Inguinal dropsy in children. Dropsy of the testicle (hydrocele) in a man, in a boy, in newborn children - a description and causes of the disease, symptoms and diagnosis, treatment (surgery, puncture), swelling after surgery. Is an operation needed

The issues of treatment of diseases of the genital organs in boys are always quite intimate for any parents. In some cases, fathers and mothers are so confused that they do not know who to turn to for help.

What it is?

The testicles are paired sex organs that are located in the scrotum. Under the influence of a number of factors, fluid accumulates in it. This leads to the development of dropsy of the testicles. This swelling is also called a hydrocele. In boys, this pathology occurs quite often.

Norm

Dropsy testis

In pediatric andrology, both dropsy of the right testicle and the left are described. Often the process is two-way. Parents will be able to notice trouble even on their own. Usually the baby's scrotum swells or its noticeable bulge is visible. These cases require immediate medical advice.

According to statistics, the disease occurs in every tenth baby. In 9-10% of children, swelling of the testicular membranes occurs together with other diseases of the intimate organs at the same time. These include: inguinal hernia, dropsy of the spermatic cord of the gland, as well as a violation of the outflow of lymph from its membranes.

Causes and consequences

In boys, this disease in most cases is congenital. Usually the disease manifests itself in 1-2 years.

Some cases proceeding with rather erased symptoms can be detected in a child only at the age of 3 years. In complex clinical cases, an additional examination of the baby is required using modern instrumental diagnostic methods.

The following conditions lead to the development of this condition in boys:

• Too low birth weight. Babies who were born prematurely for some reason are often more prone to developing dropsy. This is due to the presence of anatomical defects in the structure of the genital organs. It takes enough time for the testicles to descend into the groin. With the shortening of this period, the baby often has various defects in the structure of the genital organs.

• Birth trauma. Violation of childbirth can lead to various injuries to the child. If the fetus is in a breech presentation, as well as at the birth of twins in a natural way, various injuries often occur, including the genitals. Also, a similar situation occurs in miniature mothers who have given birth to a baby that is too large.
• Infectious diseases. Viruses and bacteria very easily penetrate the placental barrier. Getting into the body of the fetus at the stage of development of the genital organs, they cause various structural anomalies in the baby. Doctors consider the first and third trimesters to be the most dangerous period of pregnancy for the possibility of these pathologies.

• Swelling of nearby organs. The fluid that is formed in various diseases can easily flow from one anatomical zone to another and reach the scrotum. This feature is due to children's anatomy. Pathologies of neighboring organs (often the lower extremities) lead to the development of scrotal edema in the child, leading to dropsy of the testicles.

• Development of cardiovascular insufficiency. In this condition, the tendency to form various edema increases. Usually they are localized on the legs and in the pelvic area. Scrotal edema can even occur in a child with congenital heart disease. Usually this combination indicates a strong trouble in the child's body.
• Birth Defects. Often found in babies born prematurely. Parents notice adverse symptoms already in the first year of a child's life. In full-term babies, the duct connecting the peritoneum and the scrotum becomes overgrown.

Premature babies often face problems resulting from growth disorders.

• Consequences of viral infections. Pediatric andrologists note the development of acquired forms of diseases after the flu. Viruses have a strong negative effect on many internal organs, including the intimate zone. Pathology, proceeding in a rather severe form and hydrocephalus, can cause severe swelling in the scrotum in a child.

• Consequences of trauma. Damage to the external genital organs can cause the development of inflammation and swelling of the testicular membranes. This condition is more often recorded in boys aged 12-14 years. Damage contributes to the rapid development of adverse symptoms. In some cases, surgical treatment is required.
• Diseases of the urinary tract. The organs of the genitourinary system are quite close to each other. This contributes to the rapid spread of infection. Often, chronic pyelonephritis or cystitis leads to the development of inflammation in the intimate area in boys. In babies of the first year of life, this condition is recorded more often.

Dropsy of the testicles is very dangerous. It is impossible to neglect and not notice the first signs of this disease! This condition requires mandatory treatment. If the treatment of the disease for some reason was delayed, then this can lead to serious complications in the boy in the future.

The most common consequences include:

• Necrosis (death) of the tissues of the scrotum and testicles. Prolonged squeezing leads to disruption of the blood supply and innervation of the intimate organs. Ultimately, this contributes to the development of persistent hypoxia (oxygen starvation). The chronic process is accompanied by the development of severe damage and death of the cells of the genital organs.
• Reproductive dysfunction. When the process is chronic, there is a violation of the formation of spermatozoa. According to statistics, in 20% of men with poorly treated dropsy of the testicles in childhood, infertility occurs. Treatment of this condition at an older age is quite problematic. In some cases, the reproductive function of a man is reduced almost completely.

• Compression of nearby organs. Most often, this condition affects the intestines. This leads to various digestive problems. The most common manifestation is a violation of the stool. Babies who have dropsy of the testicles also suffer from constipation or have an increased tendency to constipation.
• The development of combined diseases of the genitourinary sphere. Severe swelling in the scrotum also leads to squeezing and disruption of other genital organs.

A long-term condition contributes to the appearance of a lymphocele in a baby. With this pathology, the outflow of lymph from the area of ​​\u200b\u200bthe intimate organs is significantly disturbed.

Kinds

There are several variants of dropsy of the testicles in boys. Their development is influenced by a variety of causal factors. This classification has been used in pediatric andrology for many years. It is compiled taking into account the anatomical defects that occur with different variants of the disease.

This pathology can be:

• Communicating. This form of the disease is congenital. The condition is characterized by the presence of a duct between the scrotum and the peritoneum. As a result, free fluid can easily reach the intimate area. Its accumulation leads to the development of dropsy of the testicular membranes.
• isolated. In this case, the pathological fluid is formed in the scrotum itself or between the sheets of testicular membranes, and not in the abdominal cavity. Most often, this condition contributes to the development of a unilateral process. Unfavorable symptoms occur only on one side.

When establishing and formulating a diagnosis, it is very important to indicate when this pathology arose.

When anatomical defects appear immediately after birth, they speak of a congenital variant. If the swelling of the scrotum appeared as a result of exposure to various injuries and injuries, as well as as a consequence of various infectious diseases, then they speak of an acquired variant.

signs

The severity of the clinical manifestations of this condition may be different. It depends on many different aggravating causes. These include: the age of the child, the presence of concomitant diseases, the level of immunity and even social living conditions. The mild course of the disease is quite difficult to diagnose at home. Often parents "miss" the first signs of the disease in the baby.

The most characteristic symptoms include:

• Discoloration of the skin in the scrotum. She turns red. The skin is hot to the touch. Usually this symptom is well manifested in babies of the first years of life. With traumatic injuries on the scrotum, you can see various bruises or hematomas that are dark blue in color.
• Enlargement of the scrotum. She becomes tense. With a bilateral process, the scrotum increases several times relative to the norm. If only one testicle is damaged, then asymmetry is visually visible.

• Soreness or tenderness on palpation. Inflammation leads to the fact that any touch to the scrotum causes an increase in pain. Usually parents find this manifestation when carrying out hygiene procedures with the baby.
• Sensitivity during urination. In some cases, when dropsy is combined with diseases of the urinary system, the child also has various urinary disorders. The baby often asks to go to the toilet. Some urges are accompanied by an increase in pain.

• Symptoms of intoxication. Some variants of the disease are accompanied by an increase in body temperature up to 37-38 degrees. At the height of hyperthermia, fever or chills may occur. A chronic inflammatory process in the area of ​​\u200b\u200bthe intimate organs leads to the appearance in the baby of signs of a persistent increase in temperature.
• Behavior change. Toddlers become more capricious, they can whimper. With severe pain syndrome - even cry. Children of the first years of life often ask to be held. The child's sleep is often disturbed. Difficulty falling asleep or waking up repeatedly during the night is usually noted.

• Urinary retention. This symptom develops with a rather severe and neglected course of the disease. This disrupts the excretion of urine from the bladder. Portions are getting smaller. In this case, the parameters of the general analysis of urine, as a rule, do not change.
• Increasing pain in the scrotum. The first stages of the disease are usually not accompanied by the appearance of adverse symptoms. Subsequently, if treatment is not provided, the pain syndrome becomes more noticeable. The baby may complain of discomfort or even soreness. Most often, it appears after a hot bath, a brisk walk, or going to the toilet.

Diagnostics

The disease can be suspected in the early stages. To do this, it is very important to monitor the condition of the intimate organs of the child. It is best to do this during daily hygiene procedures. Parents should pay attention to any abnormalities that occur in the area of ​​​​the external genital organs of the baby. If there is a change in the color of the skin of the scrotum or its increase, you should definitely consult a doctor.

For additional diagnostics, it is better to contact a pediatric andrologist or urologist. These doctors have sufficient knowledge in the field of treatment of diseases of the intimate organs in boys.

You can contact medical specialists from the first days of the baby's birth. Such consultations will allow to identify the disease in the early stages and help prevent the development of long-term adverse effects.

Usually, doctors conduct several additional studies to establish a diagnosis. Even a simple clinical examination is sufficient for the preliminary establishment of the disease. During this, the doctor examines the baby's external genitalia and conducts all palpation tests to establish the correct diagnosis. In complex clinical cases, additional tests are required.

According to the appointment of a pediatric urologist for the diagnosis of dropsy of the testicles, the following are used:

• Ultrasound examination of the scrotum and testicles. This method is absolutely safe and painless. During the procedure, the baby does not feel any pain at all. It only takes 15-20 minutes to establish a diagnosis. The method is quite accurate and highly informative.
• Diaphanoscopy. This method consists in that the intimate organs are translucent with the help of light. The study reveals the presence of free fluid between the membranes of the testicles. The method is widely used in pediatric urological practice around the world.

Diaphanoscopy

Laboratory tests, including complete blood and urine tests, are ancillary. Usually they are prescribed only to establish the cause of the disease, as well as to establish the degree of functional impairment. For example, a general blood test allows you to accurately determine the presence of a viral or bacterial infection in a child's body, which often causes the disease. An increase in the level of leukocytes indicates the severity of the process. Changes in the parameters of a general urine test occur only in advanced cases of the disease and are practically absent in the initial period of the disease.

Treatment

Therapy for dropsy of the testicles should be carried out as quickly as possible. Timely treatment helps to cope with adverse symptoms and reduce the likelihood of delayed consequences of the disease.

Therapy of the disease includes the sequential appointment of several groups of drugs.

For the treatment of this condition are used:

• Symptomatic pain relievers. They allow you to eliminate the pain syndrome that occurs in the scrotum with strong squeezing of the testicular fluid. As painkillers can be used: Ketorol, Ibuprofen, Analgin, Nimesulide and others. The drugs are prescribed in the form of tablets or injections. They are prescribed strictly by a doctor.
• Carrying out surgical operations. Indications for them are individual. The decision to surgically remove fluid from the scrotum is made by the treating pediatric urologist. Usually they are prescribed in cases where there are anatomical defects. The Ross operation is a fairly commonly used method for eliminating adverse manifestations of the disease.

• Reducing adverse symptoms of the disease with the help of home remedies. Some mothers suggest curing dropsy of the testicles with sea salt. This method of treatment has very conflicting reviews. Usually, such self-treatment only leads to a decrease in adverse symptoms, however, the disease does not completely cure.
• Puncture of the affected testicle. Puncture in this case allows you to eliminate all excess fluid from the scrotum. The method is traumatic and has a number of contraindications. It is carried out according to strict indications. The decision on the need for a puncture is made by the attending pediatric urologist.

• Performing sclerosing. Also applies to surgical methods for the treatment of dropsy of the testicles. During the procedure, the doctor, using a special tool, pumps out fluid from the scrotum and injects a drug into it, which helps to reduce the formation of secretions in the future. Currently, this method is not used in pediatric practice. It can cause serious problems with the child's reproductive function in the future, and even lead to the development of infertility.
• Carrying out the Winkelmann surgical method. The doctor conducts a layer-by-layer disclosure of the testicular membranes. Typically, the size of the surgical field is 4-6 cm. All fluid is pumped out of the scrotal cavity. After that, the doctor unfolds all the shells and stitches them on the back surface, which allows in the future not to form an excessive amount of fluid inside the scrotal cavity.

hydrocele- this is the accumulation of fluid between the vaginal membranes of the testicle. It is an independent pathology or accompanies certain diseases: tumors of the epididymis or testis, hydatitis, inflammation, etc. Symptoms are represented by an increase in the scrotum on the side of the lesion (or on both sides with bilateral dropsy of the testicles), a feeling of fullness. Diagnosis includes ultrasound of the scrotum, PCR tests for venereal infections, spermogram, tests for tumor markers of testicular cancer. The operation is performed with a significant hydrocele that worsens the quality of life and affects spermatogenesis. In secondary pathology, the treatment of the underlying disease is carried out.

General information

Hydrocele (from the Greek "hydro" - water, "cele" - protrusion) is a common urological pathology that occurs in men of any age. In children under one year old, fluid accumulation that does not communicate with the peritoneal cavity is considered a variant of the norm, by 12-24 months of age the condition normalizes, only in 6% of boys the hydrocele remains clinically significant. Young men experience acquired dropsy in 2-4% of cases, in 10% the lesion is bilateral, in 30% the cause cannot be established. In older patients, hydrocele is more often recorded as a complication after operations on the pelvic organs or against the background of extragenital pathology associated with massive edema.

Causes of hydrocele

The reasons depend on the type of pathology. Congenital dropsy of the testis develops against the background of non-closure of the vaginal process of the peritoneum in the process of embryogenesis. Acquired hydrocele is due to an imbalance between fluid production and reabsorption. Reactive dropsy accompanies a number of pathological processes. In endemic areas, increased exudation provokes an infectious disease - filariasis, in which lymphatic structures are affected. Radiation therapy is called a risk factor by oncourologists. The main causes of hydrocele include:

• Inflammatory process. Orchitis, orchiepididymitis of specific (including tuberculosis) or non-specific etiology are accompanied by reactive dropsy. Chronic inflammation leads to impaired blood and lymph circulation, fluid leakage and accumulation between the testicular membranes. Latent STIs (chlamydia, trichomoniasis, gonorrhea) support the inflammatory process.
• post-traumatic condition. As a result of injuries, burns and bites, the integrity of the blood and lymphatic vessels is disrupted, which prevents the natural outflow of fluid. The condition is aggravated by the addition of secondary bacterial microflora. Surgical interventions on the organs of the scrotum, especially those performed for varicocele and inguinal hernia, compression with blood flow restriction on the background of testicular torsion, are also considered as causes of hydrocele.
• Tumor pathology. A malignant neoplasm of the germinal cells of the testicle or its appendages at an advanced stage due to compression of the vessels contributes to the exudation of fluid. Sometimes only an asymmetric increase in the size of the scrotum forces a man to sign up for a consultation with a urologist.
• Diseases associated with the deposition of fluid. Cardiovascular insufficiency, chronic kidney disease accompanied by chronic renal failure in the stage of decompensation, liver failure cause fluid accumulation not only in the membranes of the testicles, but also in all serous cavities. In these conditions, hydrocele is secondary.

Pathogenesis

The exact mechanism of formation of idiopathic hydrocele in adults remains debatable. Possible pathogenetic mechanisms of hydrocele formation are increased secretion of serous fluid by the mesothelium, damage or congenital malformations of the lymphatic tract, microcirculation disorders and inadequate absorption.

Physiological dropsy in children is due to age-related anatomical features of the structure - an open hole in the peritoneal sheet after the testicles descend into the scrotum leads to the formation of a cavity where fluid accumulates. Pathology is exacerbated by the imperfection of the lymphatic apparatus. If the opening is large, part of the intestine may fall into it (hernia). Any increase in intra-abdominal pressure (with severe crying, constipation) prevents obliteration of the defect and normalization of the condition.

Classification

In practical urology and andrology, hydrocele is classified according to a number of features. By localization, hydrocele can be unilateral and bilateral. According to ICD-10, encysted (delimited), infected, unspecified (idiopathic) hydrocele, etc. are distinguished. If the cavity contains more than 200 ml of fluid, dropsy of the testicle is considered large, with a giant increase in the size of the dropsy cyst, the volume of accumulation can reach 3,000 ml. A hydrocele can be acute (exudation or extravasation occurs quickly) or chronic (fluid accumulates slowly). According to the occurrence, the following types of dropsy of the testicle are distinguished:

• Physiological. It is present from birth, over time, the opening of the peritoneal sheet is obliterated, the lymphatic apparatus is improved, the fluid is absorbed.
• Congenital. It can be communicating if there is a gap between the peritoneum and its vaginal process, or non-communicating when there is no common channel with the abdominal cavity, and the exudate is produced directly by the cells of the vaginal process.
• Acquired. There are idiopathic (primary) acquired dropsy in cases with an unknown cause, and symptomatic (secondary), which appears in the process of life and is associated with a pathogenetic factor.

In some patients, according to the results of ultrasound, it is found that the hydrocele cyst is divided into chambers by one or more partitions. This feature is characteristic of long-term hydrocele. Sometimes calcification is noted, this form raises suspicions of tuberculous etiology or a neoplastic process.

Symptoms of a hydrocele

Symptoms of the disease are associated with the volume of accumulated fluid, with a small amount of it, there are no clinical signs. With significant accumulation, the scrotum is asymmetrically enlarged, the skin is taut (non-communicating hydrocele), of normal color. On palpation, the anatomical structure is homogeneous, painless, there are difficulties in determining the contours of the testis. With an exudate volume of more than 300-500 ml, drawing pains appear, a feeling of discomfort, which intensifies during physical activity.

Urination and erectile function in all forms of pathology can be disturbed as the volume increases. For communicating dropsy, a decrease in size after sleep is typical. A multichamber hydrocele with involvement of the inguinal canal resembles an hourglass. Clinical manifestations of reactive hydrocele depend on the underlying disease. With torsion of the vascular and nerve bundle of the testicles, a sudden unbearable pain develops, redness of the skin, and an increase in the size of the scrotum.

Reactive dropsy in orchitis is caused by inflammatory effusion, general symptoms include pain, skin flushing, testicular edema, and severe pain. In diseases associated with fluid retention, there are no pronounced pain sensations. Tumors of the testicle and epididymis in most cases are asymptomatic, the accumulated aqueous environment prevents palpation of the neoplasm. In the later stages, regional lymph nodes increase.

Complications

Complications include disruption of the spermatogenesis process due to fluid compression of the testicular tissue and circulatory disorders. In advanced cases, with a long-term hydrocele of a large volume, testicular atrophy develops. Periodic traumatization while cycling, running, during sexual contact can be complicated by orchitis, the reproduction of secondary microflora (infected hydrocele).

Due to a violation of microcirculation, the skin of the scrotum becomes dry, there is a tendency to develop dermatitis. Sexual function and urination suffer with a giant hydrocele, sometimes in a man the penis is buried in the thickness of the scrotum (hidden penis). Since a neglected hydrocele reduces fertility by 20-30%, andrologists consider early detection and treatment of this disease a priority.

Diagnostics

The preliminary diagnosis of a hydrocele is established during a physical examination, however, an obligatory part of the examination is imaging techniques used to identify a possible hidden underlying pathology. In some cases, a consultation with a phthisiourologist is required to exclude a tuberculous etiology of the process or a surgeon to confirm an inguinal-scrotal hernia. The survey algorithm includes:

• Instrumental diagnostics. Ultrasound of the scrotum is the preferred way to visualize the cause and assess the hydrocele. Sonograms show the size of the testicle, its contours, the presence of a tumor mass in neoplasia. During the study, attention is paid to the condition and position of the epididymis, changes in the pelvic lymph nodes. CT and MRI are indicated for reactive dropsy against a tumor.
• Lab tests. For an uncomplicated hydrocele, the results of OAC and OAM are nonspecific, but these tests are informative in identifying the cause of secondary hydrocele. Against the background of inflammation or tumor, an increase in ESR and leukocytosis is noted. PCR analysis for STIs is used to diagnose latent vein diseases. The evaluation of the spermogram data is taken into account when deciding on the need for surgery. Tests for tumor markers (hCG, AFP) are prescribed to exclude a neoplastic process hiding behind reactive dropsy.

Differential diagnosis of hydrocele is carried out with inguinal hernia, hematocele and testicular tumor, ultrasound data are used to distinguish between these pathologies. Torsion, trauma, acute orchiepididymitis from hydrocele are distinguished by a pronounced pain syndrome. With testicular tuberculosis, positive results of special tests are determined, the diagnosis is finally confirmed by a morphological study.

Hydrocele treatment

Asymptomatic dropsy with a small volume of fluid, which does not affect fertility, suggests monitoring in dynamics. In children, isolated hydrocele without other malformations of the genitourinary system does not require intervention until 2-3 years of age, since it can resolve itself. Reactive hydrocele often disappears or decreases after adequate treatment of the underlying disease. Pronounced deposition of fluid between the parietal and visceral layers of the peritoneum is an indication for surgical treatment. Apply:

• Classic Interventions. Operations of Winckelmann and Bergman include dissection of the scrotum, removal of the dropsy cyst into the wound and its puncture. According to the Winckelmann method, the testicular membranes are everted and sewn together so that the fluid has nowhere to accumulate, and it is absorbed into the surrounding tissues. According to the Bergman method, the vaginal membrane is excised, and during Lord's operation they are corrugated, which is considered less traumatic, since the testicle is not separated from the membranes and is not removed into the wound.
• Minimally invasive techniques. These include sclerotherapy, the use of a plasma scalpel (plasma coagulation of the vaginal testicular membrane), ultrasonic dissection, laser tissue dissection, etc. The effectiveness of these methods is comparable to open operations, and the rehabilitation period and the percentage of complications are lower. With inflammatory and tumor pathology, which contributed to the appearance of a hydrocele, the listed methods are not applicable.
• Hydrocyst aspiration. This method has a high percentage of relapses and postoperative complications in the form of hematoma and inflammation. Therefore, at present, hydrocele puncture is performed only in patients with severe comorbidities as a palliative care with a significant amount of fluid.

Forecasts and prevention

The prognosis of hydrocele in children is 90% favorable, patients are fully rehabilitated after surgery. The outcome of acquired hydrocele depends on the etiological factor. The number of postoperative relapses is 1-5%. Preventive measures include the use of protection of the scrotum during traumatic sports, timely treatment of inflammatory diseases, adherence to monogamous relationships.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!

Hydrocele (hydrocele)- a condition in which fluid accumulates around the testicle, in most cases does not cause concern and does not pose a danger, can pass on its own, in other cases it requires surgical treatment.

Hydrocele in facts and figures:

• About 10% of children are born with a hydrocele.
• This condition occurs in 1% of adolescent and adult men.
• Hydrocele is most common between the ages of 15 and 30.
• Hydrocele is a purely male disease.

What is hydrocele? Causes of a hydrocele

The name of the disease comes from two ancient Greek words: "hydro" - "water, liquid" and "cele" - "swelling, expansion."

Symptoms of hydrocele

Usually dropsy of the testis is not a cause for concern. In most cases, the only symptom of this condition is an enlargement of the scrotum - on one or both sides. To the touch, the hydrocele is felt as a painless formation with an elastic consistency.

Some men experience the following symptoms:

• feeling of heaviness, discomfort in the scrotum;
• increased swelling of the scrotum and discomfort in the evening.

In what cases you need to see a doctor:

• First detected enlargement of the scrotum. You need to find out what caused it. This may be due to a hydrocele, inguinal hernia, or other conditions.
• A hydrocele was discovered in a child after birth and then does not go away within six months. You need to contact a pediatric surgeon for a re-examination.
• Rapid onset of swelling, pain in the scrotum. This may be associated with acute conditions requiring immediate surgical intervention, such as testicular torsion or Morgagni hydatid necrosis.

What dropsy of the testicle looks like (photo)

A hydrocele looks like an enlargement of the scrotum on one or both sides. Most often it has a small size:


Sometimes dropsy increases to the size of a goose egg or even the head of a child:

Survey

Usually, the doctor establishes the diagnosis after examining and feeling the scrotum. If a hydrocele is suspected, adults should contact a surgeon or urologist-andrologist, and the child should be taken to a pediatric surgeon.

To clarify the diagnosis, the doctor may prescribe additional studies:

Study title	Description
Diaphanoscopy	The study allows you to distinguish dropsy of the testicle from other conditions, such as inguinal hernia, when loops of intestine protrude into the scrotum. How is diaphanoscopy performed?: The patient's scrotum is translucent with a small flashlight in a darkened room. In a hydrocele, light passes freely evenly through a fluid-filled cyst. More dense formations delay light. If the patient has had inflammation of the testicular membranes, or there is blood in the cyst, the light passes through the scrotum unevenly, diaphanoscopy will be uninformative.
Ultrasound for hydrocele	During an ultrasound examination, you can examine the testicle, the contents of the cyst, and evaluate the volume of fluid. Doppler ultrasound allows you to assess the blood flow in the testicular vessels. Ultrasound is often prescribed in doubtful cases, it helps to distinguish dropsy of the testicle from other pathological processes in the scrotum.

The doctor may prescribe a general blood and urine test to rule out inflammatory diseases of the genitourinary system.

What diseases can resemble the symptoms of a hydrocele?

Scrotum swelling may be associated with the following diseases:

• An inguinal hernia is a condition in which intestinal loops and other internal organs exit into an unclosed vaginal process.
• Varicocele - varicose veins of the testicle. Feels like a bag of worms.
• Tumors. In young children, neoplasms in the scrotum are most often benign. Testicular cancer occurs in adolescents and adults.

Usually, the doctor can easily establish the correct diagnosis during the examination.

What are the consequences of a hydrocele?

The main complications of hydrocele:

• With a significant increase in the cavity with liquid, discomfort increases, pain, urination disorders, and difficulties during sexual intercourse may occur.
• The development of the inflammatory process in the scrotum.
• Rupture of the vessel and the formation of a hematoma (accumulation of blood).
• Sometimes, with large dropsy, the blood supply to the testicle is disturbed. Over time, this can lead to its atrophy (reduction in size), disruption of sperm formation.

In most cases, a hydrocele, unless caused by a more serious condition, is harmless and does not lead to complications.

Dropsy of the testicle in children: what is this disease, types (isolated, communicating), symptoms, treatment - video

Treatment of hydrocele

In 95% of newborns, hydrocele can resolve on its own within the first year of life. If this does not happen, surgical treatment is required.

Acquired hydrocele in adults usually resolves within six months. Usually, surgery is prescribed in cases where dropsy of the testicle is complicated by inflammation or causes severe discomfort.

If a hydrocele is associated with an inguinal hernia, surgical treatment should be performed as soon as it is discovered.

Can a hydrocele be treated without surgery?

Hydrocele does not always require surgery. In many men under 65 years of age, dropsy of the testis resolves on its own. At an older age, it usually does not go away. If surgical treatment is not indicated, medications are also not necessary.

In reactive (symptomatic) hydrocele, the underlying cause must be treated. For example, antibiotics are prescribed for infectious processes. Your doctor may recommend wearing special supportive braces.

Puncture for hydrocele

During the puncture, the cyst is pierced with a needle and the fluid is removed from it. Such a procedure in most cases brings only a temporary effect, subsequently the hydrocele returns. During the puncture, there is a risk of infection in the scrotum and the development of a purulent process. Therefore, this method of treatment is resorted to only in cases where the hydrocele needs to be eliminated, but the man, for one reason or another, cannot be surgically intervened. Also, a puncture is used for intense dropsy of the testicle.

After removing the fluid from the scrotum, sclerosing therapy can be carried out - drugs (alcohol, Betadine) are injected into the dropsy cyst, which cause a burn of its walls from the inside and close the lumen. But this method also often gives a temporary effect, and its use may be accompanied by certain complications.

Surgery for hydrocele

General instructions regarding the timing of the operation for hydrocele:

• With a hydrocele in a child under the age of 1 year, observation is usually carried out, since during this time dropsy can go away on its own.
• With a congenital hydrocele, surgery is usually performed at the age of 1.5-2 years.
• With symptomatic hydrocele, surgery is indicated if conservative treatment of the underlying cause has not been effective for a sufficiently long time.
• Dropsy of the testicle caused by trauma is operated on after 3-6 months.
• In children under 2 years of age, surgical intervention is performed in cases where dropsy is combined with an inguinal hernia, complicated by infection, is tense and grows rapidly.

There are different options for surgical interventions for dropsy of the testicle:

• With non-communicating dropsy, Lord, Winkelman, Bergman operations are performed. There is no fundamental difference between these three types of surgical interventions.
• With communicating dropsy, the Ross operation is performed.

Lord's operation for hydrocele

During Lord's operation, the testicular membranes are dissected, the liquid is removed and the so-called corrugation of the vaginal testicular membrane is carried out, as a result of which conditions are created for the outflow of liquid. This type of surgical intervention allows minimizing trauma to the testicle, the blood vessels that feed it.

Lord's method is not suitable for long-term dropsy of the testis, as this increases the rigidity of the testicular membranes, which does not allow a satisfactory result.

Ross operation for hydrocele

The goal of the Ross operation is to eliminate the communication between the vaginal process and the abdominal cavity. The vaginal process is crossed, partially removed, its upper end is tied up, and a hole is left in the lower end for the outflow of fluid.

The Ross operation is one of the best ways to treat congenital hydrocele. But its implementation requires a certain experience and skill level from the surgeon, since during the operation it is easy to damage the elements of the spermatic cord.

Winckelmann operation for hydrocele

During the Winckelmann operation, the dropsy cyst is dissected, it is literally turned inside out and, in this form, is sewn around the testicle and its epididymis.

Operations of Winckelmann and Lord are usually not used for large hydrocele, since in this case the membrane of the hydrocele cyst is greatly stretched, there is an excess of it.

Operation Bergman

The Bergman operation is suitable in cases where the hydrocele is large. During surgery, part of the testicular membrane is removed, and the rest is sutured.

Cost of surgery for hydrocele

In public clinics, hydrocele surgery can be performed free of charge. Average cost of paid surgical intervention:

• In Moscow clinics: 15,000 - 20,000 rubles.
• In regional clinics: 7,000-15,000 rubles.

What to expect after testicular hydrocele surgery?

After surgery, drainage may be left in the scrotum for some time to drain fluid, bandages are applied for several days. In most cases, absorbable sutures are used to suture the wound, so there is no need to remove the sutures.

In order to reduce discomfort after surgery, the doctor may recommend:

• applying cold to the scrotum (ice pack, towel soaked in cold water);
• wearing special supporting suspensoria (bandage, supporting bandage for the testicles).

The surgeon will schedule a follow-up visit after some time to make sure that the hydrocele has not recurred.

Bergman's operation for the treatment of hydrocele (hydrocele) - video

Are folk remedies effective for hydrocele?

Folk remedies can alleviate the condition with symptomatic hydrocele caused by another disease, but only as an addition to the main treatment. It is necessary to consult a doctor. With congenital dropsy of the testicle, traditional medicine, as well as conservative therapy in general, is not used.

Is homeopathy effective?

Homeopathic remedies, as well as traditional medicine, can be used to alleviate the condition of symptomatic hydrocele as an adjunct to the main treatment, after consultation with the attending physician.

Prevention of dropsy of the testicles

There are no special measures for the prevention of congenital hydrocele.

Prevention of acquired symptomatic hydrocele is to prevent genitourinary infections, scrotal injuries and other diseases that can lead to hydrocele.

The main measures for the prevention of dropsy of the testicle in old age are maintaining a healthy lifestyle, proper nutrition, physical activity, and prevention of cardiovascular pathologies.

Answers to frequently asked questions

What should I do if there is swelling after hydrocele surgery?

After surgery for a hydrocele, there is always swelling of the scrotum. It subsides slowly, can persist from 3-4 weeks to 3 months. If the swelling is large, worsens in the evening, accompanied by pain, fever, you need to see a doctor and do an ultrasound.

What is the ICD code for a hydrocele?

In the International Classification of Diseases of the 10th revision, hydrocele is indicated by several different codes, depending on the form and the presence of complications:

• N43 - common code for hydrocele and spermatocele;
• N43.0 - encysted hydrocele;
• N43.3 Hydrocele, unspecified;
• P83.5 - congenital hydrocele;
• N43.2 - other forms of hydrocele;
• N43.1 - hydrocele complicated by hydrocele cyst infection.

Can you have sex with a hydrocele?

With dropsy of the testicle, libido (sexual desire) and erection are not disturbed, sex is not contraindicated. But in some cases, difficulties may arise:

• If the hydrocele is large, a man may experience discomfort and pain during intimacy.
• Some men experience psychological discomfort, and they avoid intimacy, as they are embarrassed by the enlarged scrotum.
• With very large sizes, dropsy of the testicle makes the penis visually shorter, since part of it is covered by an enlarged scrotum.

After hydrocele surgery, sex and masturbation are not recommended until complete healing, which usually occurs after 2-3 weeks.

Is it possible to detect hydrocele in a fetus before birth?

During an ultrasound scan of a pregnant woman, a hydrocele can be detected in the fetus, but such a finding is not of particular importance and does not require any measures. Most newborns have physiological dropsy of the testicles, which resolves on its own by the age of one.

What to do if an inguinal hernia and dropsy of the testicle are detected at the same time?

This can occur, since the mechanisms of development of both pathologies are very similar. As the fetal testicle descends into the scrotum, it pulls a pocket from the peritoneum (the inner lining of the abdominal cavity) - the vaginal process. If it does not later close and become a band, fluid may accumulate in it (hydrocele) and/or loops of bowel may leak out (inguinal hernia). If a child has a combination of these two pathologies, surgical intervention is required.

Can dropsy of the testicle go away on its own?

Hydrocele often goes away on its own. If it persists for a long time, accompanied by severe symptoms and complications, surgery is needed.

Is there infertility due to dropsy of the testicle?

This happens extremely rarely, but large dropsy can compress the blood vessels and disrupt the blood flow in the testicle, as a result of which it develops atrophy, sperm production is disrupted.

What is reactive hydrocele?

Reactive hydrocele is an acutely developing hydrocele that occurs as a symptom of some other disease, such as infection, testicular injury. Before use, you should consult with a specialist.

Hydrocele, otherwise hydrocele or dropsy of the testicles, is the accumulation of fluid in the membranes of the testis, which leads to an enlargement of the scrotum, and sometimes swelling in the groin.

There is an isolated dropsy of the testicular membranes, when the fluid surrounds the testicle and cannot flow into other cavities, and a communicating dropsy.

A communicating hydrocele differs in that hydrocele can flow into the abdominal cavity and back through a special duct - the vaginal process of the peritoneum. Dropsy of the testicle is often combined with an inguinal hernia.

Lymphocele is a concept close to dropsy of the testicle, meaning the accumulation of lymph in the membranes of the testicle, which occurs when the lymphatic vessels of the testicle are damaged or compressed. Usually, a lymphocele is accompanied by stagnation of lymph in the testicle and its membranes - lymphostasis.

Why does hydrocele need to be treated?

The testis is extremely sensitive to changes in temperature and can only function normally within a narrow temperature range. An increase in testicular temperature even by tenths of a degree disrupts the development and function of the testicle.

Dropsy testis is an additional layer around the testicle, which prevents the release of heat and leads to overheating of the testicle. As a result, spermatogenesis and the hormonal function of the testis are disrupted, which is the cause of infertility.

Communicating hydrocele in children. What is the mechanism of formation of a communicating hydrocele?

The term communicating dropsy of the testis or communicating hydrocele means that there is a message between the cavity surrounding the testicle and the abdominal cavity - an open vaginal process of the peritoneum, through which fluid from the abdominal cavity enters the scrotum and back.

As the fetus develops, the testis descends into the scrotum through the inguinal canal. Along with it, the vaginal process descends into the scrotum - an outgrowth of the peritoneum that envelops the testicle and, thus, forms the two shells closest to the testicle.

By the time of birth or during the first months of life, the vaginal process of the peritoneum normally overgrows, and the communication of the testicular membrane with the abdominal cavity disappears. Thus, neither the peritoneal fluid nor the organs of the abdominal cavity can penetrate into the cavity where the testicle is located. The lower part of the vaginal process of the peritoneum forms a slit-like cavity around the testicle, which, in case of dropsy, serves as a reservoir for dropsy fluid.

The main reason for the occurrence of communicating dropsy of the testicle is the non-closure of the vaginal process of the peritoneum, which serves as a duct for moving peritoneal fluid from the abdominal cavity to the testicular membranes.

Causes of non-closure of the process of the peritoneum.

Many theories explain the non-closure of the vaginal process of the peritoneum. So, in the open processus vaginalis of the peritoneum, smooth muscle fibers were found, which are not found in the normal peritoneum. Smooth muscles can prevent the fusion of the peritoneal process.

According to our data, there is a higher frequency of communicating hydrocele in children born after a pathologically proceeding pregnancy with a threatened miscarriage, as well as in premature babies.

Another reason lies in the increase in intra-abdominal pressure, which is observed during resuscitation, with frequent anxiety of the child or in the process of physical exercise.

What is common between communicating dropsy of the testicles and inguinal hernia?

An inguinal or inguinal-scrotal hernia is formed in children with a wide open vaginal process of the peritoneum. Not only fluid from the abdominal cavity penetrates into the open vaginal process of the peritoneum, but also the mobile organs of the abdominal cavity (intestinal loop, strand of the omentum, appendages in girls, etc.) can exit, which characterizes the "oblique" inguinal or inguinal-scrotal hernia.

In adults, inguinal hernias are different from those in children. They are associated with defects in the muscles and tendons of the anterior abdominal wall that occur during exercise. In childhood, such hernias are extremely rare. Therefore, operations for inguinal hernias in children and adults are performed using various methods.

How can a communicating dropsy turn into an inguinal or inguinal-scrotal hernia?

Problems with the intestines or increased excitability of the child can lead to the transformation of communicating dropsy of the testicle into an inguinal or inguinal-scrotal hernia. This occurs as a result of the expansion of the peritoneal process and the inguinal canal with the child's anxiety and increased intra-abdominal pressure.

How often does a reported hydrocele disappear without surgery?

Self-fusion of the peritoneal process and self-healing of communicating dropsy of the testis is often observed in the first months of life and very rarely after 1 year (no more than 5% of cases). Most children with communicating dropsy of the testis require surgical treatment, which is recommended at the age of 1.5 - 2 years. Failure to follow these recommendations leads to underdevelopment of the testicle and reduced chances of having children.

Dropsy of the testicles in newborns and young children. Isolated hydrocele.

In newborns and infants, hydrocele in 80% of cases is (or becomes during the first months of life) isolated from the abdominal cavity and resolves on its own within 6-12 months. Isolated dropsy of newborns is associated with birth trauma, peculiarities of hormonal status and the state of lymph outflow from the scrotum in children of 1 year old.

Isolated dropsy of the testicles is more often bilateral. Often there is an increase in dropsy, and it becomes tense. With intense dropsy, punctures are usually performed to remove fluid from the membranes of the testicles. Surgical treatment is usually not indicated.

Isolated dropsy of the testicles in boys older than 3 years.

Isolated dropsy of the testicle over the age of three years often occurs after injury or inflammation. There are also cases of transformation of a communicating dropsy into a non-communicating one, due to the closure of the lumen of the peritoneal process from the inside, for example, with a strand of the omentum.

Dropsy of the testicle in adolescents 12-17 years old. Post-traumatic and postoperative hydrocele. Lymphocele.

The most common occurrence of hydrocele in adolescents occurs after surgery for inguinal hernia or varicocele. In both cases, the cause of the development of dropsy of the testicle is a violation of the outflow of lymph from the testicle, caused by damage (in the case of varicocele) or compression (in the process of hernia repair) of the lymphatic vessels of the testicle. Therefore, such dropsy is justifiably called a lymphocele. In such cases, stagnation of lymph occurs not only in the membranes of the testicle, but also in the testicle itself (testicular lymphostasis). Less common is post-traumatic dropsy.

One of the causes of lymphocele and lymphostasis in the testicle in children after hernia repair is the use of techniques intended for adults. Plasty of the inguinal canal, common for adult surgery in childhood, often causes compression of the lymphatic vessels.

Isolated dropsy in adolescents usually requires conservative treatment for 3-6 months, mandatory observation and examination. With persistent dropsy, surgical treatment is performed.

How common is dropsy of the testicles and how often is surgery required?

Dropsy of the testicular membranes in newborns and boys in the first year of life occurs in 8-10% of cases. In 80% of observations it is isolated and goes away on its own. In 20% of children, surgery is performed after a year.

Communicating hydrocele in children after 1 year 0.5-2.0%. Surgical treatment is indicated in 95% of cases.

Lymphocele and testicular lymphostasis in adolescents after surgery for varicocele from 1% to 25% of all surgical interventions, depending on the type of operation and surgical technique (on average, about 10-12%). In 80% amenable to conservative treatment. In the remaining 20%, surgical treatment is indicated.

Hydrocele and lymphocele after surgery for inguinal hernia in adolescents - statistics as in adults 3-10%. Often surgical treatment is performed.

How to diagnose hydrocele?

The disease usually proceeds with obvious external manifestations - swelling (increase in volume) of the scrotum on one or both sides. The enlargement of the scrotum may decrease or disappear at night when the child is in a horizontal position, and reappear when awake. This testifies in favor of communicating dropsy of the testicular membranes. An increase in the scrotum is sometimes also observed with tension or "inflating" the abdomen.

Subjective sensations are insignificant. Complaints are rare. With acute, infected, or tense dropsy, pain may occur.

To establish the correct diagnosis, ultrasound is used - ultrasound examination of the inguinal canals and organs of the scrotum and duplex examination of the testicular vessels.

Ultrasound often allows you to detect a problem on the other side - for example, an inguinal hernia or cyst of the spermatic cord that is invisible during examination.

Sometimes an increase in the scrotum and inguinal region appears and disappears, and may be absent when examined by a doctor. Then a photograph taken with the appearance of swelling in the scrotum or inguinal region, taken by the parents, helps to resolve the issue of the diagnosis.

Diseases and circumstances that are often accompanied by the occurrence of hydrocele

• Cryptorchidism (undescended testicle)
• hypospadias
• False hermaphroditism
• Epispadias and exstrophy
• Ventriculo-peritoneal shunt
• prematurity
• Low birth weight
• Liver disease with ascites
• Anterior abdominal wall defects
• Peritoneal dialysis
• Burdened heredity
• cystic fibrosis
• Inflammatory diseases of the scrotum leading to the development of reactive hydrocele
• Testicular torsion
• Injury
• Infection
• Past surgeries affecting the lymphatic system of the testis

Treatment of hydrocele (hydrocele) and lymphocele without surgery. Observation periods.

Hydrocele in children under the age of 1 year requires the supervision of a pediatric urologist-andrologist. In case of accumulation of fluid and the appearance of tension in the membranes of the testis, punctures are performed with the removal of dropsy fluid. Sometimes repeated punctures are required.

Communicating dropsy with a narrow peritoneal process is usually observed up to 2 years.

Observation is also required for traumatic dropsy that occurs as a result of a bruise without violating the integrity of the testicle. As a rule, 3 months are enough to assess the dynamics of the process and, in the absence of improvement, prescribe surgical treatment. The same applies to the hydrocele formed after inflammation.

The most difficult is the management of patients with lymphocele formed after surgical treatment of inguinal hernia and varicocele. In this case, a prematurely performed operation has little chance of success. Within 6-12 months, it is necessary to monitor the condition of the testicle according to ultrasound and duplex examination of the scrotum in order to assess the dynamics of the process and the effectiveness of the therapy.

When are operations performed for dropsy of the testicle?

• Operations for communicating dropsy of the testicle are more often performed in children at 2 years of age.
• From 1 to 2 years, surgery for communicating dropsy is performed if:
  1. combined dropsy and inguinal hernia
  2. when the volume of the scrotum clearly changes with changes in body position
  3. dropsy increases, causing discomfort
  4. infection joins
• Operations for post-traumatic dropsy - 3-6 months after the injury.
• Lymphocele that occurred after surgery for an inguinal hernia or varicocele is operated on 6 to 18 months after the appearance of fluid in the testicular membranes.

Which type of anesthesia is best for a child?

The best option for anesthesia during operations for dropsy of the testicle in childhood is modern combined anesthesia using local anesthesia with long-acting drugs (marcain, naropin) and mask anesthesia (sevoflurane).

Surgery for dropsy of the testicle (hydrocele). Surgical options.

The type of operation depends on the age of the patient and the features of dropsy.

Surgery for communicating hydrocele. Ross operation.

With communicating dropsy, as a rule, the Ross technique is used - isolation from the elements of the spermatic cord, excision and ligation at the internal inguinal ring of the peritoneal process, as well as the formation of a "window" in the testicular membranes. The operation is performed from a small incision in the groin.

The operation is delicate, requiring good technique - accurate and careful preparation with preservation of all anatomical formations of the spermatic cord - the vas deferens and testicular vessels, as well as the inguinal nerve.

Sometimes laparoscopic operations are used for dropsy of the testicle, however, the trauma, the risk of relapses and complications when using them is higher, and the duration of anesthesia is longer, so they are not widely used.

Operations for isolated dropsy of the testicles and lymphocele in children and adolescents.

Isolated dropsy and lymphocele serve as indications for Bergman's operation - excision of the inner membranes of the testicle from the scrotal access. In cases of voluminous hydrocele and lymphocele, drains are often left in the wound and pressure bandages are applied.

Winckelmann's operation - dissection of the testicular membranes in front and stitching together the formed edges of the membranes behind the epididymis. Currently rarely used due to changes in the appearance of the scrotum and the contours of the testis.

Among the complications, the most common recurrence of dropsy (5-20%), which can reach 70% with lymphocele. A particularly high percentage of recurrences is observed with untimely performance of operations.

Complications of operations.

The overall risk of complications is 2 to 8%.

Dropsy recurrences occur with a frequency of 0.5 to 6%. In adolescence, relapses of dropsy are more common.

The risk of infertility after such operations is due to surgical trauma and averages about 2-5% and mainly depends on the technique of performing the intervention.

Infertility is not always a manifestation of damage to the vas deferens. In 5-8% of patients, there are rudiments of the rudiments of the female genital organs, which indicate the presence of more or less pronounced defects in the reproductive system that occur in utero or are genetically predetermined.

One of the complications is the high fixation of the testicle, when the testicle is pulled up to the inguinal canal and subsequently fixed there by cicatricial adhesions.

Testicular atrophy can be observed in connection with impaired blood circulation in the testicle that occurs when the peritoneal process is mobilized from the elements of the spermatic cord.

Unpleasant or painful sensations in the area of ​​the wound or scrotum on the side of the operation - hyperesthesia associated with infringement in the scar or damage to nerve endings. These phenomena usually disappear 6-12 months after the operation.

Prevention of complications.

The high level of surgical technique and the timely determination of indications for surgical treatment allow preventing the development of complications.

Postoperative period

Operations for dropsy are usually well tolerated by children and do not significantly interfere with their movements. However, with sudden movements or constipation as a result of increased intra-abdominal pressure or direct impact, hematomas may form in the scrotum and groin. Therefore, you should limit the activity of children until the healing of the postoperative wound and follow a diet.

On the first day after surgery, non-narcotic painkillers (analgin, paracetamol, ibuprofen, Panadol and others) are usually prescribed. Laxatives are used for 4-5 days after the operation.

Dropsy testicles in boys- accumulation of serous fluid produced by the vaginal membrane of the testicle, between its sheets. Dropsy of the testicle in boys is accompanied by an increase in the size of the scrotum on one or both sides, sometimes with difficulty urinating. Diagnosis of hydrocele in boys is carried out by a pediatric surgeon or urologist, includes examination and palpation of the scrotum, diaphanoscopy, ultrasound of the scrotum. With dropsy of the testicle in boys, expectant management can be used, a hydrocele puncture or surgical treatment can be performed.

General information

In boys older than 3 years, hydrocele is usually secondary. Reactive hydrocele is associated with a violation of the processes of filtration and reabsorption of fluid produced by the vaginal membrane of the testis. Such disorders can be caused by testicular torsion, trauma to the scrotum, inflammatory diseases (orchitis, epididymitis, etc.), tumors of the testicle and its epididymis.

In rare cases, acute dropsy of the testicle in boys can be a complication of SARS, influenza, mumps and other childhood infections. In addition, acquired hydrocele in boys can develop as a postoperative complication after hernia repair or surgery for varicocele (varicocelectomy).

Classification of hydrocele in boys

Thus, the reasons discussed above make it possible to distinguish between primary idiopathic (congenital) and secondary reactive (acquired) hydrocele in boys.

In case of violation of the closure of the vaginal process and the communication of the cavity of the testicle with the abdominal cavity, they speak of a communicating dropsy of the testicle in boys. In this case, the peritoneal fluid circulates freely and accumulates in the scrotum in large quantities. If the vaginal process turns out to be blind, and the hydrocele is located in isolation, in the form of a small cyst, such dropsy of the testicle in boys is regarded as non-communicating. Communicating dropsy of the testicle in boys can be transformed into an isolated one, for example, when the lumen of the peritoneal process is closed from the inside with an omentum.

Taking into account the pressure of the fluid in the cavity of the hydrocele, tense and unstressed hydrocele in boys are distinguished. A tense hydrocele is almost always non-communicating; in this case, the fluid in the dropsy cavity is under pressure, because, accumulating, it cannot leave the scrotum. With non-tensioned dropsy of the testicle in boys, the pressure in the cavity is not increased: most often this happens with a communicating variant of the hydrocele.

Congenital dropsy of the testicle in a child up to 1-1.5 years old is regarded as physiological; more often it goes away on its own without any intervention. The nature of the course of hydrocele in boys can be acute or recurrent, chronic. Depending on the localization, one- and two-sided dropsy of the testis occurs in boys.

Symptoms of hydrocele in boys

Usually, signs of dropsy of the testicles in boys are discovered by parents during hygiene procedures. Sometimes a hydrocele is detected by a pediatric surgeon during a preventive examination of a child.

With dropsy of the testicle in boys, there is an increase in the scrotum in size on one or both sides. In the case of a communicating hydrocele, the enlargement of the scrotum is transient; with isolated - an increase in the scrotum occurs gradually. The size of the scrotum with dropsy of the testicle in boys can reach a goose egg, and in advanced cases - a child's head.

Communicating dropsy of the testicle in boys can have a different size and tension during the day: the swelling of the scrotum reaches its greatest size during the day, when the child moves; at night, in the supine position, the tumor may disappear due to the emptying of the contents of the dropsy sac into the abdominal cavity.

Dropsy of the testicle in boys, as a rule, proceeds painlessly and without signs of inflammation. With secondary infection of the hydrocele, soreness, redness of the scrotum, chills, fever, and vomiting may appear. With a large amount of accumulated fluid in children, urination may be difficult and acute urinary retention may develop. Older children note unpleasant bursting sensations, heaviness in the groin area and discomfort when walking.

In boys who have a wide open vaginal process of the peritoneum, along with dropsy of the testicle, oblique inguinal or inguinal-scrotal hernias may develop.

Diagnosis of hydrocele in boys

If a boy has swelling in the scrotum, parents should immediately contact a pediatric surgeon or pediatric urologist. During the consultation, the specialist will examine and palpate the scrotum.

The examination of the scrotum is carried out in a standing and lying position. This diagnostic technique is used to determine the form of hydrocele in boys (communicating or non-communicating with the abdominal cavity). In the event that the size of the hydrocele decreases in the supine position, one should think about the communication of the dropsy cavity with the abdominal cavity. Also in favor of communicating dropsy of the testis is an increase in the size of the hydrocele when coughing, i.e., with an increase in intra-abdominal pressure. Palpation of dropsy of the testicle in boys is defined as a pear-shaped seal, with its upper part facing towards the inguinal canal.

A non-invasive test for diagnosing dropsy of the testicle in boys is diaphanoscopy of the scrotum - a study of tissues in transmitted light (transillumination). In the process of diaphanoscopy in the scrotum, not only a liquid that evenly transmits light can be detected, but also an omentum or part of the intestine with an accompanying inguinal-scrotal hernia, which will delay light.

With the help of ultrasound of the scrotum and inguinal canals, the diagnosis of dropsy of the testicle in boys is confirmed, a more serious pathology is excluded (testicular cancer, inflammation or torsion of the testicle or its epididymis). In addition, scrotal ultrasound is highly sensitive in determining the type of hydrocele in boys (communicating or non-communicating). In addition to the main study, it is advisable to conduct an ultrasound scan of the scrotal vessels.

Differential diagnosis is carried out between dropsy of the testicle and boys and other diseases of the scrotum: testicular torsion, strangulated hernia, spermatocele, epididymal cyst.

Treatment of hydrocele in boys

In children under 1 year of age with congenital non-tensioned dropsy of the testicle in pediatrics, it is customary to adhere to expectant tactics and dynamic observation. In most cases, such a hydrocele does not require medical intervention and resolves on its own as the peritoneal process is obliterated.

With reactive dropsy of the testicle in boys, treatment of the underlying disease is necessary. Tense dropsy of the testis in boys requires a hydrocele puncture and removal of fluid from the testicular membranes. However, in this case, there is a high probability of re-accumulation of fluid in the scrotum and the need for repeated punctures.

Surgical treatment of congenital hydrocele is recommended at the age of 1.5 - 2 years; post-traumatic - after 3-6 months. after injury. Surgical treatment in boys under 2 years of age is indicated for the combination of hydrocele with an inguinal hernia; recurrent rapidly growing tense hydrocele; hydrocele infection.

With non-communicating hydrocele in boys, Winckelmann, Lord or Bergman operations (in children over 12 years old) are performed. In the case of communication of dropsy of the testicle with the abdominal cavity, the Ross operation is performed (ligation of the peritoneal process and the formation of an outflow tract of dropsy fluid). Relapses of hydrocele in boys occur in 0.5-6% of cases, more often in adolescence.

Forecast and prevention of hydrocele in boys

Physiological hydrocele in boys is not dangerous and in 80% of children it resolves on its own during the first year of life. Compliance with the terms of surgical treatment and technically competent performance of the operation allows you to radically get rid of the hydrocele and avoid complications.

Chronic hydrocele in the future can cause impaired spermatogenesis and male infertility, since the testicles are extremely sensitive to the slightest change in ambient temperature and can only function normally in a small temperature range. In addition, a tense hydrocele can lead to circulatory failure in the testis and its subsequent atrophy. With dropsy of the testicle in boys, compression or infringement of the accompanying hernia may occur.

Prevention of dropsy of the testicle in boys is mainly to prevent inflammatory diseases and injuries of the scrotum. It is necessary to regularly examine the boy's genitals by the parents and immediately contact the pediatrician and pediatric surgeon if swelling is found in the scrotum. Boys with congenital dropsy of the testis should be observed by a pediatric urologist-andrologist.