Huzaifa Muhammad, Moreno Moises A.
King Edward Medical University, Lahore
Kendall Regional Medical Center
A hydrocele is an abnormal collection of serous fluid between the two layers of tunica vaginalis of testis. It can either be congenital or acquired. Congenital hydrocele results from failure of processus vaginalis to obliterate. During development, the testes are formed retroperitoneally in the abdomen and proceed to descend into the scrotum via the inguinal canal in the third gestational week. This descent of the testes into the scrotum is accompanied by a fold of peritoneum of the processus vaginalis. Normally, the proximal portion of processus vaginalis gets obliterated while the distal portion persists as the tunica vaginalis covering the anterior, lateral, and medial aspects of the testes. The tunica vaginalis is a potential space for fluid to accumulate, provided the proximal portion of processus vaginalis remains patent and results in free communication with the peritoneal cavity, leading to congenital hydrocele. Hydroceles are divided into two types: primary and secondary. The processus vaginalis of the spermatic cord fuses at term or within 1-2 years of birth, thus obliterating the communication between the abdomen and scrotum. The distal portion, however, remains patent as the tunica vaginalis covers the testis, creating a potential space where fluid accumulation within it can lead to hydrocele formation. Depending upon the site of the obliteration of processus vaginalis, there are four types of primary hydrocele.Thisoccurs when processus vaginalis is patent and communicates with the peritoneal cavity. This communication allows the movement of peritoneal fluid but is too small to allow the intra-abdominal contents to herniate through. H: In this case, processus vaginalis gets obliterated at the level of the deep inguinal ring. However, the portion distal to it remains patent and allows fluid accumulation. Both the proximal and distal portions of processus vaginalis get obliterated while the central portion remains patent and fluid accumulates within it. Processus vaginalis remains patent only around the testes, and, as fluid accumulates, it renders the testes impalpable. This usually occurs as a result of an underlying condition, such as infection (filariasis, tuberculosis of the epididymis, syphilis), injury (trauma, post-herniorrhaphy hydrocele), or malignancy. This type of hydrocele tends to be small, with the exception of secondary hydrocele due to filariasis, which can be very large.
鞘膜积液是睾丸鞘膜两层之间浆液的异常积聚。它可以是先天性的，也可以是后天获得性的。先天性鞘膜积液是由于鞘状突未闭所致。在胚胎发育过程中，睾丸在腹膜后腹部形成，在妊娠第3周时通过腹股沟管降至阴囊。睾丸降至阴囊的过程伴随着鞘状突的腹膜皱襞。正常情况下，鞘状突近端闭塞，远端持续存在形成覆盖睾丸前、外侧和内侧的鞘膜。鞘膜是一个潜在的积液空间，如果鞘状突近端保持开放并与腹腔自由相通，就会导致先天性鞘膜积液。鞘膜积液分为原发性和继发性两种类型。精索的鞘状突在足月时或出生后1 - 2年内融合，从而闭塞腹部与阴囊之间的通道。然而，远端部分仍保持开放，因为鞘膜覆盖睾丸，形成一个潜在的空间，其中液体积聚可导致鞘膜积液形成。根据鞘状突闭塞的部位，原发性鞘膜积液有四种类型。当鞘状突开放并与腹腔相通时发生这种情况。这种相通允许腹膜液移动，但太小以至于腹腔内容物不能通过此处疝出。H：在这种情况下，鞘状突在腹股沟深环水平闭塞。然而，其远端部分仍保持开放并允许液体积聚。鞘状突的近端和远端部分都闭塞，而中央部分保持开放，液体在其中积聚。鞘状突仅在睾丸周围保持开放，并且随着液体积聚，会使睾丸无法触及。这通常是由潜在疾病引起的，如感染（丝虫病、附睾结核、梅毒）、损伤（创伤、疝修补术后鞘膜积液）或恶性肿瘤。这种类型的鞘膜积液往往较小，由于丝虫病导致的继发性鞘膜积液除外，后者可能非常大。
