Introduction
In medicine, hydrocele, or water breakage, is a collection of water in the testicular area. There are different forms of hydrocele, which can differ both in their localization and their origin. A hydrocele differs from an edema – which is also an accumulation of fluid – in the place of occurrence.
While hydrocele occurs in the scrotal compartment, edema is by definition found in scrotal sheaths. In hydrocele, the accumulation of fluid is thus found around the testicle, whereas in edema it is found in the testicle. There are different forms of hydrocele, depending on their localization:
- First, the hydrocele testis, which is the accumulation of fluid around the testis described above.
- Secondly, the hydrocele funiculi.
This form represents an accumulation of fluid along the spermatic cord. The funiculus spermaticus, or spermatic cord is a structure that extends from the groin to the testicles. The spermatic cord is a structure that runs from the groin to the testicles, and contains the spermatic duct, nerve fibers, and blood vessels that supply the testicles.
Cause
Roughly speaking, there can be two causes for a hydrocele: it can be congenital – i.e. existing from birth – or acquired. To understand the congenital form of a hydrocele, one must first consider the embryonic development of the testis: The testis sinks from the abdominal cavity into the scrotum before birth. This process is called descensus testis, it takes place in the foetus after it has been created at the level of the kidneys during the embryonic phase.
During this descent into the scrotum, the testis naturally pulls part of the peritoneum with it. The peritoneum is, so to speak, the inner lining of the abdominal cavity, which seals it like a sack, air- and watertight. The pulled along part of the peritoneum is usually sclerosed and recedes, so that the testicles and peritoneum exist separately.
However, if the connection is not sclerosed, there is still a connection between the peritoneum and the testicles. Via this connection, water from the peritoneal cavity can now reach the testicular area, thus leading to a hydrocele. The acquired form of the hydrocele has other causes: In addition to inflammation in the testicle and epididymis area, violent effects on the testicles and lower abdomen can also play a role.
However, the exact cause has not been conclusively clarified; a multifactorial event is suspected. The acquired form of the hydrocele has other causes: In addition to inflammation in the testicular and epididymal area, violent effects on the testicles and lower abdomen can also play a role. However, the exact cause has not been conclusively clarified; a multifactorial event is suspected.
The diagnosis of a hydrocele is relatively simple: On the one hand, a medical examination and a detailed discussion of the problem give a first indication. On the other hand, the attending physician can determine fluid accumulation by palpation of the testicle. An exact examination can be done very easily by means of ultrasound, often also called “sono”, or “sound” for short.
Sound waves are directed onto the body, which are then reflected differently by different body structures. This principle has been copied from the sonar of submarines and ships, which use the same principle to determine depth. In this way, liquids, bones, and tissue structures can be distinguished, which helps to answer the question of possible fluid accumulations.
The advantages of ultrasound are its simple and quick application, its low cost, and its harmlessness for the human organism. Diaphanoscopy is another, albeit somewhat outdated, method of examining hydrocele. Apart from urology, this method is also used in many other fields.
It involves placing a light source on the body part to be examined – in this case the testicle. The strong light causes the structures under the skin to form and can be evaluated. However, since ultrasound is more accurate and no less complex or expensive, this examination method is rarely used.
