Wodniak – Patofizjologia i mechanizm

Wodniak
Patofizjologia i mechanizm

Wodniak jądra (hydrocele) to patologiczne nagromadzenie płynu surowiczego pomiędzy blaszkami osłonki pochwowej jądra lub wzdłuż powrózka nasiennego, wynikające z zaburzenia równowagi między wydzielaniem a wchłanianiem tego płynu. Wyróżnia się wodniaki komunikujące, powstałe na skutek drożnego wyrostka pochwowego otrzewnej (patent processus vaginalis), oraz niekomunikujące, związane z upośledzonym wchłanianiem lub nadprodukcją płynu. Wodniaki mogą mieć etiologię wrodzoną lub nabytą, a ich patogeneza obejmuje m.in. stany zapalne, urazy, guzy, zaburzenia drenażu limfatycznego (np. filarioza) oraz czynniki genetyczne wpływające na embriogenezę układu moczowo-płciowego. Wodniak filariozowy, wywołany przez Wuchereria bancrofti lub Brugia malayi, jest istotnym problemem w krajach tropikalnych i charakteryzuje się zaburzeniem drenażu limfatycznego moszny, prowadząc do przewlekłego gromadzenia płynu o różnym składzie (płyn surowiczy, limfa, krew). Wodniak brzuszno-mosznowy (abdominoscrotal hydrocele) to rzadki typ z komponentą wewnątrzbrzuszną, mogący powodować powikłania, takie jak niedrożność nerek.

Wprowadzenie do wodniaka jądra

Wodniak jądra (łac. hydrocele) to nieprawidłowe nagromadzenie płynu surowiczego pomiędzy blaszkami osłonki pochwowej jądra (tunica vaginalis) lub wzdłuż powrózka nasiennego u mężczyzn. Powstaje na skutek zaburzenia równowagi między wydzielaniem a wchłanianiem płynu surowiczego w osłonce jądra, co prowadzi do charakterystycznego powiększenia moszny po stronie zajętej przez wodniaka ¹². Wodniak może być obecny od urodzenia (wrodzony) lub rozwinąć się w późniejszym okresie życia (nabyty), a jego patogeneza jest złożona i zależy od wielu czynników ³.

Mechanizmy patogenetyczne wodniaka

Istnieją cztery podstawowe mechanizmy prowadzące do powstania wodniaka ¹²:

Połączenie z jamą otrzewnej przez drożny wyrostek pochwowy otrzewnej (wodniak wrodzony)
Nadmierne wytwarzanie płynu (wodniak wtórny)
Nieprawidłowe wchłanianie płynu
Zaburzenie drenażu limfatycznego struktur mosznowych, jak w przypadku wodniaków spowodowanych filariozą

Zaburzenie równowagi płynowej

Patofizjologia wodniaka obejmuje przede wszystkim zaburzenie równowagi między wytwarzaniem a wchłanianiem płynu w mosznie. To zaburzenie można dalej podzielić na pochodzące z egzogennych źródeł płynu lub wewnętrznej produkcji płynu ¹². Komórki mezotelialne wyściełające osłonkę pochwową jądra stale produkują i wchłaniają płyn, a dysfunkcja tych komórek może prowadzić do nadmiernego gromadzenia się płynu ³⁴.

Wodniak komunikujący

Wodniak komunikujący (communicating hydrocele) powstaje wskutek nieprawidłowego zamknięcia wyrostka pochwowego otrzewnej (processus vaginalis) podczas rozwoju płodowego ¹. W prawidłowym rozwoju, jądra zstępują z jamy brzusznej do moszny około 7. miesiąca życia płodowego. Każdemu jądru towarzyszy wyrostek pochwowy otrzewnej, który normalnie zamyka się przed urodzeniem, zapobiegając przepływowi płynu otrzewnowego do moszny ²³.

W przypadku wodniaka komunikującego, drożny wyrostek pochwowy otrzewnej stanowi połączenie między jamą otrzewnej a osłonką pochwową jądra, umożliwiając swobodny przepływ płynu otrzewnowego między tymi strukturami ⁴⁵. Ten typ wodniaka charakteryzuje się zmienną wielkością w ciągu dnia, ponieważ płyn może swobodnie przepływać między jamą brzuszną a moszną ⁵.

Wodniak komunikujący występuje najczęściej u dzieci i wiąże się z przetrwałym drożnym wyrostkiem pochwowym otrzewnej (patent processus vaginalis, PPV) ⁶. Jeśli połączenie jest wystarczająco duże, może również prowadzić do powstania przepukliny pachwinowej ⁷.

Wodniak niekomunikujący

Wodniak niekomunikujący (non-communicating hydrocele) powstaje, gdy wyrostek pochwowy otrzewnej jest zamknięty, ale występuje zaburzenie równowagi między wytwarzaniem a wchłanianiem płynu surowiczego przez osłonkę pochwową jądra ¹². Ten typ wodniaka zwykle utrzymuje stałą wielkość lub powiększa się bardzo powoli ³.

Wodniaki niekomunikujące mogą być wynikiem zwiększonego wytwarzania płynu lub upośledzenia jego wchłaniania. Istnieje wiele przyczyn powstawania wodniaków niekomunikujących, w tym ⁴⁵:

Filarioza – najczęstsza przyczyna wodniaka niekomunikującego w skali globalnej
Skręt przyczepka jądra
Guzy jądra
Stany zapalne lub infekcyjne (kiła, gruźlica, zapalenie najądrza)

Mechanizm wodniaka pierwotnego

Wodniak pierwotny (primary hydrocele) zazwyczaj rozwija się samoistnie u osób w średnim i starszym wieku ¹². Głównym mechanizmem jest powolne gromadzenie się płynu surowiczego, prawdopodobnie z powodu upośledzonego wchłaniania, choć dokładna przyczyna pozostaje często niewyjaśniona ³⁴.

Predysponującym czynnikiem dla rozwoju wodniaka pierwotnego jest mieszkanie w ciepłym klimacie ⁵. Wodniak pierwotny powoduje bezbolesne powiększenie moszny po stronie zajętej i uważa się, że jest spowodowany wadliwym wchłanianiem płynu wydzielanego między dwiema warstwami osłonki pochwowej jądra ⁴.

Mechanizm wodniaka wtórnego

Wodniak wtórny (secondary hydrocele) powstaje w następstwie określonych stanów patologicznych jądra ¹. Może być wynikiem urazu, stanu zapalnego (zapalenie jądra, najądrza) lub obecności guza jądra ²³.

Mechanizmy patogenetyczne wodniaka wtórnego obejmują ⁴⁵:

Bezpośredni uraz moszny
Stan zapalny wywołujący dysfunkcję osłonki pochwowej jądra
Niedrożność powrózka nasiennego
Powikłania po operacji przepukliny pachwinowej
Infekcje jądra lub moszny, w tym choroby przenoszone drogą płciową

Wodniak filariozowy

Szczególnym typem wodniaka jest wodniak filariozowy, będący następstwem infekcji pasożytniczej wywołanej przez Wuchereria bancrofti lub Brugia malayi ¹². Filarioza limfatyczna dotyka około 120 milionów ludzi w ponad 73 krajach, głównie w regionach tropikalnych i subtropikalnych ³⁴.

Mechanizm powstawania wodniaka filariozowego polega na zaburzeniu drenażu limfatycznego struktur mosznowych ⁵. Dorosłe nicienie przedostają się do naczyń limfatycznych moszny, powodując ostre zapalenie naczyń limfatycznych, limfangiektazję i ostry wodniak. Powtarzające się cykle zapalenia z czasem prowadzą do powstania przewlekłego wodniaka ².

Wodniak filariozowy może występować jako ⁶:

Prawdziwy wodniak (hydrocele) – gromadzenie płynu surowiczego
Chylocele – gromadzenie limfy
Hematochylocele – gromadzenie krwi z limfą

Termin „filaricele” został zaproponowany jako określenie obejmujące wszystkie trzy powyższe typy ⁶⁷.

Wodniak brzuszno-mosznowy

Wodniak brzuszno-mosznowy (abdominoscrotal hydrocele, ASH) to rzadki stan charakteryzujący się obecnością torbielowatej masy zajmującej zarówno mosznę, jak i jamę brzuszną ¹. Charakterystyczną cechą jest obecność dwóch worków wodniaka w jamie brzusznej i mosznie, połączonych ze sobą, przy czym ucisk jednej strony powoduje powiększenie drugiej ¹.

Dokładny mechanizm powstawania ASH nie jest w pełni wyjaśniony, ale proponowane są trzy główne teorie ¹²:

Dogłowowe rozszerzenie prostego wodniaka – w wyniku zwiększonego ciśnienia wewnątrz wodniaka (teoria Dupuytrena)
Wysokie zamknięcie wyrostka pochwowego otrzewnej
Wyrostek pochwowy działający jak zastawka jednokierunkowa z dogłowowym rozszerzeniem worka wodniaka

Ten typ wodniaka jest najrzadszym rodzajem i charakteryzuje się komponentą pachwinowo-mosznową oraz drugą większą lub mniejszą wewnątrzbrzuszną. Komponent wewnątrzbrzuszny może być na tyle duży, że może powodować niedrożność nerek ³.

Wpływ czynników genetycznych i rozwojowych

Najnowsze badania sugerują, że w patogenezie wodniaka mogą odgrywać rolę również czynniki genetyczne. Pomimo powszechnego występowania wodniaka, jego podłoże genetyczne nie było wcześniej dobrze opisane ¹.

Badania wskazują na związek wodniaka z genami kluczowymi dla embriogenezy układu moczowo-płciowego. Szczególnie istotne są geny PAX8, INHBB, AMHR2 i SHH, które są krytyczne dla rozwoju układu moczowo-płciowego i są związane z zespołami moczowo-płciowymi dziedziczonymi mendlowsko ¹.

Zidentyfikowane loci wpływają na ekspresję genów w strukturach układu moczowo-płciowego i są związane z wieloma markerami funkcji nerek. Te powszechne warianty genów kluczowych dla embriogenezy układu moczowo-płciowego są związane z wodniakiem u dorosłych, sugerując, że geny te mogą utrzymywać prawidłową anatomię moszny u dorosłych ¹².

Warto również zwrócić uwagę na mechanizm zstępowania jąder i zamykania się wyrostka pochwowego otrzewnej, który jest kontrolowany przez regulację autonomicznego układu nerwowego. Jądro zstępuje przez wyrostek pochwowy dzięki sile napędowej generowanej przez mięśnie pochodzące z pasma przyczepu jądra (gubernaculum). Po przeniesieniu jądra, mięśnie gładkie powinny ulec zaprogramowanej śmierci komórkowej w celu obliteracji wyrostka pochwowego ³.

Osiągnięcie zaprogramowanej śmierci komórkowej wymaga przejściowego zmniejszenia napięcia współczulnego, ale zwiększenia napięcia przywspółczulnego. Ponieważ napięcie współczulne jest zależne od androgenów, zmniejszenie poziomu androgenów w trzecim trymestrze wydaje się być odpowiedzialne za ten proces. Zmiany w czasie, intensywności lub czasie trwania zmniejszenia napięcia współczulnego pod kontrolą ośrodkowego układu nerwowego powodują przepuklinę, wodniak lub nieprawidłową lokalizację jąder ³.

Wpływ wodniaka na tkanki jądra

Długotrwała obecność dużych wodniaków może prowadzić do atrofii jądra z powodu ucisku lub zaburzenia dopływu krwi ¹. Dysmorfizm jądra (testicular dysmorphism, TD) związany z wodniakiem brzuszno-mosznowym niemowląt może być spowodowany efektem nacisku wodniaka na jądro lub może być nieprawidłowością rozwojową ².

W wodniaku filariozowym, płyn limfatyczny z pękniętych rozszerzonych naczyń limfatycznych stanowi ważny składnik płynu wodniaka przewlekłego, który zagraża integralności jądra u dorosłej populacji żyjącej na obszarach endemicznych filariozy wańkrofta ³.

Wodniak w różnych grupach wiekowych

Wodniak u noworodków i dzieci

U dzieci najczęstszą przyczyną wodniaka jest drożność wyrostka pochwowego otrzewnej, umożliwiająca przepływ płynu otrzewnowego do moszny ¹². Wodniak występuje u około 10% wszystkich donoszonych męskich żywych urodzeń, jednakże w większości przypadków zanika samoistnie bez leczenia w ciągu pierwszych 18 miesięcy ³.

Wodniaki wrodzone zwykle ustępują przed ukończeniem 2. roku życia i obserwacja oraz nieinterwencja są zwykle odpowiednie dla wodniaków u niemowląt ⁴. Badania wykazały, że wraz z wiekiem (od niemowlęctwa do dzieciństwa) zwiększa się częstość występowania wodniaka u dzieci ⁵.

U niemowląt, większość wodniaków (około 90%) ustępuje samoistnie i uważa się, że są wynikiem niepełnej obliteracji wyrostka pochwowego ⁶.

Wodniak u dorosłych

U dorosłych najczęstszą przyczyną wodniaka na świecie jest filarioza wywołana przez Wuchereria bancrofti ¹. W krajach poza tropikalnymi, takich jak kraje europejskie i Stany Zjednoczone, przeważają czynniki jatrogenne powodujące wodniaka ².

Wodniaki, które pojawiają się w okresie dojrzewania lub w wieku dorosłym, to wodniaki typu dorosłego. Zazwyczaj nie mają one kanału łączącego jamę brzuszną z moszną, ale po prostu reprezentują nadprodukcję płynu przez tkankę otaczającą jądro ³.

Przyczyny wodniaka u starszych chłopców i mężczyzn obejmują uraz, zapalenie najądrza i jądra, skręt jądra, przepuklinę, żylaki powrózka nasiennego i guzy jądra ⁴. Wodniaki u starszych chłopców i mężczyzn mogą być również spowodowane uogólnionym obrzękiem, takim jak zespół nerczycowy lub niewydolność serca ⁴.

Typy i klasyfikacja wodniaków

Powszechnie stosowany system klasyfikacji dzieli wodniaki na ¹²:

Pierwotne – powstające samoistnie, najczęściej u osób w średnim i starszym wieku
Wtórne komunikujące – związane z drożnym wyrostkiem pochwowym otrzewnej
Wtórne niekomunikujące – wynikające z zaburzenia równowagi między wytwarzaniem a wchłanianiem płynu
Wywołane przez drobnoustroje – np. w przebiegu filariozy
Zapalne – związane ze stanem zapalnym jądra lub najądrza
Jatrogenne – po zabiegach chirurgicznych
Pourazowe – będące następstwem urazu moszny
Wywołane przez guzy – towarzyszące nowotworom jądra
Kanału Nucka – rzadki typ występujący u kobiet
Olbrzymie – wodniaki o znacznych rozmiarach

W zależności od czasu i przyczyn pojawienia się, wodniaki można również podzielić na trzy typy ³:

Idiopatyczne – spowodowane urazem, uszkodzeniem lub dysfunkcją mechanizmu osłonki pochwowej jądra, który wydziela i wchłania płyn surowiczny
Zapalne/infekcyjne – powstałe w wyniku problemów zakaźnych lub zapalnych, które powodują destrukturyzację warstw jądrowych i blokują prawidłowy przepływ płynu surowiczego
Wrodzone – występujące od urodzenia i spowodowane nieprawidłowym zamknięciem przewodu otrzewnowo-pochwowego

Nawrotowy wodniak jądra

Nawrót wodniaka po korekcji chirurgicznej jest generalnie rzadki. Każdy nawrót wodniaka po interwencjach terapeutycznych powinien wzbudzić podejrzenie co do podstawowych schorzeń, takich jak hipoproteinemia, zakażenie filariozą, nowotwór jamy miednicy lub współistniejąca przepuklina pachwinowa ¹.

Bardzo znacząca różnica w częstości nawrotów wodniaka obserwowana między pacjentami z różnych grup po dwóch różnych podejściach chirurgicznych może odzwierciedlać więcej niż różnice w technice chirurgicznej. Może również oznaczać, że patogeneza przewlekłego wodniaka filariozowego jest dość złożona ².

Na podstawie obserwacji po operowaniu pacjentów z przewlekłym wodniakiem z obszarów nieendemicznych i endemicznych oraz porównaniu wyników chirurgicznych, badacze uważają, że gromadzenie się płynu w jamie pochwowej jądra, w dużej części przypadków przewlekłego wodniaka filariozowego, może być spowodowane innym mechanizmem patogenetycznym ².

Podsumowanie patogenezy wodniaka

Podsumowując, wodniak jądra powstaje w wyniku złożonych mechanizmów patogenetycznych, które mogą obejmować ¹:

Zaburzenie równowagi między wydzielaniem a wchłanianiem płynu w osłonce pochwowej jądra
Nieprawidłowe zamknięcie wyrostka pochwowego otrzewnej podczas rozwoju płodowego
Zaburzenia drenażu limfatycznego struktur mosznowych
Stany zapalne, infekcyjne lub nowotworowe jądra i okolicznych tkanek
Czynniki genetyczne wpływające na rozwój układu moczowo-płciowego

Mechanizm powstawania wodniaka zależy od wieku pacjenta, obecności czynników predysponujących oraz chorób współistniejących. Dokładne zrozumienie patogenezy wodniaka jest kluczowe dla właściwego postępowania diagnostycznego i terapeutycznego ².

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Materiały źródłowe

#1 Hydrocele: Practice Essentials, Background, Problem
https://emedicine.medscape.com/article/438724-overview
Hydrocele is an abnormal fluid collection within the tunica vaginalis of the scrotum or along the spermatic cord in males. Fluid accumulates due to the persistence of developmental structures or an imbalance of peritoneal fluid production versus absorption. […] The pathophysiology of hydroceles involves an imbalance between scrotal fluid production and absorption. This imbalance can be divided further into exogenous fluid sources or intrinsic fluid production. […] A commonly utilized classification system classifies hydroceles into primary, secondary communicating, secondary non-communicating, microbe-induced, inflammatory, iatrogenic, trauma induced, tumor induced, canal of Nuck or giant. […] Noncommunicating hydroceles may result from increased fluid production or impaired fluid absorption. Multiple causes have been cited for the development of noncommunicating hydroceles. This is typically the type of hydrocele noted in patients with filariasis. Noncommunicating hydroceles may also be secondary to torsion of the appendix testis, tumors, or inflammatory or infectious conditions, including syphilis, tuberculosis, and epididymitis. […] The presence of a hydrocele alone has minimal clinical significance. Hydroceles do not have an effect on later fertility. The primary concern is to rule out associated malignancy, infection, or other treatable conditions.
#1 Hydrocele – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK559125/
Hydroceles arise from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis. […] There are four basic mechanisms by which hydrocele can develop. These are mentioned below: 1. Connection with the peritoneal cavity through a patent processes vaginalis (congenital). 2. Excessive production of fluid (secondary hydrocele). 3. Defective absorption of fluid. 4. Interference with the lymphatic drainage of scrotal structures as in filarial hydroceles. […] In children, patency of processus vaginalis, allowing peritoneal fluid to flow into the scrotum, is the main cause of hydrocele. However, in adults, filariasis caused by Wuchereria bancrofti is the main culprit globally, affecting 120 million people in more than 73 countries. […] The primary hydrocele is predominant in middle and later life. A common predisposing factor for hydrocele is residing in a warm climate. […] The prognosis of the adult-onset hydrocele is mainly dependent on the underlying cause. For instance, filarial hydrocele’s prognosis depends on its size and the severity of lymphatic obstruction.
#1 Hydrocele – TeachMePaediatrics
https://teachmepaediatrics.com/surgery/urology/hydrocele/
Communicating hydroceles occur due to the persistence of a patent processus vaginalis (PPV), allowing the free flow of peritoneal fluid from peritoneum to the tunica vaginalis. If the connection is large enough, an inguinal hernia may occur due to the protrusion of intra-abdominal contents. […] Non-communicating hydroceles occur due to an imbalance between the production and absorption of serous fluid.
#1 Hydrocele – Symptoms, diagnosis and treatment | BMJ Best Practice
https://bestpractice.bmj.com/topics/en-gb/1104
A hydrocele is a collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord. Rarely, similar fluid collection can occur in females along the canal of Nuck. […] A non-communicating or simple hydrocele occurs when the processus vaginalis is closed and more fluid is being produced by the tunica vaginalis than is being absorbed. […] In communicating hydroceles, a patent processus vaginalis connects the peritoneum with the tunica vaginalis, which allows peritoneal fluid to flow freely between both structures.
#1 Hydrocele testis – Wikipedia
https://en.wikipedia.org/wiki/Hydrocele_testis
A primary hydrocele testis 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. […] The accumulation can be a marker of physical trauma, infection, tumor or varicocele surgery, but the cause is generally unknown. […] Congenital hydrocele testis results when the processus vaginalis remains, allowing fluid from the peritoneum to accumulate in the scrotum.
#1 Hydrocele – Wikipedia
https://en.wikipedia.org/wiki/Hydrocele
A hydrocele is an accumulation of serous fluid in a body cavity. A hydrocele testis, the most common form of hydrocele, is the accumulation of fluids around a testicle. It is often caused by fluid collecting within a layer wrapped around the testicle, called the tunica vaginalis, which is derived from peritoneum. […] Primary hydroceles may develop in adulthood, particularly in the elderly and in hot countries, by slow accumulation of serous fluid. This is presumably caused by impaired reabsorption, which appears to be the explanation for most primary hydroceles, although the reason remains obscure. […] A hydrocele can also be the result of a plugged inguinal lymphatic system caused by repeated, chronic infection of Wuchereria bancrofti or Brugia malayi, two mosquito-borne parasites of Africa and Southeast Asia, respectively.
#1 A Case Giving Proof of Pathogenesis of Abdominoscrotal Hydrocele: A Case Report
https://jsms.sch.ac.kr/journal/view.php?number=592
An abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by cystic mass that occupies the scrotum and abdomen. The characteristic aspect is the presence of two hydrocele sacs in the abdominal cavity and the scrotum, and compression of one side causes enlargement of the other side, thereby connecting the two sacs. […] The exact mechanism underlying ASH is still unclear. However, the most commonly proposed theories are as follows: (1) cephalad extension of a simple hydrocele, (2) high obliteration of processus vaginalis, (3) and processus vaginalis acting as a one-way valve with cephalad extension of hydrocele sac. […] Various theories about the etiology of ASH have been suggested, but are not yet fully understood. The three most commonly proposed theories are as follows: (1) cephalad extension of simple hydrocele by increasing intra-hydrocele pressure, (2) high extinction of patent processus vaginalis (PPV), and (3) PPV acting as a one-way valve with a cephalad extension of the hydrocele.
#1 Critical genes in genitourinary embryogenesis are related to the development of adult hydrocele | Scientific Reports
https://www.nature.com/articles/s41598-024-81187-3
Despite being a common urologic disorder with potentially complicated sequela, the genetic background of adult hydrocele has not previously been described. […] Multiple gene prioritization strategies highlighted PAX8, INHBB, AMHR2, and SHH, all known to be critical to genitourinary embryogenesis and associated with Mendelian genitourinary syndromes and model organism phenotypes. Identified loci affect gene expression in genitourinary structures and are associated with multiple markers of renal function. These common variants in genes critical for genitourinary embryogenesis are associated with adult hydrocele, suggesting these genes may maintain normal scrotal anatomy in adults. […] We prioritized four genes, PAX8, INHBB, TARBP2, and AMHR2, that met three or more gene prioritization criteria. PAX8, INHBB, and AMHR2 have well-described roles in genitourinary development and are associated with severe human and/or model organism phenotypes. However, a role for them in the development of a common adult trait is novel.
#1 Hydrocele – Wikipedia
https://en.wikipedia.org/wiki/Hydrocele
A hydrocele can be produced in four ways: by excessive production of fluid within the sac, e.g. secondary hydrocele; through defective absorption of fluid; by interference with lymphatic drainage of scrotal structures as in case of elephantiasis; by connection with a hernia of the peritoneal cavity in the congenital variety, which presents as hydrocele of the cord. […] The long continued presence of large hydroceles causes atrophy of testis due to compression or by obstructing blood supply. […] Secondary hydroceles due to testicular diseases can be the result of cancer, trauma (such as a hernia), or orchitis (inflammation of testis), and can also occur in infants undergoing peritoneal dialysis. […] A hydrocele is usually an expression of a patent processus vaginalis (PPV). […] Communicating hydrocele, caused by the failure of the processus vaginalis closure. […] The accuracy of the diagnosis must be ascertained. Great care must be taken to differentiate a hydrocele from a scrotal hernia or tumor of the testicle.
#1
https://journals.lww.com/heur/fulltext/2021/33030/recurrence_of_primary_hydrocele_1_month_after.6.aspx
A hydrocele is a painless enlargement of the scrotum resulting from an irregular accumulation of serous fluid between the parietal and the visceral layers of the tunica vaginalis which surrounds the testis. […] The etiology of primary hydrocele is considered to be an imbalance between secretion of fluid inside the tunica vaginalis of the testis and its absorption through lymphatic channels secondary hydrocele can result from trauma, infection, or even neoplasms (e.g. rhabdomyosarcoma, mesothelioma, adenocarcinoma, and neuroblastoma). […] Recurrence of hydrocele after surgical correction such as in the case presented in this article is generally rare. Any recurrence of hydrocele after therapeutic interventions should raise suspicions for underlying medical conditions such as hypoproteinemia, filarial infection, pelvic cavity malignancy, or concurrent inguinal hernia. […] The presence of intact tunical anatomy of the scrotum found during revision hydrocelectomy in our case raised questions concerning the extent of the previous excision and as such recurrence should be attributed to the uninverted remaining tunical sack.
#1 Hydrocele | Calgary Guide
https://calgaryguide.ucalgary.ca/hydrocele-pathogenesis-and-clinical-findings/hydrocele/
Hydrocele: Pathogenesis and clinical findings […] Accumulation of fluid within tunica vaginalis […] Imbalance between secretion and absorption of fluid in tunica vaginalis […] Increased scrotal fluid volume […] Increased volume stretches layers of the scrotum […] Longstanding compression of vascular supply, nutrients to testicles […] Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications
#2 Hydrocele – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK559125/
Hydroceles arise from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis. […] There are four basic mechanisms by which hydrocele can develop. These are mentioned below: 1. Connection with the peritoneal cavity through a patent processes vaginalis (congenital). 2. Excessive production of fluid (secondary hydrocele). 3. Defective absorption of fluid. 4. Interference with the lymphatic drainage of scrotal structures as in filarial hydroceles. […] In children, patency of processus vaginalis, allowing peritoneal fluid to flow into the scrotum, is the main cause of hydrocele. However, in adults, filariasis caused by Wuchereria bancrofti is the main culprit globally, affecting 120 million people in more than 73 countries. […] The primary hydrocele is predominant in middle and later life. A common predisposing factor for hydrocele is residing in a warm climate. […] The prognosis of the adult-onset hydrocele is mainly dependent on the underlying cause. For instance, filarial hydrocele’s prognosis depends on its size and the severity of lymphatic obstruction.
#2 Hydrocele | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/23067
There are four basic mechanisms by which hydrocele can develop. These are mentioned below: 1. Connection with the peritoneal cavity through a patent processes vaginalis (congenital). 2. Excessive production of fluid (secondary hydrocele). 3. Defective absorption of fluid. 4. Interference with the lymphatic drainage of scrotal structures as in filarial hydroceles. […] In children, patency of processus vaginalis, allowing peritoneal fluid to flow into the scrotum, is the main cause of hydrocele. However, in adults, filariasis caused by Wuchereria bancrofti is the main culprit globally, affecting 120 million people in more than 73 countries. […] The primary hydrocele is predominant in middle and later life. A common predisposing factor for hydrocele is residing in a warm climate. […] Congenital hydrocele tends to be intermittent as it usually reduces when lying flat due to drainage of hydrocele fluid into the peritoneum. However, applying pressure on the congenital hydrocele does not reduce it. […] The prognosis of the adult-onset hydrocele is mainly dependent on the underlying cause. For instance, filarial hydrocele’s prognosis depends on its size and the severity of lymphatic obstruction.
#2 Hydrocele: Practice Essentials, Background, Problem
https://emedicine.medscape.com/article/777386-overview
Hydrocele is an abnormal fluid collection within the tunica vaginalis of the scrotum or along the spermatic cord in males. Fluid accumulates due to the persistence of developmental structures or an imbalance of peritoneal fluid production versus absorption. […] The pathophysiology of hydroceles involves an imbalance between scrotal fluid production and absorption. This imbalance can be divided further into exogenous fluid sources or intrinsic fluid production. […] A commonly utilized classification system classifies hydroceles into primary, secondary communicating, secondary non-communicating, microbe-induced, inflammatory, iatrogenic, trauma induced, tumor induced, canal of Nuck or giant. […] Communicating hydroceles are typically noted in children and are associated with a persistent patent processus vaginalis (PPV).
#2 Hydrocele | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/hydrocele
A hydrocele is produced by fluid in the sac which normally surrounds the testicle. […] Hydroceles that occur in boys during puberty (or pubertal development) are adult-type hydroceles. These typically have no channel connecting the abdomen to the scrotum, but simply represent overproduction of fluid by tissue surrounding the testicle. […] When the sac does not close, the hydrocele is called communicating or open. This means that the fluid around the testicle can flow back up into the abdomen. […] During the seventh month of fetal development, the testicles move from the abdomen into the scrotum. When the testicle travels downward, it brings the sac-like lining of the abdominal cavity with it. The sac allows fluid present in the abdomen to surround the testicle. This sac usually closes before birth, preventing additional fluid from going from the abdomen into the scrotum, and the fluid is absorbed.
#2 Hydrocele – Symptoms, diagnosis and treatment | BMJ Best Practice US
https://bestpractice.bmj.com/topics/en-us/1104
A hydrocele is a collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord. Rarely, similar fluid collection can occur in females along the canal of Nuck. […] A noncommunicating or simple hydrocele occurs when the processus vaginalis is closed and more fluid is being produced by the tunica vaginalis than is being absorbed. […] In communicating hydroceles, a patent processus vaginalis connects the peritoneum with the tunica vaginalis, which allows peritoneal fluid to flow freely between both structures.
#2 Hydrocele – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK559125/
Hydroceles arise from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis. […] There are four basic mechanisms by which hydrocele can develop. These are mentioned below: 1. Connection with the peritoneal cavity through a patent processes vaginalis (congenital). 2. Excessive production of fluid (secondary hydrocele). 3. Defective absorption of fluid. 4. Interference with the lymphatic drainage of scrotal structures as in filarial hydroceles. […] In children, patency of processus vaginalis, allowing peritoneal fluid to flow into the scrotum, is the main cause of hydrocele. However, in adults, filariasis caused by Wuchereria bancrofti is the main culprit globally, affecting 120 million people in more than 73 countries. […] The primary hydrocele is predominant in middle and later life.
#2 Hydrocele – Wikipedia
https://en.wikipedia.org/wiki/Hydrocele
A hydrocele can be produced in four ways: by excessive production of fluid within the sac, e.g. secondary hydrocele; through defective absorption of fluid; by interference with lymphatic drainage of scrotal structures as in case of elephantiasis; by connection with a hernia of the peritoneal cavity in the congenital variety, which presents as hydrocele of the cord. […] The long continued presence of large hydroceles causes atrophy of testis due to compression or by obstructing blood supply. […] Secondary hydroceles due to testicular diseases can be the result of cancer, trauma (such as a hernia), or orchitis (inflammation of testis), and can also occur in infants undergoing peritoneal dialysis. […] A hydrocele is usually an expression of a patent processus vaginalis (PPV). […] Communicating hydrocele, caused by the failure of the processus vaginalis closure. […] The accuracy of the diagnosis must be ascertained. Great care must be taken to differentiate a hydrocele from a scrotal hernia or tumor of the testicle.
#2 Filarial Hydrocele | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/23069
Hydrocele results from the accumulation of fluid in the tunica vaginalis in the scrotal sac. Chronic hydrocele has multiple etiologies and may occur secondary to other disorders like testicular malignancy or filarial infection. […] A filarial hydrocele is not only debilitating but also has economic implications due to the huge numbers of affected adult males throughout the tropical and subtropical endemic regions and countries. […] Lymphatic filariasis is caused by three species of parasitic worm, Wuchereria bancrofti, Brugia malayi, and B. timori. However, it is Wuchereria bancrofti that is most commonly linked to the chronic disease manifestation of hydrocele. […] Eventually, some adult worms make their way to the scrotal lymph vessels, causing acute filarial lymphangitis, lymphangiectasia, and acute hydrocele. This may produce transient symptoms in the form of pain or nodularity. Repeated cycles of inflammation over time will lead to chronic hydrocele. Thus, a majority of men with lymphatic filariasis will eventually develop symptomatic hydroceles.
#2 A Case Giving Proof of Pathogenesis of Abdominoscrotal Hydrocele: A Case Report
https://jsms.sch.ac.kr/journal/view.php?number=592
Some authors have suggested that ASH is caused by the opening of the processus vaginalis, which must act as a valve, and obstruction in the high level, thereby resulting in the pressure in the inguinoscrotal hydrocele against the occlusion point on the internal inguinal ring leading to intra-abdominal expansion. […] In particular, the authors assumed that inflammation of the tissue surrounding processus vaginalis could trigger a one-way valve mechanism. […] The causes of primary hydrocele are lymphatic hypoplasia, lymphatic obstruction (secondary to the presence of inguinal hernia, minor trauma, chronic epididymitis, filaria worms, or a high-ligature operation for varicocele). In addition, imbalance between the rate of exudation of fluid in the tunica vaginalis and its absorption are the cause of hydrocele.
#2 Critical genes in genitourinary embryogenesis are related to the development of adult hydrocele | Scientific Reports
https://www.nature.com/articles/s41598-024-81187-3
Several genome-wide significant variants associated with hydrocele have been previously associated with markers of renal function and genitourinary cancers. However, despite the anatomic and clinical overlap, none of the loci or mapped hydrocele genes from our study have previously been associated with inguinal hernia, suggesting a distinct genetic architecture for these two conditions. […] The association of common variants in these genes with adult hydrocele suggests potential novel roles for these genes in maintaining normal scrotal anatomy in adults.
#2
https://link.springer.com/article/10.1007/s11255-014-0665-6
Testicular dysmorphism (TD) associated with infantile abdominoscrotal hydrocele (ASH) may be due to the pressure effect of hydrocele on the testis or may be a developmental abnormality. […] Only a few reports are referred to the etiology of testicular changes in infantile ASH. […] focusing on insights into etiology of TD and its appropriate management. […] Effect of hydrocele on testis and spermatogenesis.
#2 Azthena logo with the word Azthena
https://www.news-medical.net/health/Hydrocele-in-Adults.aspx
Many cases of hydrocele worldwide are due to a parasitic infection with Wuchereria bancrofti, which is endemic in the tropical and subtropical regions of the Americas, the Pacific, Middle East and Africa. This puts up to one fifth of the worlds population at risk. […] The filarial infestations classically cause a decrease in the absorption of lymphatic fluid, which results in hydrocele. […] In countries outside of the tropics, such as those in Europe and the United States, there is a predominance of iatrogenic factors causing hydrocele. […] Patients who have small hernias or an incompletely closed processus vaginalis are particularly at risk following transplant or laparoscopic surgeries.
#2 A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000695
Chronic hydrocele is the most common manifestation of bancroftian filariasis, an endemic disease in 80 countries. […] Lymph fluid from ruptured dilated lymphatic vessels is an important component of chronic filarial hydrocele fluid that threatens the integrity of the testis in an adult population living in bancroftian filariasis endemic areas. […] The mechanism of generating hydrocele has been considered to be the same in all acquired hydroceles and the etiology, per se, has not been considered when choosing the surgical approach. […] The very significant difference in hydrocele rate recurrence observed between patients from G1 and CG after two different surgical approaches could reflect more than differences in surgical technique. It may also signify that the pathogenesis of chronic filarial hydrocele is rather complex.
#2 A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000695
The primary lesion of bancroftian filariasis, while adult worms are alive, is non obstructive lymphatic vessel dilation without inflammation. […] However, the risk factors and mechanism that lead acute filarial hydrocele to persist and to progress toward a chronic condition are not completely understood. […] Based on observations after operating on patients with chronic hydrocele from non-endemic and endemic areas, and comparing surgical findings, we believe the accumulation of fluid in the vaginal cavity of the testis, in a large proportion of chronic filarial hydrocele cases, may be due to a different pathogenetic mechanism. […] The surgical findings in recurrent and non recurrent hydroceles in G2 and G1 respectively, support the conclusion that lymph fluid composes the hydrocele fluid.
#2 Hydrocele (Causes, Symptoms and Treatment)
https://patient.info/doctor/hydrocele-causes-symptoms-and-treatment
In children, most hydroceles are the communicating type, in which patency of the processus vaginalis allows peritoneal fluid to flow into the scrotum. […] Investigations are not required for simple hydroceles but are essential if there is any doubt in the diagnosis or any suggestion of an underlying hydrocele cause. […] Failure to delineate the testis clearly, tenderness on palpation or internal shadows on transillumination are all indications for further investigation. […] Many hydroceles in infancy resolve before the age of 2 years and so observation and non-intervention are usually appropriate for hydroceles in infants. […] Once underlying pathology has been excluded, adults with non-communicating hydroceles can be managed conservatively, with reassurance and a scrotal support. […] The prognosis is dependent on the presence of any underlying cause. […] Most congenital hydroceles resolve by the end of the first year of life.
#3 Hydrocele – Wikipedia
https://en.wikipedia.org/wiki/Hydrocele
A hydrocele is an accumulation of serous fluid in a body cavity. A hydrocele testis, the most common form of hydrocele, is the accumulation of fluids around a testicle. It is often caused by fluid collecting within a layer wrapped around the testicle, called the tunica vaginalis, which is derived from peritoneum. […] Primary hydroceles may develop in adulthood, particularly in the elderly and in hot countries, by slow accumulation of serous fluid. This is presumably caused by impaired reabsorption, which appears to be the explanation for most primary hydroceles, although the reason remains obscure. […] A hydrocele can also be the result of a plugged inguinal lymphatic system caused by repeated, chronic infection of Wuchereria bancrofti or Brugia malayi, two mosquito-borne parasites of Africa and Southeast Asia, respectively.
#3 Hydrocele: Causes, Types, and Treatments
https://www.healthline.com/health/hydrocele
Hydroceles can occur at any age, yet tend to be more common in newborns. While they can occur without any underlying causes, an underlying injury or even inflammation can also contribute to their development. For most people, hydroceles are nothing more than an inconvenient yet temporary condition. […] Hydroceles can also form later in life, mostly in men over 40. They can occur from a hernia but this is less common. Most of the time it is either from inflammation or from the sac (called the tunica vaginalis) not reabsorbing fluid properly. The epithelial cells in the sac produce and reabsorb the fluid constantly and there can be dysfunction with these cells leading to excess fluid. […] Hydroceles can also be caused by inflammation or injury in the scrotum or along the channel. The inflammation may be caused by an infection (epididymitis) or another condition.
#3 ð Hydrocele
https://thefetus.net/content/hydrocele-1
Between the seventh week and birth, the testes descend into the scrotum due to shortening of the gubernaculum. […] After the processus vaginalis has evaginated into the scrotum, the gubernaculum shortens and pulls the gonads through the canal. […] Within the first year after birth the superior part of the processus vaginalis is usually obliterated leaving a distal remnant sac, the tunica vaginalis, which lies anterior to the testis. Its lumen is normally collapsed but sometimes it may fill with serous secretions forming a testicular hydrocele.
#3 Communicating Hydrocele: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/16303-communicating-hydrocele
A communicating hydrocele occurs while the fetus is in utero (in a biological mother’s uterus, before birth). A thin membrane (processus vaginalis) extends through the inguinal canal in the abdominal wall into the scrotum. If the processus vaginalis remains open, fluid flows back and forth from the abdominal cavity and the scrotum, like waves at a beach. […] A communicating hydrocele has an opening (communication) to your abdominal cavity. Your abdominal cavity is a large, hollow space in your body that contains many vital organs, including your stomach, small and large intestines, kidney, bladder and liver, as well as abdominal fluid. The communication allows abdominal fluid to pass into your scrotum, which causes the swelling. […] A communicating hydrocele is more serious than a non-communicating hydrocele. A non-communicating hydrocele usually remains the same size or has very slow growth. A communicating hydrocele can change in size throughout the day. It may become very large and uncomfortable.
#3 Hydrocele (Causes, Symptoms and Treatment)
https://patient.info/doctor/hydrocele-causes-symptoms-and-treatment
A hydrocele is an abnormal collection of fluid within the remnants of the processus vaginalis. […] Causes in older boys and men include trauma, epididymo-orchitis, testicular torsion, hernia, varicocele, and testicular tumour. […] Hydroceles in older boys and men may also be due to generalised oedema, such as nephrotic syndrome or heart failure. […] Persistence of the processus vaginalis allows peritoneal fluid to communicate freely with the scrotal portion of the processus. […] They are congenital but may first present in older boys and men as a result of increased intra-abdominal pressure, continuous peritoneal dialysis or fluid overload. […] Non-communicating hydroceles are caused by excessive fluid production within the tunica vaginalis. […] Hydroceles need to be fully investigated if there is any suspicion of an underlying cause.
#3 Hydrocele – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK559125/
Hydroceles arise from an imbalance of secretion and reabsorption of fluid from the tunica vaginalis. […] There are four basic mechanisms by which hydrocele can develop. These are mentioned below: 1. Connection with the peritoneal cavity through a patent processes vaginalis (congenital). 2. Excessive production of fluid (secondary hydrocele). 3. Defective absorption of fluid. 4. Interference with the lymphatic drainage of scrotal structures as in filarial hydroceles. […] In children, patency of processus vaginalis, allowing peritoneal fluid to flow into the scrotum, is the main cause of hydrocele. However, in adults, filariasis caused by Wuchereria bancrofti is the main culprit globally, affecting 120 million people in more than 73 countries. […] The primary hydrocele is predominant in middle and later life. A common predisposing factor for hydrocele is residing in a warm climate. […] The prognosis of the adult-onset hydrocele is mainly dependent on the underlying cause. For instance, filarial hydrocele’s prognosis depends on its size and the severity of lymphatic obstruction.
#3 Hydrocele: Practice Essentials, Background, Problem
https://emedicine.medscape.com/article/777386-overview
Noncommunicating hydroceles may result from increased fluid production or impaired fluid absorption. Multiple causes have been cited for the development of noncommunicating hydroceles. This is typically the type of hydrocele noted in patients with filariasis. Noncommunicating hydroceles may also be secondary to torsion of the appendix testis, tumors, or inflammatory or infectious conditions, including syphilis, tuberculosis, and epididymitis. […] This is the most uncommon type of hydrocele. These have an inguinoscrotal component, with a second larger or small intra-abdominal component. The intra-abdominal component can be so large that it can cause renal obstruction.
#3
https://turkjpediatr.org/article/view/2758
The testis is descended through the processus vaginalis via propulsive force generated by the muscles derived from the gubernaculum. After propelling the testis, the smooth muscle should undergo programmed cell death for obliteration of the processus vaginalis. Achievement of programmed cell death mandates a transient decrease in sympathetic, but an increase in parasympathetic, tonuses. Since the sympathetic tonus is androgen-dependent, the decrease in androgen levels during the third trimester appears to be responsible for the process. Alterations in timing, intensity or duration of the decrease in sympathetic tonus under the control of the central nervous system give rise to hernia, hydrocele or abnormal testis localizations. […] Absence or inadequacy of the decrease in sympathetic tonus results in rescue of more smooth muscle, thus inhibiting the obliteration. Inadequacy in the intensity or duration rescues less smooth muscle and gives rise to a hydrocele.
#3 A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000695
Chronic hydrocele is the most common manifestation of bancroftian filariasis, an endemic disease in 80 countries. […] Lymph fluid from ruptured dilated lymphatic vessels is an important component of chronic filarial hydrocele fluid that threatens the integrity of the testis in an adult population living in bancroftian filariasis endemic areas. […] The mechanism of generating hydrocele has been considered to be the same in all acquired hydroceles and the etiology, per se, has not been considered when choosing the surgical approach. […] The very significant difference in hydrocele rate recurrence observed between patients from G1 and CG after two different surgical approaches could reflect more than differences in surgical technique. It may also signify that the pathogenesis of chronic filarial hydrocele is rather complex.
#3 Hydrocele – Children’s Hospital of Orange County
https://choc.org/programs-services/urology/hydrocele/
A hydrocele occurs from an accumulation of fluid in the tunica vaginalis (a thin pouch that holds the testes within the scrotum). In the fetus, the tunica vaginalis is formed in the abdomen and then migrates into the scrotum with the testes. After the tunica vaginalis is in the testes, it seals off from the abdomen. Some fluid may remain in the area causing a hydrocele. […] A hydrocele is present in as many as 10 percent of all full-term male live births; however, in most cases, it disappears without treatment within the first 18 months. Treatment after this time is usually done for cosmetic reasons as simple hydroceles do not increase the risk to a testicleâs health. Some hydroceles may also be accompanied by inguinal hernias. […] Most hydroceles will self-resolve within the first 18 months of life. If a hydrocele persists past this time, a surgery may be recommended in order to improve how the scrotum looks. If the size of the hydrocele is also progressing, or the size varies throughout the day a surgery may also be recommended. […] A hydrocele surgery is normally performed by making a small incision in the scrotal or inguinal area and draining the fluid while also closing off the opening to the tunica vaginalis.
#3 Hydrocele | Boston Children’s Hospital
https://www.childrenshospital.org/conditions/hydrocele
A hydrocele is produced by fluid in the sac which normally surrounds the testicle. […] Hydroceles that occur in boys during puberty (or pubertal development) are adult-type hydroceles. These typically have no channel connecting the abdomen to the scrotum, but simply represent overproduction of fluid by tissue surrounding the testicle. […] When the sac does not close, the hydrocele is called communicating or open. This means that the fluid around the testicle can flow back up into the abdomen. […] During the seventh month of fetal development, the testicles move from the abdomen into the scrotum. When the testicle travels downward, it brings the sac-like lining of the abdominal cavity with it. The sac allows fluid present in the abdomen to surround the testicle. This sac usually closes before birth, preventing additional fluid from going from the abdomen into the scrotum, and the fluid is absorbed.
#3 What is a bilateral hydrocele? Causes and treatments
https://www.operarme.com/blog/what-is-a-bilateral-hydrocele-causes-and-treatments/
What is a testicular hydrocele? […] By definition, bilateral hydrocele refers to the accumulation of fluid involving both testicles. […] The causes of the appearance of hydrocele can be divided into three, depending on the time and causes of its appearance: […] This type of hydrocele is due to injury, damage or dysfunction of the tunica vaginalis mechanism that secretes and reabsorbs the serous fluid that lubricates the testicles into the scrotal sac. […] These are hydroceles formed as a result of infectious or inflammatory problems which, as mentioned above, cause a destructuring of the testicular layers, blocking the correct flow of serous fluid and, consequently, forming a bilateral or unilateral testicular hydrocele. […] As its name indicates, this is a type of hydrocele that appears from birth and is due to the fact that the peritoneovaginal duct has not closed correctly, maintaining communication between the inside of the scrotal sac and the intra-abdominal cavity, which causes the accumulation of liquid and the consequent formation of the hydrocele.
#4 Pathology Outlines – Hydrocele
https://www.pathologyoutlines.com/topic/testishydrocele.html
Accumulation of serous fluid between visceral and parietal layers of tunica vaginalis […] Accumulation of serous fluid between visceral and parietal layers of tunica vaginalis […] Mostly idiopathic, putative causes: excessive secretion or decreased reabsorption of fluid by parietal mesothelial cells, congenital lack of efferent lymphatics […] Association with inguinal hernia, scrotal trauma, inflammation (epididymoorchitis) or tumors of the testis / paratestis […] Defective closure at both proximal and distal ends of processus vaginalis […] Defective closure of the distal end of tunica vaginalis.
#4 Hydrocele – Symptoms, diagnosis and treatment | BMJ Best Practice US
https://bestpractice.bmj.com/topics/en-us/1104
A hydrocele is a collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord. Rarely, similar fluid collection can occur in females along the canal of Nuck. […] A noncommunicating or simple hydrocele occurs when the processus vaginalis is closed and more fluid is being produced by the tunica vaginalis than is being absorbed. […] In communicating hydroceles, a patent processus vaginalis connects the peritoneum with the tunica vaginalis, which allows peritoneal fluid to flow freely between both structures.
#4 Hydrocele: Practice Essentials, Background, Problem
https://emedicine.medscape.com/article/438724-overview
Hydrocele is an abnormal fluid collection within the tunica vaginalis of the scrotum or along the spermatic cord in males. Fluid accumulates due to the persistence of developmental structures or an imbalance of peritoneal fluid production versus absorption. […] The pathophysiology of hydroceles involves an imbalance between scrotal fluid production and absorption. This imbalance can be divided further into exogenous fluid sources or intrinsic fluid production. […] A commonly utilized classification system classifies hydroceles into primary, secondary communicating, secondary non-communicating, microbe-induced, inflammatory, iatrogenic, trauma induced, tumor induced, canal of Nuck or giant. […] Noncommunicating hydroceles may result from increased fluid production or impaired fluid absorption. Multiple causes have been cited for the development of noncommunicating hydroceles. This is typically the type of hydrocele noted in patients with filariasis. Noncommunicating hydroceles may also be secondary to torsion of the appendix testis, tumors, or inflammatory or infectious conditions, including syphilis, tuberculosis, and epididymitis. […] The presence of a hydrocele alone has minimal clinical significance. Hydroceles do not have an effect on later fertility. The primary concern is to rule out associated malignancy, infection, or other treatable conditions.
#4 Hydrocele testis – Wikipedia
https://en.wikipedia.org/wiki/Hydrocele_testis
A primary hydrocele testis 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. […] The accumulation can be a marker of physical trauma, infection, tumor or varicocele surgery, but the cause is generally unknown. […] Congenital hydrocele testis results when the processus vaginalis remains, allowing fluid from the peritoneum to accumulate in the scrotum.
#4 Hydrocele Symptoms, Surgery, Treatment, Causes, Medical Test
https://www.medicinenet.com/hydrocele_pediatric_testicular/article.htm
A hydrocele is a scrotal collection of clear fluid („hydro” = water) in a thin walled sack („cele” = swelling) that also contains the testicle. […] Between the 28th and 36th week of gestation, the testes, associated blood vessels and nerves migrate from the upper posterior abdominal wall adjacent to the kidneys to the lower abdominal cavity and through a tunnel (inguinal canal) into the scrotum. […] Should this closure be incomplete and the communication narrow, free fluid in the abdominal cavity (peritoneal fluid) may seep into and through the process vaginalis and collect in the scrotum forming a hydrocele. […] Communicating hydroceles are present at birth and occur as a consequence of the failure of the „tail” end of the process vaginalis to completely close off. Peritoneal fluid (free fluid in the abdominal cavity) is thus free to pass into the scrotum in which the process vaginalis surrounds the testicle. […] In a non-communicating hydrocele the tail end of the process vaginalis has closed appropriately. The fluid surrounding the testicle is created by the lining cells of the process vaginalis and is unable to either drain or be reabsorbed efficiently and thus accumulates.
#4 Azthena logo with the word Azthena
https://www.news-medical.net/health/Hydrocele-in-Adults.aspx
Many cases of hydrocele worldwide are due to a parasitic infection with Wuchereria bancrofti, which is endemic in the tropical and subtropical regions of the Americas, the Pacific, Middle East and Africa. This puts up to one fifth of the worlds population at risk. […] The filarial infestations classically cause a decrease in the absorption of lymphatic fluid, which results in hydrocele. […] In countries outside of the tropics, such as those in Europe and the United States, there is a predominance of iatrogenic factors causing hydrocele. […] Patients who have small hernias or an incompletely closed processus vaginalis are particularly at risk following transplant or laparoscopic surgeries.
#4 Hydrocele (Causes, Symptoms and Treatment)
https://patient.info/doctor/hydrocele-causes-symptoms-and-treatment
In children, most hydroceles are the communicating type, in which patency of the processus vaginalis allows peritoneal fluid to flow into the scrotum. […] Investigations are not required for simple hydroceles but are essential if there is any doubt in the diagnosis or any suggestion of an underlying hydrocele cause. […] Failure to delineate the testis clearly, tenderness on palpation or internal shadows on transillumination are all indications for further investigation. […] Many hydroceles in infancy resolve before the age of 2 years and so observation and non-intervention are usually appropriate for hydroceles in infants. […] Once underlying pathology has been excluded, adults with non-communicating hydroceles can be managed conservatively, with reassurance and a scrotal support. […] The prognosis is dependent on the presence of any underlying cause. […] Most congenital hydroceles resolve by the end of the first year of life.
#4 Hydrocele (Causes, Symptoms and Treatment)
https://patient.info/doctor/hydrocele-causes-symptoms-and-treatment
A hydrocele is an abnormal collection of fluid within the remnants of the processus vaginalis. […] Causes in older boys and men include trauma, epididymo-orchitis, testicular torsion, hernia, varicocele, and testicular tumour. […] Hydroceles in older boys and men may also be due to generalised oedema, such as nephrotic syndrome or heart failure. […] Persistence of the processus vaginalis allows peritoneal fluid to communicate freely with the scrotal portion of the processus. […] They are congenital but may first present in older boys and men as a result of increased intra-abdominal pressure, continuous peritoneal dialysis or fluid overload. […] Non-communicating hydroceles are caused by excessive fluid production within the tunica vaginalis. […] Hydroceles need to be fully investigated if there is any suspicion of an underlying cause.
#5 Communicating Hydrocele: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/16303-communicating-hydrocele
A communicating hydrocele occurs while the fetus is in utero (in a biological mother’s uterus, before birth). A thin membrane (processus vaginalis) extends through the inguinal canal in the abdominal wall into the scrotum. If the processus vaginalis remains open, fluid flows back and forth from the abdominal cavity and the scrotum, like waves at a beach. […] A communicating hydrocele has an opening (communication) to your abdominal cavity. Your abdominal cavity is a large, hollow space in your body that contains many vital organs, including your stomach, small and large intestines, kidney, bladder and liver, as well as abdominal fluid. The communication allows abdominal fluid to pass into your scrotum, which causes the swelling. […] A communicating hydrocele is more serious than a non-communicating hydrocele. A non-communicating hydrocele usually remains the same size or has very slow growth. A communicating hydrocele can change in size throughout the day. It may become very large and uncomfortable.
#5 Hydrocele: Practice Essentials, Background, Problem
https://emedicine.medscape.com/article/777386-overview
Noncommunicating hydroceles may result from increased fluid production or impaired fluid absorption. Multiple causes have been cited for the development of noncommunicating hydroceles. This is typically the type of hydrocele noted in patients with filariasis. Noncommunicating hydroceles may also be secondary to torsion of the appendix testis, tumors, or inflammatory or infectious conditions, including syphilis, tuberculosis, and epididymitis. […] This is the most uncommon type of hydrocele. These have an inguinoscrotal component, with a second larger or small intra-abdominal component. The intra-abdominal component can be so large that it can cause renal obstruction.
#5 Hydrocele | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/23067
There are four basic mechanisms by which hydrocele can develop. These are mentioned below: 1. Connection with the peritoneal cavity through a patent processes vaginalis (congenital). 2. Excessive production of fluid (secondary hydrocele). 3. Defective absorption of fluid. 4. Interference with the lymphatic drainage of scrotal structures as in filarial hydroceles. […] In children, patency of processus vaginalis, allowing peritoneal fluid to flow into the scrotum, is the main cause of hydrocele. However, in adults, filariasis caused by Wuchereria bancrofti is the main culprit globally, affecting 120 million people in more than 73 countries. […] The primary hydrocele is predominant in middle and later life. A common predisposing factor for hydrocele is residing in a warm climate. […] Congenital hydrocele tends to be intermittent as it usually reduces when lying flat due to drainage of hydrocele fluid into the peritoneum. However, applying pressure on the congenital hydrocele does not reduce it. […] The prognosis of the adult-onset hydrocele is mainly dependent on the underlying cause. For instance, filarial hydrocele’s prognosis depends on its size and the severity of lymphatic obstruction.
#5 Pulsenotes | Hydrocele notes
https://app.pulsenotes.com/surgery/urology/notes/hydrocele
Hydrocele refers to a collection of serous fluid between the parietal and visceral layers of the tunica vaginalis. […] Communicating hydroceles occur due to the failure of normal closure of the processus vaginalis. This allows the passage of peritoneal fluid into the tunica vaginalis. […] Non-communicating hydroceles occur when there is an imbalance between fluid production and absorption. Many are idiopathic but identifiable triggers include trauma, infection (e.g. epididymo-orchitis) and testicular torsion. […] It should always be remembered that a hydrocele may occur secondary to epididymo-orchitis, testicular torsion or testicular cancer. […] Management of hydroceles depend on the age, underlying cause, association with hernia and symptoms present. […] Communicating hydroceles that develop above the age of two are somewhat less likely to resolve and may increase the risk of an incarcerated inguinal hernia.
#5 Global prevalence of hydrocele in infants and children: a systematic review and meta-analysis | BMC Pediatrics | Full Text
https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-025-05492-0
This study was designed to present the global prevalence of PH in two groups of infants and children. […] The findings showed that by the age (from infancy to childhood), the rate of pediatric hydrocele increases. […] It is also suggested that multiple environmental factors can lead to the occurrence of PH in the post-infant period. […] Hydrocele in infants is a benign condition commonly disappears with no treatment. […] However, in persistent cases beyond infancy, careful screening is essential to determine the need for surgical intervention.
#6 Hydrocele: Practice Essentials, Background, Problem
https://emedicine.medscape.com/article/777386-overview
Hydrocele is an abnormal fluid collection within the tunica vaginalis of the scrotum or along the spermatic cord in males. Fluid accumulates due to the persistence of developmental structures or an imbalance of peritoneal fluid production versus absorption. […] The pathophysiology of hydroceles involves an imbalance between scrotal fluid production and absorption. This imbalance can be divided further into exogenous fluid sources or intrinsic fluid production. […] A commonly utilized classification system classifies hydroceles into primary, secondary communicating, secondary non-communicating, microbe-induced, inflammatory, iatrogenic, trauma induced, tumor induced, canal of Nuck or giant. […] Communicating hydroceles are typically noted in children and are associated with a persistent patent processus vaginalis (PPV).
#6 Filarial Hydrocele | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/23069
A filarial hydrocele is an accumulation of fluid, due to true hydrocele (fluid), chylocele (lymph), or hematochylocele (blood with lymph), in the scrotum. The term „filaricele” is inclusive of all three and has been suggested as the all-inclusive term in recent years. The hydrocele may be of two types: communicating and non-communicating. Non-communicating hydroceles develop with filarial infections and may present as acute or chronic conditions. In filarial infections, migration of adult worms and then their persistence in the scrotal lymph system result in a hydrocele. […] Acute hydroceles result from the death of these worms, often after medical therapy. Acute filarial hydrocele can be triggered by post-treatment death and/or disintegration of the worm, the filarial antigen thus produced may lead to acute filarial lymphangitis (AFL).
#6 Hydrocele | Radiology Reference Article | Radiopaedia.org
https://radiopaedia.org/articles/hydrocele-2?lang=us
Hydroceles are acquired or congenital serous fluid collections between the layers of the tunica vaginalis surrounding a testis or spermatic cord. They present with painless scrotal enlargement. […] In the communicating type, fluid collects around a patent processus vaginalis which failed to successfully obliterate. […] In infants, most hydroceles (around 90%) resolve spontaneously, and they are thought to result from incomplete obliteration of the processus vaginalis.
#7 Inguinal Hernia and Hydrocele | Children’s Hospital Colorado
https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/inguinal-hernia-hydrocele/
When the opening left by the processus vaginalis allows fluid or part of the intestine into the scrotum, the hernia or hydrocele sac occurs. […] If the opening is only wide enough to let in fluid, this creates a hydrocele.
#7 A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair | PLOS Neglected Tropical Diseases
https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000695
Based on the current findings it is suggested that the term filaricele be introduced for chronic straw colored fluid accumulation in the vaginal cavity in endemic areas. […] In conclusion, in bancroftian filariasis endemic areas, lymphatic fistulae are likely to be an important mechanism responsible for chronic hydrocele, whether recurrent or not.