Why does fluid accumulate?
The testicle is surrounded by membranes, between the layers of which a small amount of liquid is normally contained - it ensures gliding. Fluid is constantly produced and absorbed, and these processes are balanced.
A hydrocele occurs when production exceeds absorption or lymph drainage is impaired. In children, the cause is often congenital - non-closure of the peritoneal process, through which fluid comes from the abdominal cavity. In adults, dropsy is usually acquired.
- Previous inflammations: epididymitis, orchitis
- Scrotal injuries
- Consequences of operations: varicocelectomy using outdated methods, operations for hernia
- Testicular tumors are an important cause that must be excluded
- Lymphatic drainage disorders
- Heart failure and other conditions with edema
- Idiopathic form, when the cause cannot be determined
Symptoms
- Painless enlargement of one or both halves of the scrotum
- Feeling of heaviness and discomfort, increasing in the evening
- A smooth, elastic formation in which the testicle is difficult to palpate separately
- With a large volume - discomfort when walking, physical activity, sexual activity
- Difficulty urinating due to displacement of the penis into the scrotum with giant dropsy
- In the reported form in children, there is a change in size during the day: smaller in the morning, larger in the evening
- Pain appears only with inflammation or concomitant pathology
Diagnostics
- Examination and palpation of the scrotum
- Diaphanoscopy - transillumination of the scrotum: the liquid transmits light, the dense formation does not
- Ultrasound of the scrotum with Dopplerography is a mandatory study: confirms the diagnosis, assesses the condition of the testicle and epididymis and excludes a tumor
- Ultrasound of the abdominal cavity and groin areas if a communicating form or hernia is suspected
- Tumor markers for suspicious changes in testicular tissue
- General analysis of blood and urine for signs of inflammation
Treatment
- Observation - with a small asymptomatic hydrocele in an adult and with a congenital form in children of the first years of life, when independent resolution is possible
- Hydrocelectomy is the main operation in adults: fluid is removed and the membranes of the testicle are everted or excised so that the fluid no longer accumulates
- Bilateral hydrocelectomy for lesions on both sides
- Operation for communicating form in children - ligation of the patent process of the peritoneum
- Puncture with aspiration of fluid is a temporary measure: fluid almost always accumulates again, therefore it is rarely used as an independent method in adults
- Treatment of the underlying disease with secondary hydrocele
Indications for surgery include significant size, discomfort, cosmetic considerations, rapid growth, and the inability to fully examine the testicle.
After surgery
- Wearing support garments in the first weeks
- Moderate swelling of the scrotum in the first days is an expected phenomenon, which gradually decreases
- Limiting physical activity and heavy lifting for a period determined by the surgeon
- Sexual rest for a designated period
- Follow-up examination and, if necessary, ultrasound
- Relapses after correctly performed surgery are rare
How does a hydrocele differ from other scrotal formations?
- Inguinal hernia - the formation extends into the inguinal canal, may decrease with pressure, and sometimes bowel sounds are heard; not see-through
- Spermatocele is a cyst of the epididymis, palpable separately from the testicle itself.
- Varicoceles are tortuous veins that feel like a “bag of worms” and get smaller when lying down
- A testicular tumor is a dense, painless formation in the testicle itself that is not translucent.
- Epididymitis and orchitis - pain, redness, temperature
- Testicular torsion - sudden severe pain, emergency
All these conditions are confidently distinguished by ultrasound of the scrotum, which is why it is mandatory for any enlargement or formation in the scrotum.
Where is hydrocele operated on in Tashkent
Treatment requires consultation with a urologist, ultrasound of the scrotum, and the ability to perform surgery with adequate pain relief.
In Tashkent, hydrocelectomy, including bilateral, is performed at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Even if the enlargement of the scrotum does not bother you, it is worth doing an ultrasound: this is the only way to make sure that a testicular tumor is not hidden behind the dropsy. Clinic contacts are below on the page.
