Dropsy of the testicle (hydrocele) is a process in which fluid accumulates in the scrotum. Sometimes pathology is accompanied by other diseases. Hydrocele can be a congenital disease (this is a minor malformation) or acquired. Sometimes this physiological state of the child is normalized in early childhood, in other cases it is treated with surgery. Treatment of dropsy of the testicle in a child (parental reviews confirm this) is effective, complications after surgery are rare.
The mechanism of the development of the disease
The testicles of the fetus descend into the scrotum at about the seventh month of pregnancy. Together with them, a part of the thin film is lowered, which lines the inner cavity of the peritoneum. A pocket forms, which should close during the first three months of life or before birth, but sometimes this process does not occur.
The mechanism of accumulation of hydrocele depends on the type of disease. With communicating dropsy, fluid enters through the process connecting the abdominal cavity and scrotum. By one and a half years, this process closes on its own in most cases, but such a pathology should not be overlooked.
With isolated dropsy, fluid is produced by the testicle shell. It is necessary for the testes to move freely in the scrotum. The balance between the synthesis and absorption of the liquid in this case is preserved naturally. If the process is disturbed, then the liquid accumulates.
Causes of dropsy
The causes of the disease can be divided into congenital and acquired. Congenital hydrocele is not associated with a gene mutation and is a minor defect. Usually, in this case, a communicating type of dropsy is diagnosed in a newborn boy. Such a pathology should not cause anxiety in parents, which is also confirmed by reviews. In most cases, physiological dropsy goes away by itself.
The appendix does not close before birth for many reasons. This can be affected by pathologies of the course of pregnancy, birth trauma, undescended testicle in the scrotum, premature birth, anomalous penile development, in which the urethra opens not on the head, but on the trunk.
Hydrocele occurs at a constant high intra-abdominal pressure. This pathology usually accompanies the accumulation of fluid in the abdominal cavity or other defects. The operation to remove the dropsy of the testicle in the child (intense form) in this case is always carried out. Testimonials from parents and doctors' recommendations confirm that this is the only treatment option.
For secondary dropsy, resulting from acquired causes, a non-communicating mechanism is characteristic. The disease can occur with injuries in the scrotum, testicular torsion, various inflammatory diseases, lymph node injuries caused by helminth infections and other diseases affecting the lymphatic system, testicular and appendage tumors, complications after infectious diseases or surgical operations, and severe cardiovascular failure.
Hydrocele Classification
As mentioned earlier, depending on whether the duct is closed or open, a communicating hydrocele and a non-communicating (isolated) are distinguished. They also distinguish between tense dropsy and unstressed depending on the pressure of the fluid in the scrotum. Intense edema is most often non-communicating, usually requiring urgent surgery. Loose - communicating type.
Depending on the course of the process, the condition may be acute or chronic. Chronic dropsy recurs, and the acute condition is usually the result of inflammatory processes, tumors, and injuries. Without treatment, dropsy becomes chronic.
Localization in medical practice distinguishes between single and bilateral hydrocele, and depending on the cause, congenital (diagnosed in boys under three years of age) and acquired (can be determined after three years). Is an operation necessary for dropsy of a testicle in a child? This will be determined by the doctor depending on the type and course of the pathological process. Reviews of parents confirm that in this matter you need to rely on the opinion of the doctor.
Symptoms of pathology
Parents can detect the disease in the child during hygiene procedures. Hydrocele can be detected during a routine examination of the baby by a qualified surgeon. Such a condition usually does not bother the child himself, there is neither pain nor discomfort.
A common symptom of dropsy is an enlargement of the scrotum on one or both sides and a bluish skin. Swelling may indicate the presence of a hernia or other pathological conditions. With trauma, pain always appears, and secondary infection with hydrocele has already more serious symptoms.
With secondary infection, the baby becomes restless and cries when touched by the scrotum, the temperature rises, general weakness, chills, redness of the skin, vomiting and nausea appear. Possible urinary retention and even urinary retention. The sensations of dropsy are unpleasant, bursting, felt in the inguinal region. There is discomfort when walking, which older children may complain.
With communicating dropsy, the scrotum can change the size and degree of stress during the day, and the isolated one does not immediately increase. Especially such a disease is dangerous in adolescence. Boys are often embarrassed to tell their parents about problems, which can lead to complications.
Diagnosis of the disease
Diagnosis is not difficult. The pediatrician will listen to the complaints of the parents and the child, and then will send them to a surgeon or urologist for examination. Inspection is carried out in a lying or standing position. Such a pose will help to understand the type of dropsy. In the supine position, the communicating hydrocele is usually reduced in size.
To determine the diagnosis allows palpation, that is, palpation. In this case, the doctor will reveal an elastic seal, which the upper end faces the inguinal canal. Applied as a diagnostic measure diaphanoscopy (or transillumination) - transillumination of a flashlight through the scrotum. The liquid transmits light well, and a tumor or omentum, as well as (possibly) the intestines, if a hernia is suspected, will delay it.
A more accurate method is ultrasound. During the procedure, you can see the type of disease, assess the condition of the testicle, the presence of fluid and its amount, and also exclude serious pathology, such as torsion of the ovary and appendages, inflammation. As an additional study, ultrasound of vessels is carried out. This will help to make a correct diagnosis. General blood and urine tests will show the overall health of the child.
Dropsy treatment methods
Therapy directly depends on the causes of the disease, and the type of dropsy. Physiological dropsy (congenital) is very simple to observe. In babies up to a year, the disease often goes away by itself, so expectant tactics are used. The only thing required of parents is to prevent colds, disruptions in the digestive system. This contributes to the flow of fluid into the scrotum.
If the disease is acquired, then it is necessary to treat the underlying disease that caused the pathology. In post-traumatic dropsy, anti-inflammatory drugs (Nurofen, Fanigan, Ibuprofen, Dolaren, Diclofenac, Paracetamol, and so on) are used to relieve pain and swelling, and antibiotics are additionally indicated for infectious infections (Flemoxin) , "Augmentin", "Cipronol" and others) or antiviral.
Surgical treatment of dropsy
With isolated dropsy of the testicle in a child, surgery is indicated. Bergman, Winkelmann or Lord intervention may be performed if the boy is over 12 years old, as well as puncture. During surgery (dropsy of the testicle in a child is often treated precisely by surgery, if the reasons are not congenital or the disease is advanced), an incision is made, the testicle is brought out and the liquid is aspirated.
The Winkelmann operation involves turning the shell out and stitching. Then the fluid will be physiologically absorbed by the surrounding tissues. Further, the wound is sutured, and inside there is a small rubber drainage for normal blood outflow.
According to Bergman’s technique, in case of dropsy of the testis in a child, the operation is carried out as follows: the process is cut at the base, and the remainder is sheathed with special sutures. After the testicle is immersed back into the scrotum, the wound is sutured, a small drainage remains inside. Typically, such an intervention is performed with a hydrocele of significant size. Lord's operation is much less traumatic. Doctors ligate the process and cut it off, and then form a hole for the outflow of fluid.
The injury caused by dropsy of the testicle in a child requires surgery after 3-6 months. Until this time, you need only regular monitoring. Sometimes there is a decrease in hydrocele in size. Indications for surgery for dropsy of the testicle in a child up to two years of age are the presence of an inguinal hernia with a risk of infringement, constant pain in the genital area, an increase in size, infection.
Only surgical intervention can be used to treat tense dropsy. The sooner the operation is performed with such dropsy of the testicle in the child (parental feedback confirms this), the lower the risk of complications. A puncture is required, in which doctors will remove all the accumulated fluid. But there is no guarantee that the liquid will not accumulate again.
Preparation and operation
Surgical treatment is carried out in a half to two years. This is necessary if the dropsy of the testicle in a child does not pass for a long time. The operation (parental reviews and doctors' recommendations on this issue agree) should be performed earlier if the scrotum is rapidly growing in size.
The child must be healthy before surgery, after a cold and other illnesses, at least a month must pass before the body is strong enough. Before surgery, in case of dropsy of the testicle in a child (how the intervention goes, it will be described later), blood and urine tests should be taken. For six hours, the patient should not drink and eat.
Technically, the intervention is not too complicated. Ross surgery for dropsy of the testicle in children and other techniques require general anesthesia. A general one can be used, because in this case it is easier for the doctor to control the condition of the child. Perhaps the additional introduction of painkillers.
With the help of special devices, monitoring of respiration and heartbeat is mandatory. The operation lasts about 40 minutes, can only be performed in a hospital setting. After that, an ice bladder is placed on the wound for two hours. The doctor is applying a bandage. After a few hours, the patient is already released home. After a couple of hours, it is already allowed to drink and eat.
With dropsy of the testicle in a child after surgery, pain can be removed with conventional anti-inflammatory drugs, such as Ibuprofen or Paracetamol. After each hygiene procedure (for example, changing a diaper), the seam must be treated with an antiseptic. Chlorhexidine will do. Perhaps in a week you need to remove the sutures from the doctor, but if absorbable material was used, then this is not necessary. The next examination is needed a month after the operation.
Possible complications
Complications are rather rare after anesthesia. Infection is also a rare problem, and a course of antibiotics will be prescribed for the child to prevent it. Bleeding can be stopped by pressure in the wound area. Relapse occurs if the testicle is higher than before the intervention.
If blood vessels were damaged during surgery, there is a chance of infertility. This is especially dangerous if another testicle is involved in the pathological process. With insufficient blood supply, atrophy is possible. Common consequences of the operation are pain in the groin area, which will soon go away. The appearance of the scrotum may slightly change.