A hydrocele is an accumulation of serous fluid between the layers of the serous membrane of the testicle, congenital or acquired. Some authors associate the appearance of hydrocele (dropsy of the testicle) with physical labor, more often with horseback riding (riders) and cars (chauffeurs).
Hydrocele can be limited only to the area of the testicle itself, having, in this case, the form of an ovoid tumor. With an increase in Hydrocele, the sheaths of the cord can also take part, and the tumor becomes pear-shaped, with a sharp end facing the inguinal canal. In the presence of cicatricial constrictions on the cord (congenital or acquired), Hydrocele takes the shape of an hourglass: one sac in the scrotum, the other under the skin, in the region of the inguinal canal.
With an hourglass-type hydrocele, the inner sac is located in the abdominal cavity, communicating with the outer one through the unsealed vaginal process of the peritoneum.
In the presence of inflammatory adhesions between two layers of the serous membrane, a multi-chambered Hydrocele is formed. With congenital hydrocele, there is no obliteration of the vaginal process of the peritoneum, and the fluid can freely move from the scrotum to the abdominal cavity and back.
During a hydrocele, two forms should be distinguished - acute and chronic.
Acute hydrocele, otherwise acute periorchitis, develops over several days and stays in one position for 1-2 weeks to then disappear without a trace or become chronic. Clinically, in acute hydrocele, there is a tumor of half of the scrotum. On the skin of the scrotum with acute hydrocele, diffuse redness with symptoms of edema may be observed. The tumor of the scrotum in acute hydrocele is elastic, clearly fluctuates.
The scrotum in acute hydrocele percussion gives a dull sound, shines through to the light, is very sensitive. It is not possible to feel the testicle, which is pushed backward. An acute hydrocele is accompanied by a significant increase in temperature and is observed, as a rule, as a result of a traumatic or acute inflammatory process in the epididymis or testicle.
Chronic hydrocele usually develops gradually, with little disturbance to the patient. Having reached a large size, Chronic hydrocele, by its severity, causes pain in the groin, discomfort during intercourse, and often during urination. Pulling the penis into the tumor in chronic hydrocele can change the flow of urine, which, by moisturizing the skin of the scrotum, causes its eczema.
Clinically, chronic hydrocele has a pear-shaped tumor. The upper border of the tumor in chronic hydrocele is well defined. The skin with small hydroceles does not present changes, with large hydroceles it is thinned, but mobile. Depending on the amount of fluid, the tumor can be sharply tense, in the form of a dense elastic formation, with fluctuation, and it is impossible to feel the testicle and epididymis in it. Sometimes the tension of the fluid is so slight that the testicle and epididymis are palpable quite well.
Percussion tumor in chronic hydrocele gives a dull sound and shines through. With a communicating hourglass-type hydrocele, which also has a chronic course, the tumor appears only when walking and moving, in a supine position it can disappear in whole or in part.
A characteristic symptom of a hydrocele is transillumination, which is performed using a flashlight closely attached to the surface of the tumor, opposite to the stethoscope placed on the tumor. The passage of light rays excludes hematocele, orchitis, testicular tumors, which differ from hydrocele also in their tuberosity. With a thickened serous membrane, the translucency of the testicular membranes may be absent. A large Hydrocele, when the sheaths of the cord are involved in the process, has to be differentiated from a hernia.
The prognosis for acute hydrocele is favorable. With chronic hydrocele, there is no need to count on a spontaneous cure. With an hourglass-type hydrocele in children, subsequent obliteration of the vaginal process of the peritoneum can sometimes occur with the complete cure.
Complications of hydrocele
Complications of hydrocele:
- endogenous and exogenous fluid infection (as a result of puncture)
- hemorrhage into the cavity of the membranes
- rupture of membranes due to trauma (sometimes spontaneous ruptures are observed)
The reason for the rupture of the membranes is the loss of elasticity of the membranes due to chronic inflammation. There is no definite localization of the gap. Experiments indicate that rapidly enlarging hydrocele often contributes to rupture.
Prevention of complications with hydrocele (dropsy of the testicle): wearing a suspensor for any disease of the genitourinary system.
Conservative Hydrocele treatment is indicated in acute and operative in chronic cases. Conservative treatment is reduced to the use of warming, compresses on the scrotum.
Radical operations for hydrocele:
- According to Bergman (Vegdtapp): a longitudinal section through all layers of the scrotum to the serous membrane of the testicle, without cutting it. The testicle is dislocated into the wound. The sac is incised and the outer layer of the serous membrane near the epididymis is resected. Thorough stopping of bleeding. The testicles are placed in place. Deaf seams. The method is recommended for thick casings.
- According to Winkelman (Jaboulay-Winkelmann): an incision along the anterior outer surface of the scrotum through all layers to the serous membrane, dislocation of the testicle into the wound. The incision of the serous membrane up and down to the tail of the epididymis. The sutures on the inverted shell are behind the epididymis. Blind stitches on the skin. Relapses in 1-2%. The method, which gives almost no complications, is popular, it takes the patient away from work for a short time.
- Alferov's method: cutting all the shells, releasing the liquid. For permanent drainage, the serous membrane is sutured to the subcutaneous tissue of the scrotum. Blind skin seam. Bandage.