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Hydrocele in adult men: Why it happens?

Hydrocele Topic
FB Dr Soarawee
Soarawee Weerasopone, MD

Andrologist
Royal Phnom Penh hospital, Kingdom of Cambodia

Usually, there are a lot of patients getting to my office with a painless scrotal swelling.  The disease that we should have aware of, is a Hydrocele, therefore in this context we will remain our discussion on the hydrocele in adult men. Firstly, we better clarify whether why hydrocele happens. I might have your permission for me to pay a little explanation on the scrotal anatomy. There is a room between scrotal skin and testicles which is containing a minimal fluid for making testes freely mobilized. This room is covered up with a layers so-called “Tunica vaginalis”. Tunica vaginalis is facilitating the fluid volume to be balanced so between fluid production and absorption within this room shall not be overflowed. But when this equilibrium is interfered, so the remains fluid in this room becomes increasing, so they called this a “Hydrocele” conditions.

Balloon like appearance
Scrotal hydrocele – A Balloon-like appearance inside the scrotal sac.

When we can rule out the cause of a Hydrocele, then we can categorized it into 2 etiologies

  1. The overproducing of the fluid
    • Inflammation process for examples; infection of the testis or epididymis, syphilis
    • Injury from trauma or the complication after hernia operation
    • Malignancy around genital area
  2. Abnormal in fluid absorbed

Once patients got to Urology office, full history will be taken, and a scrotal physical examination must be done in order to make sure that it is not something else camouflage. Here are some diseases that is important to rule out:

Full history taking
Full history taking and physical examination will be done once patients visit at Urology office.
  • Inguinal hernia
  • Epididymo-Orchitis – Infection of the testes and epididymis
  • Testicular tumor

The imaging modality which is very usefully to confirm a Hydrocele diagnosis; it is the “Ultrasonography of the scrotum”. It takes very seriously role to measure the size and characteristic of the Hydrocele accuracy, either way it also has ability to confirm that there is no any suspicious of testicular tumor hidden within the hydrocele.

Scrotal ultrasound
Scrotal ultrasonography is frequently used imaging modality in scrotal hydrocele.

Once Hydrocele is diagnosed, we will treat hydrocele according to its own causes and the surveillance will take after the solution whether it was solve or not. In the meantime, if the hydrocele isn’t gradually resolved then the surgery will be granted to have role in this circumstance. There are 2 major surgical techniques dealing with Hydrocele.

  1. Open scrotal surgery – Need to perform in the operating room under anesthesia, lower in postoperative complication and recurrent rate.
  2. Needle aspiration – for someone who doesn’t want to do the surgery, In-the-office needle aspiration may be a choice for them, but patient has to accept more chances in intra-scrotal bleeding and higher in recurrent rate.
Operation for Hydrocele
Surgical intervention will be considered when scrotal hydrocele becomes complicated.

The important message that Urologist would like to give to the patient is, Hydrocele is a benign disease that means it will never be at risk for their lives, but it rather annoying their quality of lives instead. One way that could have punched a Hydrocele, it is mainly will be take on the surgery and still flush back for some recurrent rate by the way.

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