What causes hydroceles?

Updated: Oct 28, 2020
  • Author: Jacob C Parke, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

The causes of hydroceles are legion. In children, most hydroceles are of the communicating type, in which patency of the processus vaginalis allows peritoneal fluid to flow into the scrotum, particularly during Valsalva maneuvers.

In the adult population, filariasis, a parasitic infection caused by Wuchereria bancrofti, accounts for most causes of hydroceles worldwide, affecting more than 90 million people in more than 52 countries. [6] (see Hydrocele, Filarial) However, this condition is virtually nonexistent in the United States, where iatrogenic causes of hydroceles predominate.

Following laparoscopic or transplant surgery in males, inadequate irrigation fluid aspiration may cause hydroceles in patients with a patent processus vaginalis or a small hernia. Careful aspiration of fluid at the end of laparoscopic procedures helps prevent this complication. In noncommunicating hydroceles, for both children and adults, the balance between fluid production within the tunica and the fluid absorption is altered.

A few studies have attempted to show a link between certain molecular derangements and an increased incidence of patent processus vaginales (and therefore hydroceles and indirect hernias). Two such examples include increases in maternal estrogen concentrations during pregnancy and abnormalities in the calcitonin gene-related peptide (CGRP) released by the genitofemoral nerve. [7]

Mesotheliomas of the tunica vaginalis are rare, but should be considered in patients with a history of asbestos exposure who have a complex hydrocele with hypervascular parietal vegetations. [8, 9, 10]


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