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A hydrocele, or dropsy, is an accumulation of serous fluid in the membranes of an organ. The volume of liquid is usually from 20 to 200 ml, but cases of huge dropsy (up to 3 liters) have been recorded. According to medical statistics, this disease occurs in approximately 1-5% of men of mature age. The danger of pathology is that it is one of the most common causes of male infertility.
Causes of dropsy in men
Dropsy in men almost always has an acquired character. The reason for its appearance is an imbalance between the secretion and reabsorption of serous fluid by the walls of the vaginal membrane of the testicle. Pathological processes lead to sclerosis of the parietal and visceral sheets of the peritoneum, the lumen between them undergoes obliteration, blood and lymph circulation is disturbed. As a result, a cavity filled with serous fluid is formed.
Causes of dropsy:
Traumatic damage to the scrotum;
Chronic and acute inflammatory process, as a result of tuberculosis, gonorrhea, chlamydia, causing epididymitis, orchitis, epididymo-orchitis;
Testicular tumors of any etiology;
Side effects of radiotherapy;
Testicular torsion;
A complication of a viral infection that caused inflammation of the serous membranes of the whole organism;
Infection with filariasis, or “elephantiasis” – a parasitic disease common in the tropics;
Heart and liver failure;
Complication after surgery to remove an inguinal hernia, varicocelectomy.
When an infectious and inflammatory process is attached, the clear liquid becomes cloudy due to purulent inclusions. In rare cases, an admixture of blood (hematocele) appears in it.
Symptoms of dropsy in men
Manifestations of hydrocele depend on the causes that caused it, on the prevalence of hydrocele on one or both testicles, on the form of the disease.
Symptoms of an acute form of hydrocele:
Violation of urination;
Sharp pain in the scrotum on one or both sides, radiating to the groin;
Severe hyperthermia;
Weakness, reaching loss of consciousness, limitation of movements.
Symptoms of chronic hydrocele:
Enlargement of the scrotum;
Unpleasant sensations that appear when walking, sexual intercourse;
Irritation of the epidermis, its maceration, the appearance of diaper rash.
For the chronic course of hydrocele pain syndrome is not typical. In 7-10% of cases, dropsy affects both testicles.
The consequences of dropsy in men
In addition to tangible discomfort and a visual cosmetic defect, a hydrocele is dangerous for the development of the following conditions:
Violation of blood and lymph flow, leading to infertility;
Unpleasant sensations during sexual intercourse and urination;
The risk of developing a malignant process.
Symptoms of dropsy in men
Before conducting a visual examination of the patient, the doctor collects an anamnesis of the disease, is interested in previous injuries, infections.
Methods that contribute to the accurate diagnosis of the disease:
Diaphanoscopy, or transillumination – transillumination of the scrotum with a directed beam of light. When the cyst is filled with transparent contents, the glow has a red tint, the absence of glow characterizes a cloudy exudate.
Ultrasound of the scrotum is a differential diagnosis that allows you to distinguish a hydrocele from an inguinal hernia, spermatocele, cysts of the spermatic cord.
Doppler ultrasound – an assessment of the blood supply to the testicle is carried out, a varicocele is diagnosed.
General analysis of blood and urine – is carried out for differential diagnosis from diseases similar in symptoms.
The study of the level of alpha-fetoprotein and human chorionic gonadotropin is carried out to confirm or exclude a malignant process.
Treatment of dropsy in men
In most cases, surgical methods are used to treat dropsy of the testicle. An indication for surgery may be the risk of infertility, severe discomfort, the presence of a tumor formation, torsion of the spermatic cord, suspicion of an inguinal hernia. Surgical intervention is not performed in elderly men with severe heart failure, severe kidney and liver diseases, in patients with mental illness.
Therapy for mild hydrocele, which does not manifest itself as pain and discomfort, in patients who do not plan to conceive a child, is carried out with anti-inflammatory drugs.
Methods of surgical intervention:
Operation by Lord – the cyst is dissected, in which fluid accumulates, it is removed. In this case, the testicle is not displayed in the wound, its shell is corrugated. The intervention is considered the least traumatic; it is not carried out in the chronic form of the disease.
Winckelmann operation – an incision is made on the scrotum in the projection of dropsy, the testicle is brought out into the wound, fluid is aspirated from the cyst, the vaginal membrane is dissected, everted out and sutured.
Operation by Bergman – the vaginal membrane of the testicle is opened, part of the tissues is excised after aspiration of the fluid, the rest are sutured. The method is used with a large volume of cysts and non-communicating dropsy.
The consequence of the last two methods may be testicular hypotrophy, impaired spermatogenesis, hormone synthesis.
An alternative to traditional surgical methods are modern methods of treating dropsy of the testicle:
Laser scalpel;
Radio wave method using the apparatus “Surgitron”;
Plasma or ultrasonic knife.
The use of these methods minimizes the consequences and complications after the intervention, there is no bleeding during their implementation.
The method of sclerotherapy in some cases replaces surgical treatment. It consists in removing the fluid accumulated in the cyst and sclerotherapy with alcohol, solutions of Tetracycline, Doxycycline. The method has a large number of complications, is dangerous for the development of obstruction of the epididymis, and is painful. If the cavity is large, a small amount of alcohol is re-introduced. The sclerosing agent, as it were, “solders” the hole, due to which fluid accumulates in the testicle, which reduces the risk of relapse.
Surgical treatment of hydrocele is performed under local anesthesia and takes from 20 to 40 minutes. After a few hours, if no drainage was placed during the intervention, the patient can go home.
[Video] Surgeon Shevtsov A. N. – dropsy of the testicle, symptoms, consequences and treatment: