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Hydrocele, as dropsy of the testicular membranes is also called, is a rather rare disease that affects no more than 1% of men and, as a rule, it does not bother them much. A hydrocele is formed due to the accumulation of serous fluid between the parietal and visceral layers of the testicular membrane. Sometimes its volume can exceed 3 liters.
Doctors distinguish congenital and acquired dropsy. The congenital form is associated with intrauterine developmental pathologies and is diagnosed after birth by a pediatrician. If the disease occurred at an older age, then we are talking about an acquired form. The reasons for its occurrence lie in any pathological processes in the body. Such dropsy can occur in acute or chronic form.
“The accumulation of fluid is sometimes so pronounced that the scrotum increases several times in size, and it is not possible to feel the testicle,” says urologist Rinaz Kamaletdinov. – In such cases, one speaks of tense dropsy. Conversely, such forms of hydrocele can be observed when the scrotum contains a small amount of fluid. Such dropsy is usually called unstressed.
Dropsy can affect the right, left, or both testicles at once. Quite often there is a special form of the disease, when fluid accumulates in the membranes of the spermatic cord. And if in newborns such a problem goes away on its own, then adult men need medical care and surgery.
Causes of hydrocele in men
According to statistics, hydrocele is quite rare. And if in children the pathology is congenital, then in adults it is acquired. In adulthood, dropsy of the testicular membranes can occur due to trauma to the genital organs, benign and malignant neoplasms of the testicle or its membrane, against the background of inflammatory diseases, including sexually transmitted diseases, congestive cardiovascular insufficiency, tuberculosis, and parasite damage to the body. But the most common cause of hydrocele is injury. Sometimes dropsy of the testicles can develop after a removed hernia or after other operations.
If the disease developed against the background of injuries, after surgery, or during inflammatory processes in the genital organs and the body as a whole, then they speak of a reactive form.
If the cause of hydrocele is age-related changes in the body that affect the outflow of fluid in the testicular membrane and disruption of the normal functioning of the lymphatic vessels, then this form of the disease is called idiopathic.
Lymph vessels cut during surgery or stagnation of blood in the veins after bandaging can lead to fluid accumulation in the testicles. In such cases, it can be difficult to visualize the problem during examination and ultrasound should be done. The good news is that most of the condition goes away without treatment.
– At the heart of the pathogenesis of hydrocele is a violation of the outflow of lymph, – emphasizes PhD, urologist-surgeon Kirill Kasanov. It is an amber-yellowish liquid, odorless. When injured, it acquires a dark red or rusty color, and when suppurated, it becomes cloudy.
The cause of dropsy of the testicular membranes, according to Rinaz Kamaletdinov, can also be such an occupational disease as asbestosis. It develops due to prolonged inhalation of asbestos dust and a malignant tumor of mesothelioma, as well as against the background of fluid accumulation in the abdominal cavity – ascites.
Symptoms of hydrocele in men
The main symptom of a hydrocele is a visible deformity of the testicle compared to the other.
Therefore, a sharp change in the shape, size and severity of only one of the testicles are classic signs of an acquired hydrocele. The first “beacon” of the disease is a rapid increase in the scrotum on one side and less often on both. The size, density and shape of the testis changes, in some cases there may be a feeling of heaviness, especially when walking. At the same time, concomitant symptoms in adults are always more pronounced than in children. Sometimes men may experience a slight increase in temperature and, in rare cases, erectile dysfunction.
Doctors note that tangible discomfort and pain with dropsy are rare in practice, as long as the fluid volumes do not exceed the critical ones of 500 ml or more. Patients may experience pain in the late and advanced stages of the disease.
Treatment of hydrocele in men
Treatment of a hydrocele is a complex task that depends on various factors, including the age of the patient and the presence of complications. Basically, doctors resort to a surgical method of treatment, but in some cases it is possible to do without surgery.
So with symptomatic dropsy of the testicle, which is formed due to injuries, inflammation of the testicle and its appendages or torsion, there is a chance to cure the underlying pathology and thereby get rid of the accompanying dropsy. In this case, orchitis, orchiepididymitis, gonorrhea, or neoplasms can become a hydrocele provocateur in this case. And the main thing here is to choose the right therapy. To destroy bacteria and prevent purulent complications, patients are prescribed a course of antibiotics. For orchitis and orchiepididymitis, antibacterial drugs are used: ofloxacin, levofloxacin and ciprofloxacin, as well as a macrolide-type antibiotic – azithromycin. Sometimes such therapy is not enough and surgery is indispensable.
To eliminate pain, patients are prescribed painkillers, and to eliminate edema – anti-inflammatory drugs. The course of treatment can last for several weeks, depending on the underlying disease.
With traumatic dropsy of the testicle, it is important to restore normal blood circulation in the groin area. If the cause of the disease is heart failure, drugs are prescribed to improve the functioning of the heart muscle.
Our experts emphasize that self-treatment of hydrocele is unacceptable, and all drugs are taken strictly under medical supervision.
Diagnostics
Experts emphasize that it is impossible to diagnose a hydrocele on its own. Therefore, at the first suspicion of dropsy of the testicle, you need to contact a specialist. Urologists and surgeons are engaged in the diagnosis of dropsy of the testicles in men. When making a diagnosis, the decisive factor is the presence of injuries of the perineum or genital organs, chronic inflammation of the testicle or urinary system, surgery on them, as well as cardiovascular insufficiency.
The nature of the deformation during dropsy depends on the amount of accumulated fluid, if its volume does not exceed a few milliliters, then the disease may not be noticed. The testicle in this case is groped in the lower part of the scrotum. With its significant increase in the scrotum, it is already difficult to feel the testicle. In the chronic form of the disease, palpation does not cause pain to men, but in the acute form, everything will be the other way around.
The skin of the scrotum with dropsy looks normal, but when probing it is more elastic and less dense, and the affected organ itself, as a rule, takes the form of a pear. The fluid inside the testicle most often accumulates slowly, but in cases where the process accelerates, it approaches the inguinal canal and penetrates into it, as a result, the affected organ becomes like an hourglass. The skin of the scrotum in this case remains the same as always and easily forms folds.
A complete diagnosis of hydrocele includes the following manipulations:
- palpation;
- transillumination (transillumination of an organ to detect cysts or tumors);
- Ultrasound diagnostics to assess the condition of the testes and exclude other diseases;
- Ultrasound of vessels in the pelvic area;
- general analysis of blood and urine to determine the state of the body.
When diagnosing a hydrocele, it is important to exclude other diseases in which the scrotum can also increase. This is a tumor of the testicle, cyst of the spermatic cord, groin and groin cyst, brucellosis dropsy of both testicles, as well as severe sexually transmitted and viral diseases such as influenza, mycoplasmosis, chlamydia and others.
If the disease becomes severe and involves surgical intervention, then in addition to the urologist, it is necessary to visit a general practitioner, cardiologist, nephrologist, hepatologist and endocrinologist. Together, these specialists will establish the final diagnosis and determine the postoperative treatment. Sometimes you may need to consult an infectious disease specialist. If dropsy affects the blood vessels, on the surface of the testicles, then an examination by a vascular surgeon is necessary, and in the postoperative rehabilitation period, consultations of an andrologist and a sexologist.
Modern treatments
Surgery remains the main treatment for hydrocele today. To combat the disease, both abdominal and laparoscopic interventions are used. At the same time, the former are resorted to more often due to fewer complications and relapses.
For the surgical treatment of dropsy of the testicle in adults, use:
- Winkelmann operation – the cavity in which fluid accumulates is eliminated, takes place in 3 stages;
- Lord’s operation, or plication of the testicular membranes – is considered one of the most effective;
- Ross operation – used for communicating dropsy of the testicle;
- for a speedy recovery in the postoperative period, analgesic, antiseptic and antibacterial therapy is carried out.
– The use of puncture and injection methods is indicated only in cases where the severity of the patient’s general condition does not allow surgery, – emphasizes Kirill Kasanov.
Prevention of dropsy of the testicle in men at home
To avoid such an unpleasant disease as dropsy of the testicle, it is important to treat inflammatory diseases of the scrotum in time and prevent its hypothermia.
To prevent hydrocele, you need to avoid injuries, protect yourself from genital infections and treat them, and also consult a doctor in a timely manner at the first alarming symptoms. Otherwise, dropsy of the testicle can become chronic.