Hydrocele

Classification of hydrocele

The reasons

Symptoms in children and adults

Diagnosis of hydrocele

Treatment

complications of hydrocele

Hydrocele or dropsy of the testicle is a disease in which fluid accumulates in the area of ​​the scrotum and testicular membranes. The nature and volume of this fluid may be different.

The disease can occur in boys of the first year of life or in adults aged from 20 to 40 years.

When hydrocele fluid accumulates between the membranes of the testicle, leading to an increase in the size of the scrotum. It occurs at birth in about 10-15% of boys, but passes without treatment in the first months of life. In adults, edema usually does not disappear on its own, has a tendency to progression.

Classification of hydrocele

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By origin can be divided:

  • congenital form, it happens in children of the first year of life,
  • Acquired hydrocele , mostly in adults.

Congenital hydrocele by the mechanism of formation can be:

  • simple, when the opening between the scrotum and the abdominal cavity is closed, and the fluid accumulated in utero, it resolves in the first year of life.
  • communicating when the hole between the abdominal cavity and the scrotum is maintained for some time.

Between the membranes of the testicle can accumulate fluid, different in nature:

  • transudate (accumulation of non-inflammatory fluid, lymph or extracellular fluid),
  • exudate – accumulation in the cavity of inflammatory secretions or pus,
  • blood, accumulation in the cavity of blood from injured vessels,
  • effusion fluid after suturing the inguinal ring.

By the nature of the lesion, hydrocele can be one-sided, two-sided.

With the flow allocate acute or chronic form.

The reasons

Congenital form

In congenital dropsy of the testicle, the main reason is the non- opening of a particular opening into which the testicle in utero passed from the abdominal cavity.

It usually closes during the first year of life. Through this hole penetrates the fluid from the abdominal cavity, which in a small amount is always present inside it.

Acquired dropsy

Arises due to the following reasons:

  • with inflammation in the area of ​​the testicle and its appendage, due to the accumulation of inflammatory fluid.
  • with scrotal injuries,
  • due to impaired lymphatic drainage,
  • because of perineal surgery,
  • against the background of gonorrhea, tuberculosis or inflammation of the epididymis. 
  • after radiation or chemotherapy.

Risk factors for developing hydrocele in adults are:

  • disorders of lymph circulation in the groin area when lymph nodes are damaged,
  • heart failure with congestion 
  • surgery for varicocele or inguinal hernia,   
  • strikes to the groin area, groin damage during sports activities,
  • power loads.

Symptoms in children and adults

The main symptoms of a hydrocele will depend on the type of disease and its causes. The main manifestations include:

  • the increase in the scrotum in size compared with the norm
  • its decrease in volume after sleep, and an increase in the afternoon with congenital forms,
  • pain is absent.

In acute forms of hydrocele, the symptoms mainly depend on the cause, if this is inflammation of the testicle, then there are:

  • acute pain
  • temperature rise,
  • a sharp increase in the scrotum in size on one side or two.

The size of the scrotum in dropsy can be different:

  • fluid accumulates in the lower pole and forms a “pear” shape,
  • fluid accumulates in the scrotum and inguinal canal – an hourglass shape is formed,
  • the size of the scrotum may be from slightly increased to the size of the children’s head, then urination and sexual function may suffer.
  • when probing the surface is smooth,
  • skin gathers loosely,
  • the consistency is dense, elastic, defined as the flow of fluid,
  • testicle in the thickness of the fluid is not detectable.

Hydrocele usually does not cause complications unless it is caused by an acute infection or trauma. With long-term dropsy, testicular atrophy may occur.

Diagnosis of hydrocele

Initially, the examination and palpation (palpation) of the scrotum in a standing and lying position are necessary, in addition, the patient’s story about how and how the disease began is important.

Since the skin of the scrotum is thin, there is a method of examining it – diaphanoscopy, transmission of the scrotum with a special lamp. This will allow not only to confirm the dropsy, but also to determine the content – what is there – pus, blood or serous, inflammatory fluid.

If an infection is suspected, blood and urine tests will be needed, and the most basic diagnostic method is scrotal ultrasound and the exclusion of other diseases.

Treatment

In newborns, hydrocele is usually observed without taking active actions for up to a year, if after a year it does not pass or there is a tendency to a sharp increase, surgical correction is necessary. 

In adults, hydrocele is treated only operatively, except for the symptomatic acute form caused by testicular inflammation. In this case, anti-inflammatory and analgesic drugs, rest and wearing of dressings (supporting sling) are shown.

Surgical treatment includes:

  • performing an operation under local anesthesia,
  • opening a cavity with liquid
  • thorough removal of excess fluid
  • suturing the defect.

After surgery for a couple of weeks, limit physical activity.

In rare cases, puncture the testicle with the removal of excess fluid, but this is a temporary measure.  

Complications of hydrocele

If you do not carry out operations and do not correct hydrocele, this can lead to:

  • compression and atrophy of the testicle with the development of infertility,
  • circulatory disorders in the testicle,
  • lower potency
  • impaired sexual function, ejaculation,
  • aesthetic defects and psychological discomfort,

To avoid this, it is necessary to protect the perineum from injuries, promptly treat infectious diseases, and not overwork.

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