Hydrocele test is known as one of the important medical fitness test for UPSC Candidates. A hydrocele is basically a collection of fluid in a sac in the scrotum next to a Testes. Here we will discuss more about the Symptom, diagnosis and Investigation of hydrocele which is being done as part of the Medical Fitness Test. This will provide an insight about this condition and how it is being find out in an investigation.

Hydrocele: Causes, Symptoms and Treatment

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A hydrocele is an abnormal collection serous fluid in a part of the processus vaginalis, usually the tunica. It usually occurs on one side, but some times a hydrocele forms over both testes. It can be of two types:-

• Primary, if fluid accumulates due to a congenital defect, and
• Secondary, if it is due to irritation of the Tunica vaginalis.

A hydrocele can be produced in four different ways:-

• By excessive production of fluid within the sac. For e.g: Secondary
• By defective absorption of fluid, this appear to be the explanation.
• For most primary hydroceles although the reason why the fluid is not absorbed is obscure, by interference with Lymphatic drainage of scrotal structures(elephantiasis).
• By connection with the peritoneal cavity via a patent processus.

Symptom 

The main symptom of Hydrocele is a painless enlargement of scrotum on one or both sides. In the early stages, hydrocele is usually asymptomatic. As it enlarges, it bulge out and then become a cosmetic problem. Symptoms can develop as the swelling increases in size, which includes:-

• Heaviness, Fullness or dragging sensations due to an enlarged scrotum.
• There may be mild discomfort radiating along the inguinal area to the mid portion of the back.
• If pain develops in a hydrocele, it is usually an indication of acute epididymal infection.
• The size may decrease with recumbency or increase in the up right positions.
• Fever, Chills, Nausea or Vomiting indicate an infection of a hydrocele.
• Hydrocele generally cause no Interference with Sexual Activities. However some reports from India have indicated that it can adversely affect sexual functioning and can cause moderate anxiety or depression.
• If there is a sudden painless enlargement of scrotum in a young man then one should rule out a tumor of the testes. Testicular Malignancy is an uncommon cause of hydrocele that can be excluded by ultrasound examination of the Scrotum.

Diagnosis

A complete examination of the Scrotum consisting of inspection, palpation and Transillumination which can help clinch the diagnosis of Hydrocele.

• For transillumination, a torch light can be used in a dark room and it is pressed against the Scrotum and the fluid inside the Scrotum shines and light up. A tube made up of black paper can be used to view the illumination if it is not dark.
• A smooth cystic feeling mass completely surrounding the testicle and not involving the spermatic cord is characterized of a hydrocele. The consistency of hydroceles can vary with position. Sometimes a hydrocele can become smaller and softer on lying down and become larger and tenser after prolonged standing.
• Hydrocele are generally painless. The presence of pain, redness and edema with loss of the normal scrotal rugae is suggestive of an inflammatory lesion like epididymitis or epididymo-orchitis or filarial velapses. More on PIB.

Investigation

• A blood count and urine analysis can help rule out the presence of an Infection.
• Imaging Studies can help rule out the presence of a coexisting hernia or other causes of Scrotal swellings like a tumor or an infection.
• Inguinal-scrotal imaging ultrasound: This study is indicated to confirm the diagnosis. May useful to identify abnormalities in the testis, cystic masses, tumors, appendages. spermatocele or associated hernia.
• In the context of pain or testicular bleeding after trauma, an imaging test can differentiate between a hydrocele and incarcerated bowel.
• Doppler Ultrasound Flow Study: This study helps to assess the blood flow to the testis. It is usually done to rule out varicocele of the Cord. Varicocele can occur due to dilation of the veins of the cord of the testis. It can also be done to rule out testicular torsion or traumatic hemorrhage into a hydrocele or testes.
• Testicular Scintigraphy: This Nuclear Scan is particularly useful especially in children, if testicular torsion is suspected. Decreased pole indicates torsion complications of hydrocele.
• Untreated hydrocele can lead to infection of the fluid and testicular atrophy.
• A large hydrocele may obstruct the testicular blood supply leading to testicular atrophy and subsequent impairment of fertility.