Patient's question:
Patient Gender: MaleDetailed Condition and Purpose of Consultation: Testicular hydrocele was diagnosed about 1 month ago. It has been growing rapidly now. The right side is about 6 cm, and the left side is about 4 cm. Is the diagnosis correct? Why is it growing so fast? How should it be treated?
Doctor's answer:
Hello, an increase in fluid within the tunica vaginalis testis or spermatic cord is called hydrocele. It is classified into primary and secondary based on its cause. Primary hydroceles often occur during fetal development when the testis descends from the abdominal cavity into the scrotum through the inguinal canal, carrying the processus vaginalis along (Figure 43).After birth, most of the processus vaginalis closes, leaving only a small sac around the testis as the tunica vaginalis testis. Excessive fluid accumulation within this sac constitutes a hydrocele. If the deep ring (internal inguinal ring) of the processus vaginalis closes while the spermatic part remains open, the spermatic hydrocele communicates with the testicular hydrocele, forming an infantile hydrocele. If the processus vaginalis remains open, the testis, spermatic cord, and abdominal cavity are connected, allowing fluid to move in and out of the abdomen, resulting in a communicating hydrocele, which is known as congenital hydrocele. If only the ends of the processus vaginalis close while the middle part remains open, it forms a spermatic hydrocele.
Secondary hydroceles are caused by lesions of the testis or epididymis (a structure adjacent to the testis composed of efferent ductules and epididymal ducts), such as trauma, tumors, or infections (especially filariasis).
Clinical manifestations include the gradual enlargement of a cystic mass in the scrotum. When the fluid is minimal, there are no symptoms, but excessive fluid can cause pulling or aching discomfort. Significant pain suggests infection within the hydrocele. The fluid is translucent, so when a hydrocele is present, shining a flashlight on one side of the mass allows faint red light to pass through from the other side. The testis may be difficult to palpate (as it is buried within the cyst). In infantile hydroceles, the spermatic cord is also difficult to feel. In communicating hydroceles, when the patient lies down, the fluid flows into the abdomen, causing the scrotal mass to shrink or disappear, at which point the testis can be palpated.