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Hydrocele testis

Hydrocele testis
Gray1148.png
The right testis, exposed by laying open the tunica vaginalis. (Tunica vaginalis is labeled at upper right.)
Classification and external resources
Specialty urology
ICD-10 N43.0-N43.3
ICD-9-CM 603
DiseasesDB 6137
eMedicine emerg/256 med/2778 ped/1037
MeSH D006848
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A hydrocele testis is an accumulation of clear fluid in the tunica vaginalis, the most internal of membranes containing a testicle. A primary hydrocele causes a painless enlargement in the scrotum on the affected side and is thought to be due to the defective absorption of fluid secreted between the two layers of the tunica vaginalis (investing membrane). A secondary hydrocele is secondary to either inflammation or a neoplasm in the testis.

A hydrocele usually occurs on one side, but can also affect both sides. The accumulation can be a marker of physical trauma, infection, tumor or varicocele surgery, but the cause is generally unknown. Indirect inguinal hernia indicates increased risk of hydrocele.

A hydrocele is normally seen in infant boys, as enlarged scrotum. In infant girls, it appears as enlarged labia. However, hydroceles are more common in boys than girls.

During embryogenesis, the testis descends through the inguinal canal, drawing a diverticulum of peritoneum into the scrotum as it descends. This peritoneal tissue is known as the processus vaginalis. Normally, the communication between the processus vaginalis and the peritoneum is obliterated, and the tunica vaginalis is the tissue that remains overlying the testis and the epididymis. Congenital hydrocele results when the processus vaginalis remains patent, allowing fluid from the peritoneum to accumulate in the scrotum.

A hydrocele feels like a small fluid-filled balloon inside the scrotum. It is smooth, and is mainly in front of the testis. Hydroceles will vary greatly in size and are normally painless and harmless. However, as the fluid continues to accumulate and the scrotum further enlarges, more discomfort can be expected. Large hydroceles will cause discomfort because of their size. Sometimes pain can be in both testicles as pressure from the enlarged area puts pressure against the unaffected area which can cause discomfort to the normal testicle. It has also been found to decrease a man's sex drive and makes him less active for fear of enlarging the mass. As the fluid of a hydrocele is transparent, light shone through the hydrocelic region will be visible from the other side. This phenomenon is called transillumination.


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