Dropsy of testicular shells( hydrocele) - Causes, symptoms and treatment. MF.

Hydrocele( edema of the testicle) is a cluster in the cavities of the membranes of one or both testicles of a fluid that can have a different nature:

- blood;
- exudate - effusion in the testicle cavity of an inflammatory fluid - pus;
- a transudate - effusion in the cavity of the testicles of fluid( lymph) is not inflammatory;
- effusion in the cavity of the testicles of fluid after tight suturing of the outer inguinal ring of the inguinal ring after hernia repair;
- a consequence of the previous operation for varicocele and a violation of the outflow of venous blood from the testicle, which gives an effusion in the testicle cavity;
is the result of relapse after surgery for varicocele and hernia repair( inguinal and inguinal and scrotal) hernia.

A dropsy can be congenital and pre-acquired, acute and chronic, one- and two-stringed.

Hydrocele is most common in men 20-30 years and newborns.

Causes of dropsy hydrocele( hydrocele)

The main function of one of the shells of the testicle( vaginal membrane) is to produce a fluid that promotes free movement of the testicles inside the scrotum. There is a certain balance between the production of the liquid and its reverse absorption. If the process of fluid absorption by the vaginal membrane is violated, then its accumulation takes place and, as a result, hydrocephalus begins.

The cause of congenital dropsy in newborns - the unvaccinated vaginal process from the abdominal cavity collects fluid in the cavity of its own testicle shell. Depending on the presence of communication with the abdominal cavity, congenital dropsy of the testicle may be communicating and not communicating. Most often the hydrocele that communicates with the abdominal cavity disappears in the first year of life, becauseat this time the vaginal process is closed.

Causes of acquired testicular dropsy:

• inflammatory processes of the testis and its epididymis( orcoepididymitis);
• disturbance of lymph drainage in case of lesions of inguinal and pelvic lymph nodes( filillariasis);
• scrotal injury;
• severe heart failure;
• as a complication after surgery for varicocele and for correction of inguinal hernias.

The disease can occur in acute or chronic form. The acute form occurs as a consequence of inflammation of the testicle, testicular tumor or scrotal injury. An acute form without appropriate treatment can go into a chronic one.

Risk factors for dropsy of testicles( hydrocele)

- bruises in the region of external genital organs( kicks, hands, household objects);
- traumatic damage of testicles during sports( wrestling, weightlifting, powerlifting, cycling, fitness and other sports);
- tight suturing of the outer ring of the inguinal canal;
- relapse or consequence of "zealously" carried out varicocelectomy - removal of varicose veins of the spermatic cord;
- intense, long-term exercise in sports with power loads.

Symptoms of dropsy of the testicles( hydrocele)

Symptoms of dropsy:

• testicle or both, the eggs grow in volume, the testicle can not usually be palpated, the skin of the scrotum is smoothed but freely folded;
• appears dull aching pain in the scrotum or one of the testicles( acquired chronic edema usually does not cause pain);
• , when pressed on an enlarged testicle, is expressed by the symptom of fluctuations( as though protruding the testicles from the opposite side of the pressure site);
• can increase body temperature;
• with a large accumulation of fluid is impaired motor activity and wearing of underwear;
• a thin wall of the testicle with a large amount of accumulated fluid can break through into the scrotum and cause both a pain syndrome and a diffuse enlargement of the scrotum.

The amount of water fluid can be different, and in neglected cases it can reach up to several liters. At large sizes, it causes discomfort when walking, interferes with the sexual act, causes inconvenience with urination. With congenital edema, the volume of effusion increases throughout the day and decreases after sleep.

Acute edema occurs with acute inflammatory diseases of the scrotum( orcoepididymitis, inflammation of the spermatic cord).This causes a sudden increase in the corresponding half of the scrotum. The patient may experience acute pain and an increase in body temperature.

Diagnosis of hydrocele hydrocele( hydrocele)

To establish the correct diagnosis, it is necessary to perform a series of studies that include:

• Examination and palpation( palpation) of the external genitalia;
• Diaphanoscopy( transmission of the scrotum by a special light source).In this case, if the serum contains a serous fluid( which occurs, usually, with a dropsy testicle), then the light passing through the swelling is uniform. If, on the basis of the swelling, not the liquid lies, but, for example, the organs( intestine, strand of the omentum, etc.), then the light does not pass through the swelling;
• Ultrasound examination of the scrotum organs to exclude hernia. Ultrasound can accurately determine the volume of fluid, the presence in the scrotum of organs from the abdominal cavity, as well as the structure of the testicle;
• In some cases, additional research methods may be required to exclude or confirm other diseases.

Treatment of hydrocele shells of the testicles( hydrocele)

Treatment of hydrocele only operative.

There are two main ways to release the testicle from accumulated fluid: puncture hydrocele and operation to open the cavity with fluid, remove fluid, then suturing.

Temporary and quick help to the patient can be provided by puncturing the dropsy with a special needle and evacuation of the water fluid with a syringe - puncture. Puncture, as a rule, gives a temporary positive effect and relief of the patient's condition, followed by a gradual re-accumulation of fluid in the cavities and shells of the testicles.

Operation for radical removal of dropsy is a more competent way to treat hydrocele, which is carried out under anesthesia, painlessly, for two hours you are in the ward of the clinic after the operation, then go home, limiting physical activity for 1 week and come to dressings. Usually, in the case of dropsy, Winckelmann and Bergman's operations are performed.

There are no medicinal methods for treating edema of testis shells. The only exception is reactive edema of the testicles with acute epididymitis, orchitis, which requires conservative treatment - complete rest, wearing a suspension, antibacterial therapy.

In neonates, there are communicating edema of the testicles, which in half of the cases pass independently.

What can lead to dropsy of testicles if it is not operated on?

- compression of the testicle or both testicles with impaired spermatogenesis and development of male infertility;
- squeezing of testicles with liquid, development of circulatory disorders in the testicle and its gradual, complete atrophy;
- decreased potency and erectile dysfunction;
- accelerated, rapid ejaculation or premature ejaculation;
- the emergence of necrosis and necrosis of testicles on the background of compression of the fluid with subsequent removal of the testicle or both testicles;
- aesthetic affect - an increase in the volume of the scrotum, which becomes visible through clothing.

With the timely access to a doctor, the outcome of the disease is favorable in most cases. However, it should be remembered that in young people with large size of dropsy and prolonged squeezing of the testicle with fluid may develop testicular hypotrophy and impairment of spermatogenesis.

Prevention of dropsy of the testicles( hydrocele)

To avoid the formation of hydrocele of the testicle shells, it is necessary to protect the scrotum from trauma, to avoid and prevent infectious diseases, in particular chlamydia, which causes 55% of acute inflammations of the epididymis, epididymitis.

Doctor andrologist, urologist Vyatkin K.V.