying acute epididymal infection. In congenital hydrocele, it is typical that the swelling in the scrotum disappears in the morning and becomes evident later in the day. Fever, chills, nausea, vomiting are not usually seen in simple hydroceles.
In the examination of the scrotum, hydrocele is located in the upper anterior part of the testis. In 7-10 percent of cases it presents bilaterally. Especially right side hydroceles are often associated with inguinal hernia. If there is no infection, there will be no redness or discoloration of the scrotum. When the light is shone on the scrotum in a dark room, if the cause of swelling is hydrocele, it transmits the light, this is called transullimination. In congenital hydrocele, swelling becomes evident when the child stands up or cries, but disappears during examination or when lying down.
Inguinal-scrotal ultrasonography can be performed to confirm the diagnosis, and is effective in demonstrating abnormalities in the testis and its appendages (especially testicular tumors), complex cystic masses, spermatocele, or concomitant hernia. Testicular color Doppler ultrasonography is used to show testicular blood flow and should be performed especially if testicular torsion is suspected.