Causes
The causes for the accumulation of water in the testicles can be manifold. In addition, a distinction must be made in the search for causes as to whether a hydrocele is congenital or acquired. The congenital (primary) hydrocele is caused by fluid accumulating in a funnel-shaped bulge of the peritoneum in the region of the unborn child’s abdomen during embryonic development.
This bulge represents the transition from the peritoneum to the child’s scrotum. Normally, the bulge develops completely back within the womb except for a rest. In addition, it must be noted in this context that the testicles do not mature in the scrotum but in the abdominal cavity during the development of the fetus.
Only shortly before birth, shortly after birth, the testicles descend from the abdominal cavity into the scrotum. During this descent the testicles slide down through the funnel-shaped bulge into the scrotum. Afterwards the connection to the actual peritoneum should close.
Primary water in the scrotum is formed when the connection to the peritoneum is not or only to a small extent formed. Children who suffer from congenital water in the testicles often also tend to develop a so-called inguinal hernia. However, the accumulation of water in the testicles can also have acquired causes (secondary water hernia).
The typical causes for the accumulation of water in the testicles of older boys or adults are: inflammatory processes in the area of the testicle or epididymis injuries or violent effects Ulcers (tumors) of the testicles In addition, it can often be observed that after a surgical procedure on the scrotum, water accumulates in the testicles. In general, it can be assumed that the secondary water rupture leads to an imbalance between the formed and absorbed testicular fluid. The body of the affected person either produces too much testicular fluid or is not able to absorb enough fluid.
- Inflammatory processes in the area of the testis or epididymis
- Injuries or violent impacts
- Ulcers (tumors) of the testicles
Diagnosis in case of suspected presence of water in the testicles is divided into several steps.First of all, during a detailed doctor-patient consultation (anamnesis), it is determined which complaints are present in the patient concerned. Also the chronological course of the disease, possible previous diseases and complaints that frequently occur in the family of the affected person play a decisive role in the diagnosis of water in the testicles. Especially tumor diseases of the testis can occur more frequently within the family and can be a cause for the accumulation of water in the testis.
Following this doctor-patient consultation, an orienting physical examination is usually performed. During this examination the doctor palpates the scrotum and checks whether changes in the area of the scrotum can be detected. In case of a hydrocele, the testicle is usually swollen on one side (in rare cases on both sides).
If the presence of water in the testicle is suspected, imaging procedures should be performed urgently. Especially the ultrasound examination (sonography) of the testis plays a decisive role in the diagnosis of water in the testis. In addition, magnetic resonance imaging may be useful in the case of water in the testis.
Furthermore, the so-called diaphanoscopy can help to identify the water breakage as such. In this procedure, the doctor uses a powerful lamp to illuminate the scrotum. If there is an accumulation of water in the testicles, brighter areas appear during the fluoroscopy. However, the problem with this examination method is that x-raying the scrotum cannot help to distinguish a water hernia from an inguinal hernia. You can read more information on this topic here: Ultrasound of the testicle