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A hydrocele is a condition in which there is an accumulation of fluid in the membranes of the testicle, which leads to an increase in the size of the scrotum and swelling in the groin area. It can be lymph, interstitial fluid, blood, or even pus with a volume of several milliliters and up to several liters in advanced cases.
In most cases, dropsy is congenital and resolves on its own by 1 to 2 years. And only a small percentage of children have pathology. Doctors consider injuries or infections to be the causes of later manifestations of the disease.
Dropsy of the testicle in children is divided into congenital and acquired. Congenital hydrocele is associated with intrauterine developmental disorders. In some cases, dropsy is first diagnosed only at school age.
Based on the mechanisms of formation, the anatomical features of the structure of the scrotum and the presence of concomitant complications, hydrocele in children can be:
- communicating – when the scrotum is connected to the abdominal cavity;
- isolated – if the testicular membranes remain isolated from the abdominal cavity;
- complicated – when the hydrocele is accompanied by pathologies such as hernia, infections or ruptures of the testicular membranes;
- bilateral – if both testicles are affected;
- unilateral – pathology covers only one half of the scrotum;
- uncomplicated – if the disease passes without complications;
- tense – when the fluid in the cavity is under pressure, which does not allow it to leave it, therefore such dropsy is almost always non-communicating;
- unstressed – if there is no fluid pressure;
- reactive – occurs against the background of inflammatory processes of the genital organs and injuries in adolescents.
– Congenital dropsy of the testicle can be both communicating and non-communicating.
An unstressed hydrocele with a small amount of fluid may disappear during treatment. This form of dropsy in children under 2 years of age is a physiological condition and may be a variant of the norm! Therefore, operations are carried out only after 2 years, explains Rinaz Kamaletdinov, urologist at the First Danilovsky Multidisciplinary Medical Center in Moscow.
If this did not happen, then there is nothing wrong with this, according to the doctors. The main thing is under the supervision of a urologist.
Causes of hydrocele in a child
Most often, the cause of the formation of hydrocele in children lies in the anatomical features of the structure of the scrotum. During intrauterine development of the fetus, the testicles of boys are located in the abdominal cavity and only at birth descend into the scrotum. Most male babies have a canal that connects the scrotum to the abdominal cavity and through which fluid flows, normally it should close. But sometimes this does not happen, and the fluid continues to flow into the scrotum. This is the mechanism of formation of communicating hydrocele.
Much less often, doctors diagnose isolated dropsy, which develops due to improper overgrowth of the inner membranes of the testicle. Under normal circumstances, tissues should become connective and not produce fluid. But in some cases, the membranes overgrow incorrectly, as a result of which there are no gaps between the scrotum and the abdominal cavity, but the membrane produces fluid that accumulates in the testicles.
“The cause of such intrauterine disorders can be breech presentation of the fetus, the mother taking hormones during pregnancy, low birth weight or prematurity of the child,” says Rinaz Kamaletdinov.
In children older than 3 years and adolescents, hydrocele, as a rule, is a consequence of an acquired pathology. These are mainly infections of the genital organs or rectum, orchitis, vesiculitis and other diseases or injuries. With mechanical damage, the membranes of the testicles are injured, and fluid from the abdominal cavity enters the scrotum.
Much less often, dropsy of the testicle is associated with anomalies in the development of inguinal lymph nodes. In such cases, the disease manifests itself both after birth and in early preschool age. Even less often, the causes of hydrocele in children are cardiovascular diseases, congenital heart defects, as well as tumors in the small pelvis, and associated disorders of the fluid exchange process in the abdominal region and in the scrotum. Increase the risk of hydrocele removal of inguinal hernia and varicocele or excessive exercise.
Symptoms of hydrocele in a child
The main symptom of the disease is an increase in the scrotum, on one or both sides. At the beginning of the disease, the change in the size of the testicles may remain invisible, but later the external signs become apparent. In medicine, cases have been recorded when the testicles accumulated up to several liters of fluid, taking the shape of a soccer ball.
With communicating dropsy, the size of the scrotum can change during the day. In the morning, the fluid goes into the abdominal cavity, and they decrease, and by the evening the water flows back into the testicles and they increase. An increase in the scrotum also occurs due to an increase in intra-abdominal pressure. In babies, it increases due to crying, constipation or colic. In older children, this is facilitated by excessive exercise, lifting something heavy, as well as a strong cough. With isolated dropsy of the testicle, the size of the organ always increases gradually.
The main symptoms of dropsy of the testicle in children:
- pain in the scrotum;
- swelling of the scrotum;
- redness of the scrotum;
- sensations of pressure and discomfort near the penis.
Babies cannot explain what they feel, parents need to pay attention to restlessness and crying for no reason. In the late course of the disease, pulling pains in the groin join the initial discomfort. Some children complain of discomfort when running or walking. The consistency of the scrotum changes, it becomes denser, which makes it difficult to feel the testicle. With a large accumulation of fluid in the testicles due to squeezing of the urethra, there may be difficulty emptying the bladder.
Treatment of hydrocele in a child
Hydrocele treatment depends on the form of the disease. Physiological dropsy can go away on its own up to 2 years. In the reactive form in adolescents, therapy is aimed at eliminating the underlying disease or the consequences of injuries. Surgical treatment of post-traumatic dropsy is carried out no earlier than 3 months after the injury.
If the patient has severe and non-communicating dropsy, puncture of the scrotum is used as an emergency. To do this, a hollow needle is inserted into the shells of the testicle and fluid is drawn out to it. However, such manipulation, according to Dr. Kamaletdinov, has a temporary effect and does not solve the problem.
If dropsy is caused by epididymitis or orchitis, patients are prescribed a course of antibiotics. With infections, immunomodulators are recommended to patients to strengthen the immune system. In the acute stage of the disease, children should remain in bed and, if necessary, wear a bandage or make dressings to avoid swelling.
Diagnostics
Any swelling of the testicles in children is a reason to see a pediatric surgeon or an andrologist-urologist. The examination is carried out in a standing and lying position, which allows you to find out the shape of dropsy and determine whether it communicates with the abdominal cavity. On palpation, it is defined as a pear-like seal. If the testicle decreases in the supine position or when coughing, it means that the hydrocele is communicating. It is important not to confuse dropsy with testicular torsion, epididymal cysts, or testicular cancer.
For a more accurate diagnosis of hydrocele, use:
- diaphanoscopy of the scrotum – examination of tissues by transillumination or transillumination;
- Ultrasound of the scrotum – to confirm the diagnosis of “dropsy of the testicle” and exclude other more serious pathologies;
- UZDG (Ultrasonic dopplerography of vessels) of scrotal vessels – as an addition to the main types of studies.
Modern treatments
Operations for babies under 2 years of age may be prescribed if dropsy of the testicle is combined with a hernia, as well as with relapses or an infected hydrocele. Older children with non-communicating dropsy do the Winckelmann operation. The procedure consists in cutting the skin and the outer shell of the testicle, followed by removal of the fluid and suturing with folds of excess tissue. The length of the suture during this operation does not exceed 5 cm, and it itself can be self-absorbable. Depending on the age of the patient, the operation is performed under general or local anesthesia.
With advanced stages of the disease and thickened walls, a similar Bergman operation is used, with the difference that excess tissue is sutured.
With dropsy that has developed after injuries or inflammations, they resort to intervention according to the Lord’s method, the advantages of which are the preservation of the integrity of most vessels and tissues. With communicating dropsy and concomitant pathologies, children aged 2–5 years undergo the Ross operation. The essence, which is in the intersection of the vaginal process of the peritoneum, which provokes the accumulation of fluid and in the formation of a hole in the testicle for its outflow.
Sclerotherapy is considered to be the modern and least traumatic method of treatment for an isolated hydrocele. This method is widely used in Europe and in some medical centers in Our Country. To do this, a small puncture is made through which the liquid is pumped out, and then a special adhesive is introduced that connects the tissues.
Minimal damage and faster recovery are also associated with laparoscopic methods. Laparoscopic instruments, along with a mini-camera, are inserted through a pair of small punctures. The procedure does not leave scars on the skin and reduces the risk of postoperative complications. Such interventions are recommended for complex hydroceles with a high risk of tissue damage. The disadvantage of laparoscopy is the high cost.
“In modern medicine, less traumatic laparoscopic interventions are preferable for children,” emphasizes Rinaz Kamaletdinov.
Prevention of dropsy in a child at home
The basis for the prevention of hydrocele is examinations by a pediatric surgeon and urologist at least once every six months. If a child is diagnosed with congenital dropsy, he should be taken for examinations more often.
Popular questions and answers
What are the complications of hydrocele in a child?
“The most unpleasant consequences can be observed with intense dropsy, so it needs to be treated surgically,” answers urologist Rinaz Kamaletdinov. – An untreated disease threatens with the same complications as in adults, for example, underdevelopment of the testicle or hypoplasia. If dropsy arose during life, then a normal testicle, against the background of constant pressure from the outside, sometimes decreases in size significantly. This process is called atrophy.
Hypoplasia and atrophy, of course, will negatively affect fertility, that is, the ability to have children. In addition, the constant accumulation of fluid maintains inflammation in the scrotum, which brings constant pain.
Some people mistakenly believe that one-sided dropsy does not threaten anything, because the other testicle is normal and does not suffer. But this is a delusion. Due to constant inflammation, the body can perceive its organs as foreign. As a result, antibodies appear in the blood – something that is directed against the cells, in this case, the cells of the affected testicle. But antibodies can affect a healthy testicle too. Therefore, the appearance of the so-called autoimmune process in the tissues of the gonads is possible, which is fraught with hormonal and reproductive problems. In general, everything will be fine with the genitals for a long time. Testicular underdevelopment can be very noticeable externally, usually it looks like an asymmetric scrotum. This can serve as the basis for psychological and sexual problems in personal life, the army, sports, and so on.
When to call a doctor at home with dropsy of the testicles in a child?
– Congenital dropsy is diagnosed by pediatricians in the maternity hospital or a pediatric surgeon during an examination during a medical examination. If the symptoms of the disease are detected later, then the parents of the child should contact the specialists at the place of residence or any specialized clinic.