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What is testicular hydrocele?
We call testicular hydrocele accumulation of fluid around the testicle, in the scrotum. Note that this is a very general definition here. In reality, we distinguish rather two very different types of hydroceles: the hydrocele of the baby or the child, which is physiological and related to a small congenital anomaly ; and adult hydrocele, the cause of which is quite different.
The main symptom of a hydrocele is the swelling, sometimes bothersome, of one of the two bursae. It is generally not painful (excepttesticular torsion partner). Testicular hydrocele can appear and then disappear, especially if it is due to an infection.
What are the causes of hydrocele of the testis?
Testicular hydrocele in babies, visible from birth
In babies or very young children, hydrocele is due to the persistence of the peritoneo-vaginal canal. Between the third month of pregnancy andterm of pregnancy, the fetal testicles migrate from the lumbar region to the future scrotum. During this process, a small piece of the peritoneum, membrane (or “bag”) in which the digestive organs are located, will descend towards the scrotum accompanying the descent of the testicle, thus forming the peritoneo-vaginal canal. This channel closes naturally in the first months of the baby’s life. But when it persists, fluid can pass from the peritoneum to the scrotum, and form a hydrocele. Normally, the duct degenerates naturally, and a very small sac persists: the vaginal tunica, a vestige of the peritoneal cavity, which contains the testicle.
If this canal persists, a little fluid from the peritoneum can therefore migrate into the bursa, and cause a hydrocele. The amount of fluid may vary during the same day, or change very little if the opening of the channel is very small. It is not uncommon, therefore, for a 20-year-old adult to present with what is called a child’s hydrocele, linked to the persistence of the peritoneo-vaginal canal. Because it depends on the degree of opening of the canal and the activities practiced.
Note that other pathologies linked to the persistence of this peritoneo-vaginal canal can be more serious than a hydrocele, such as the inguino-scrotal hernia (when a piece of intestine has inserted into the canal) with a risk of hernial strangulation, or in a much more benign way, cord cyst (presence of a fluid pocket between the peritoneum and the scrotum).
In adults, it appears more frequently following infection, inflammation or trauma
In adults, the peritoneo-vaginal canal is closed, there is no communication between the peritoneum and the bursae. The occurrence of a hydrocele is then linked to an infection or a trauma: shock on the bursae, testicular torsion, infection with inflammation … There, the fluid is secreted by the tunica vagina which protects the testicle. There is both a phenomenon of secretion and resorption of this liquid. “But one day, for a reason related to an inflammatory phenomenon, the resorption capacities of this serous fluid are lower than the capacities of production of the liquid.”, Explains Dr Ludovic Ferretti, urologist near Bordeaux. Hence the formation of a hydrocele, an excess of fluid in the testis.
How to differentiate it from cancer, hernia or testicular varicocele?
A testicular hydrocele is differentiated from other pathologies of the testis by clinical examination, which may be supplemented by ultrasound.
The clinical diagnosis of hydrocele is made by transillumination : this consists in placing a flashlight at the level of the scrotum, on the skin of the bursa, and to observe what happens. In the case of hydrocele, the swollen bursa will “light up” because the excess fluid allows light to pass through. This will not necessarily be the case in the presence of another pathology.
In the case of a cancer, the urologist will feel like a “stone”, a solid mass, when palpating the testicle. Ultrasound may also reveal the presence of a nodule in the testis, where only fluid would have been seen in the case of a hydrocele.
La varicocèle refers to the dilation of the veins at the level of the spermatic cord, a cord which includes in particular the blood vessels supplying the testicle as well as the vas deferens used by the spermatozoa during ejaculation. Varicocele is diagnosed both by a clinical examination and by a so-called “scrotal” ultrasound, which makes it possible to visualize the venous dilation.
Lainguinal hernia of the newborn corresponds to passage of abdominal viscera (small intestine most often) in the peritoneal-vaginal canal which has persisted, and is visible in the groin (more precisely the inguinal canal). It is diagnosed using the same clinical examination as hydrocele: at the lamp, the urologist will not observe light, where a hydrocele will let light through. Note that, here too, ultrasound can confirm the diagnosis. In addition, hydrocele does not cause digestive symptoms, while theinguinal hernia may cause digestive obstruction with nausea, vomiting, stop transit. In this case there is a risk to life with the possibility of acute peritonitis.
Hydrocele: what treatment to cure it?
In children, treatment for congenital hydrocele is surgical, and consists in closing the peritoneo-vaginal canal which has persisted. Because it is a question of avoiding the other complications, more serious, related to the persistence of this channel, such as thehernia inguino-scrotale.
The surgery usually takes place after 12-18 months, because the peritoneo-vaginal canal sometimes persists for several months after birth, without it being pathological. Therefore, some time should be allowed to ensure that surgery is necessary if not inevitable.
In adults, reaction hydrocele generally causes discomfort due to the large volume of the concerned purse, as well as aesthetic damage. If it persists for several months, or even years, after the treatment of the cause (infection, trauma, etc.), surgery must also be used, because there is no medical treatment. The puncture of the excess liquid does not solve anything if the cause of the hydrocele has not been treated upstream, because the hydrocele then returns shortly after (notion of balance between production and absorption of the liquid).
How to operate and remove a hydrocele?
In children, hydrocele surgery involves closing the peritoneo-vaginal canal through an inguinal incision in the groin. This operation can be performed on an outpatient basis or require hospitalization from one to several days. General anesthesia is most often required, although some urologists opt for locoregional anesthesia. As with any operation, a pre-anesthetic consultation takes place with an anesthetist before the surgery.
In adults, the intervention consists of a scrotal incision, in other words at the level of the stock exchanges. It is then a question of removing the vaginal tunica (often more simply called “vaginal” by urologists), this pocket of fluid contained in the bursae and in contact with the testicles. “There are a little more hematomas in this type of surgery (compared to hydrocele surgery in children, editor’s note) because nature abhors a vacuum ”, specifies Dr. Ludovic Ferretti, who adds that it is the most frequent postoperative complication in this type of surgery, and which results from bleeding during or after the operation. On the other hand, infection at the surgical site remains relatively rare and benign.
Note that a temporary drain is sometimes posed to evacuate liquids, but this technique is little used in the case of hydrocele of the child.
Some information to know about the postoperative follow-up: in adults, convalescence and sick leave depend on the profession you exercise; baths are not recommended until complete healing, and local care can be extended in the event of delayed healing. Traditional painkillers are prescribed for postoperative pain.
Hydrocele: what consequences for fertility?
If done correctly, the surgery to remove a hydrocele will have no effect on the skin.fertility. A hydrocele by itself does not cause a decrease in fertility. “There is a small risk if you damage the vas deferens or the epididymis where sperm pass.”, But this risk is under control and well known to urologists.