Testicular hydrocele in newborn boys: what to do, how to treat?

Hydrocele of the testicle in a newborn is a very common surgical pathology that occurs when the process of overgrowing of the testicular membranes is disrupted after the birth of the baby. This condition may be normal, especially in premature babies, but under certain conditions it is considered a pathology. To prevent reproductive dysfunction in a boy, you need to know when exactly this is a pathology and what to do about it.

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Epidemiology

Statistics show that dropsy is the second most common disease after hernias. This pathology is very common in children of the first six months of life. More than 89% of cases of dropsy in children of the first year of life is a physiological process that disappears without a trace by 1.5 years. Such statistics indicate not only the peculiarities of the spread of dropsy, but also the need for treatment only in rare cases.

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Causes testicular hydrocele in a newborn

When a child is developing, the testicles are inside the abdominal cavity and this happens for eight months of intrauterine life. This allows the sperm cells to mature and divide better. Towards the end of the seventh month of intrauterine life, the testicles begin to descend into the scrotum. This is also a necessary stage, since the temperature there is one degree lower than the human body temperature. This allows the sex cells to actively grow and spermatozoa to be renewed every three months. The scrotum is connected to the abdominal cavity by a special outgrowth of the membrane - the vaginal process of the peritoneum. Due to this, the testicle can descend along this process into the scrotum without much effort. This process should obliterate (overgrow) during the first year of the child's life. If this does not happen, then all the conditions are created for fluid to accumulate there, or it can be a weak spot through which hernias can come out. If a newborn develops a build-up of fluid in the testicular membrane, this is called hydrocele or the medical term is hydrocele.

The main pathogenetic mechanism of this phenomenon is that the vaginal process does not close in time and fluid from the abdominal cavity gets there.

But the causes of hydrocele in newborns are not limited to this, since in all babies this process is not covered in the neonatal period. Among other causes of this pathology, one can single out excessive activity of parietal peritoneum cells in the synthesis of intra-abdominal fluid. Under normal conditions, the peritoneum is covered from the inside with a parietal layer of epithelium, which takes part in the synthesis of fluid. A child secretes several grams of it and it is necessary to reduce friction between organs and improve metabolic processes. If there are some structural features of this epithelium, or in conditions of inflammation of the abdominal organs, there may be excessive synthesis of such fluid. This creates conditions for its accumulation in the membranes between the testicles. Another reason can be considered insufficient activity of the proper membrane of the testicle. This membrane covers the testicle and its main function is to absorb excess fluid that can enter through the vaginal process from the peritoneum. If the individual structural feature of this membrane does not allow this fluid to be absorbed in sufficient quantities, then this also becomes the cause of hydrocele.

The next cause of hydrocele is most often the insufficient functioning of the lymphatic vessels of the testicle and its appendages. Under normal conditions, the main function of the human lymphatic system is the absorption of cellular metabolic products from the intercellular and interstitial space. The same thing happens in the testicles - the lymphatic system ensures the exchange of fluid. Therefore, when there is an excess of it, the lymphatic vessels take on the function of removing this fluid. If the lymphatic vessels are underdeveloped or do not function properly, this process is disrupted, which leads to hydrocele.

Thus, the pathogenesis of the formation of hydrocele in a newborn often consists of a combination of all the given reasons that disrupt the outflow of fluid from the membranes of the testicle and lead to its accumulation.

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Risk factors

Risk factors for hydrocele of the testicle are based on the main conditions for the development of this pathology:

1. Prematurity is one of the main factors, since all premature boys are born with undescended testicles. This occurs after birth, when the risk of non-closure of the vaginal process is much higher;
2. hereditary problems with venous and lymphatic system insufficiency in parents;
3. Unoperated cryptorchidism (non-descending of the testicles into the scrotum on one side) much more often causes complications in the form of hydrocele;
4. disturbances in the development of the genitourinary organs in utero;
5. congenital malformations of the reproductive system in boys.

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Symptoms testicular hydrocele in a newborn

The first signs of hydrocele may appear a few days after the baby is born, or at the end of the first month of life. The process may develop over several days, or the symptoms may appear almost overnight.

First of all, it is necessary to understand what physiological hydrocele of the testicles in newborns is. In children of the first month of life, hydrocele can be due to incomplete obliteration of the vaginal membrane of the peritoneum. But it can be obliterated on its own both in the first month of the child's life and before the end of the first year of life. It is considered normal when in the first month of a child's life he has hydrocele, which is considered physiological. It can resolve on its own, so it is considered a normal phenomenon.

Depending on the path of obliteration of the vaginal process, there are different types of hydrocele. Hydrocele of the testicular membranes is the most common form. In this type, the fluid accumulates only between the membranes and there is no connection with the peritoneum. This form cannot resolve itself, since there is no outlet for this fluid.

Communicating hydrocele develops when the vaginal process connects to the abdominal cavity and thus there is an accumulation of fluid between the membranes, which is freely connected to the abdominal cavity. Hydrocele of the membranes of the spermatic cord is characterized by an accumulation of fluid only along the course of this spermatic cord.

But such types of hydrocele can develop into different stages over a long period of time: for example, communicating hydrocele of the testicles can become isolated.

Bilateral hydrocele of the testicles in newborns occurs when both vaginal processes are not closed. In this case, the process usually does not resolve on its own.

Hydrocele of the right and left testicle in a newborn occurs equally often and does not depend on any conditions.

The main clinical symptom of hydrocele is an increase in the size of the scrotum on one side. This does not bother the baby in any way, the skin is not red and does not cause any sensations. A simple increase in its volume indicates this process.

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Complications and consequences

Is hydrocele dangerous in newborns? Many parents ask themselves this question, especially if they are expecting surgery. The answer to this question is ambiguous. If we are talking about physiological hydrocele, then it is certainly not dangerous and goes away on its own. But there may be some complications of hydrocele if it is significant in size. One of these complications is prolonged intense pressure on the testicles and germinal epithelium, which can cause their ischemia and infertility in the future. It is necessary to be very careful with such a pathology, avoiding injury to the child, since the consequence of injury can be hemorrhage into the cavity of the testicle or in its membrane, which can also lead to ischemia. One of the consequences can be strangulation of the hernia, if the abdominal organs come out with hydrocele. Therefore, it is necessary to carefully examine and conduct a thorough diagnosis to establish the correct diagnosis and avoid such complications.

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Diagnostics testicular hydrocele in a newborn

Diagnosis of dropsy is usually not difficult, since the disease is very common.

During examination, it can be seen that the baby's scrotum is enlarged on one side, or less often on both sides. At the same time, the skin above it is unchanged, without redness or defects. When palpating the scrotum, its soft elastic structure is noted. Palpation does not cause any painful sensations. Sometimes, during palpation, you can feel the symptom of fluid overflow, which indicates hydrocele. The mother may note that when the child has been lying for a long time, the scrotum is slightly larger in size than when he was carried in an upright position. These are the main diagnostic signs that indicate a possible hydrocele. If this pathology is combined with cryptorchidism or inflammatory reactions of the testicle, then other symptoms may appear - pain during palpation, increased body temperature, tension in the abdominal muscles, the absence of a testicle in the scrotum with its enlarged size.

Tests are usually not required to confirm the diagnosis, since dropsy is not accompanied by changes in laboratory parameters.

Instrumental diagnostics are widely used to clarify the diagnosis of hydrocele, as well as for differential diagnostics. The most accessible and fastest method is diaphanoscopy. To do this, you just need to take a flashlight and shine it on the back of the scrotum. If the volumetric formation is caused by fluid accumulation, then the light rays will penetrate the scrotum and the scrotum will shine through evenly. If the formation is from tissue structures or blood, then the symptom will be negative.

Another method of instrumental diagnostics is ultrasound examination of the scrotum. This method allows you to accurately determine the contents between the membranes of the testicle or determine additional tissue structures in other pathologies. If you use Doppler examination, you can also determine the blood flow in the vessels and exclude other pathologies.

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Differential diagnosis

Differential diagnostics of hydrocele should be carried out primarily with pathologies that are signs of "acute scrotum". Such diseases as torsion of the testicle or appendages, scrotal trauma, testicular ischemia are very serious pathologies that require immediate surgical intervention to avoid complications. The main differential symptom of these pathologies is hyperemia of the scrotum and sharp pain, to which the child will react with any movements.

It is also necessary to conduct differential diagnostics between hydrocele and hernias. With a hernia, the abdominal organs come out through weak spots into the scrotum. This is also accompanied by an increase in its size. When it comes to a hernia, it can be easily pushed back into the abdominal cavity when palpated, but this does not happen with hydrocele.

Treatment testicular hydrocele in a newborn

Treatment of hydrocele with medications is not used, since it is a surgical pathology.

Most often, in children under one year of age with hydrocele, simple observation is used, since up to this point the vaginal process can still be eliminated on its own. After reaching one year, this is considered unlikely and the issue of surgical treatment is considered.

During this wait-and-see approach, some parents may use folk methods to treat this pathology. These folk methods include:

1. Pumpkin and celery juice have pronounced diuretic properties, so it can reduce the severity of hydrocele. For treatment, you need to make fresh juice from the celery plant and pumpkin and mix in equal quantities. It is recommended to give a child no earlier than six months old half a teaspoon eight times a day. For younger children, you need to start treatment with one drop to avoid allergic reactions.
2. Often, for home treatment, an infusion of birch buds or birch sap itself is used. If there is a season of pure birch sap, then it should be diluted by 50% with warm boiled water and given to the child one teaspoon up to five times a day. If there is no opportunity to drink fresh juice, then you can make an infusion from the fruits. To do this, take 20 grams of birch buds and insist in one glass of hot boiled water. The dosage for the baby is the same as when using birch sap.
3. Lingonberry and elderberry have good dehydrating properties for this pathology. To do this, take 20 milliliters of juice from each berry and dilute them with water to a total volume of 100 milliliters. Give the child two drops four times a day.

The use of any compresses and ointments for hydrocele is prohibited, as it can cause complications.

Surgical treatment can be performed by the puncture method. In this case, after treating the field, a puncture of the scrotum is performed with suction of the fluid. This method can be used in the shell form of dropsy, when there is no connection with the abdominal cavity. In combined dropsy, this method is ineffective, since the fluid accumulates again.

Surgical treatment of hydrocele is the most effective method using a special method of excision of the vaginal process. This operation is performed on children after one year under general anesthesia. The essence of the operation is the excision of the membrane and the sac where the fluid was. After this, the vaginal process is bandaged and the operation is considered complete. Relapses are not observed with the correct tactics.

Prevention

Prevention of dropsy is non-specific and consists only of preventing complications.

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Forecast

The prognosis for hydrocele is favorable with proper wait-and-see tactics and subsequent surgical intervention. No complications are observed with physiological hydrocele either.

Hydrocele of the testicle in a newborn can be physiological and does not require any action during the first year of life. In the future, the main method of treatment is surgical. With proper care, no complications are expected.

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