Filarial Hydrocele

Excerpt

Hydroceles result from the accumulation of fluid within the tunica vaginalis inside the scrotum. This common condition, typically observed in adult males, results in painless enlargement of the scrotum. Chronic hydroceles have multiple etiologies and may occur secondary to other disorders, such as testicular malignancy or infection. There is a remarkably high incidence of chronic hydroceles in parts of the world where filariasis is endemic, and Wuchereria bancrofti is by far the most common causative agent in these regions.

Filariasis is a mosquito-transmitted parasitic disease. Filarial hydroceles are a late, chronic manifestation of W bancrofti filariasis in men. Late-stage manifestations of lymphatic filariasis—including elephantiasis, filarial hyodrceles, and severe lymphedema—occur later in life and can lead to disfiguring sequela, reduced mobility, social isolation, mental health problems, increased poverty, and permanent disability. Genital deformities often lead to social stigma and isolation, mental health issues, job loss, reduced employment opportunities, decreased mobility, and increased medical expenses for patients and their caregivers. These consequences contribute to a severe socioeconomic burden, particularly in regions already affected by poverty, limited employment opportunities, and suboptimal medical care.

In men, genital pathology manifests most often as a large, chronic hydrocele due to blockage or dysfunction of the scrotal lymphatic vessels that have become clogged, scarred, or damaged by nematodes. Filarial hydroceles are the most common manifestation of W bancrofti filariasis in men. In contrast, the most common clinical findings in women include swollen legs, lower limb lymphedema, and elephantiasis. A filarial hydrocele is not only debilitating and disabling to the individual, but also has significant regional economic implications due to the huge numbers of affected adult males throughout the tropical and subtropical regions and countries where the disease is endemic.