Pediatric testis in a newborn is a very frequent surgical pathology, which occurs when the processes of overgrowing of the testicle shells after the birth of the baby are disturbed. This condition can be and in norm, especially at premature babies, but under certain conditions it is considered a pathology. To prevent the violation of the reproductive function of the boy, you need to know when exactly this is a pathology and what to do about it.
Statistics show that dropsy ranks second after hernia in prevalence. This pathology is very common among the 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 until 1.5 years. Such statistical data indicate not only the features of the spread of dropsy, but also the need for treatment only in rare cases.
Causes of the dropsy of a testicle in a newborn
When a child develops, the testicles are inside the abdominal cavity and this happens for eight months of his intrauterine life. This allows the seed cells to mature and divide better. Closer to the end of the seventh month of intrauterine life, the testicles begin to descend into the scrotum. This is also a necessary stage, since there the temperature is one degree lower than the temperature of the human body. This allows the germ cells to actively grow and renew sperm every three months. The scrotum is connected with the abdominal cavity at the expense of a special outgrowth of the membrane - the vaginal process of the peritoneum. Due to this, the testicle can descend through this process into the scrotum without much effort. This process must be obliterated during the first year of life. If this does not happen, then all conditions are created for the accumulation of liquid there, or it may be a weak point through which hernias can escape. If a newborn has a fluid in the testicle, then this is a dropsy testicle or a medical term - hydrocele.
The main pathogenetic mechanism of this phenomenon is that the vaginal process does not overgrow in time and fluid from the abdominal cavity enters there.
But the causes of dropsy in newborns are not limited to this, since all babies have this process in the neonatal period unlicensed. Among the other causes of this pathology is the excessive activity of the cells of the parietal peritoneum in the synthesis of the intra-abdominal fluid. Under normal conditions, the peritoneum is covered internally with a parietal layer of epithelium, which takes part in the synthesis of the liquid. The child has a few grams of it and is needed to reduce friction between organs and improve the exchange processes. If there are some features of the structure of this epithelium, or in conditions of inflammation of the abdominal cavity, there may be an excessive synthesis of such a liquid. This creates a condition for its accumulation in the shells between the testicles. One more reason can be considered insufficient activity of its own testicle shell. This shell covers the testicle and its main function is the absorption of excess fluid that can enter the vaginal process from the peritoneum. If the individual structural feature of this shell does not allow sufficient absorption of this liquid, it also becomes the cause of the hydrocele.
The next cause of dropsy may most often be insufficient work of the lymphatic vessels of the testis and its appendages. Under normal conditions, the main function of the human lymphatic system is the absorption of cell-exchange products from the intercellular and intertwine space. In the testicles, the same thing happens - the lymphatic system provides fluid exchange. Therefore, with its excess, the lymphatic vessels take on the function of removing this fluid. If the development of lymphatic vessels is insufficient or their functions are insufficient, this process is disrupted, which leads to dropsy.
Thus, the pathogenesis of the formation of dropsy in the newborn is more often in the aggregate of all these causes, which disrupt the outflow of fluid from the testicles and lead to its accumulation.
Risk factors for dropsy testicles are based on the main conditions for the development of this pathology:
prematurity is one of the main factors, since all premature babies are born with eggs unopened in the scrotum. This occurs after birth, when the risk of vaginal sprouting is much greater;
hereditary problems with inadequacy of the venous and lymphatic apparatus of the parents;
unoperated cryptorchidism (undescended testicles in the scrotum on the one hand) causes complications in the form of hydrocele much more often;
disorders of the development of urogenital organs in utero;
congenital malformations of the organs of the reproductive system in boys.
Symptoms of the dropsy of a testicle in a newborn
The first signs of dropsy may appear a few days after the birth of the baby, or at the end of the first month of life. The process can develop over a period of several days, or the symptoms can appear almost overnight.
First of all, it is necessary to understand what is the physiological dropsy of testicles in newborns. In the children of the first month of life, dropsy may be due to incomplete obliteration of the vaginal membrane of the peritoneum. But it can self-obliterate both in the first month of the child's life, and until the end of the first year of life. This is considered normal when in the first month of a child's life he has a dropsy, which is considered physiological. It can be resolved independently, so it is considered a normal phenomenon.
Depending on the way of obliteration of the vaginal process, there are different types of dropsy. The dropsy of the testicles is the most common form. In this form, the fluid accumulates only between the membranes and there is no connection with the peritoneum. This form alone can not be resolved, since there is no way out for this liquid.
Communicated dropsy of the testicles develops when the vaginal process connects to the abdominal cavity and thus there is fluid accumulation between the membranes that freely connects to the abdominal cavity. Dropsy shells of the spermatic cord is characterized by the accumulation of fluid only in the course of the given spermatic cord.
But such kinds of hydrocephalus in a long process can go to different stages: for example, communicating dropsy of the testicles can become isolated.
Two-sided dropsy of testicles in newborns happens when both vaginal processes are not overgrown. In this case, the process is often not independently resolved.
A dropsy of the right and left testicles in a newborn occurs equally often and does not depend on any conditions.
The main clinical symptom of dropsy is the enlargement of the scrotum from one side in size. This does not bother the baby, the skin is not red and does not cause any sensations. Simply increasing it in volume speaks about this process.
Complications and consequences
Is dysentery dangerous in newborns? This question is asked by many parents, especially if they are waiting for an operative intervention. The answer to this question is ambiguous. If it is a question of physiological dropsy, then it certainly is not dangerous and passes by itself. But there may be some complications of dropsy with its considerable size. One of such complications is a prolonged intense pressure on the testicles and the germinal epithelium can cause their ischemia and infertility in the future. It is very cautious to behave with this pathology avoiding trauma in the child, because the consequence of the trauma may be a hemorrhage into the testicle cavity or in its shell, which can also lead to ischemia. One of the consequences may be infringement of the hernia, if the exit of the abdominal cavity occurs with dropsy. Therefore, it is necessary to carefully examine and conduct a thorough diagnosis to establish the correct diagnosis and avoid such complications.
Diagnostics of the dropsy of a testicle in a newborn
Diagnosis of dropsy usually does not represent any effort, because the disease is very common.
Upon examination, you can see that the baby has a larger scrotum on one side, or less often on both sides. At the same time the skin over it is not changed, without redness and defects. When palpation of the scrotum, its soft elastic structure is noted. Palpation does not cause any painful sensations. Sometimes when palpation you can feel a symptom of a transfusion of fluid, which indicates exactly the hydrocele. Mom may note that when the child has been lying for a long time, the scrotum is slightly larger in size than when he was vilified in an upright position. These are the main diagnostic signs that speak of a possible dropsy testicle. If this pathology is combined with cryptorchidism or inflammatory reactions of the testicle, other symptoms may appear-pain in palpation, an increase in body temperature, tension in the muscles of the abdominal press, and absence of a testicle in the scrotum with increased size.
Analyzes are generally not required to confirm the diagnosis, as dropsy is not accompanied by changes in laboratory parameters.
Instrumental diagnosis is widely used to clarify the diagnosis of dropsy, as well as for differential diagnosis. The most accessible and fastest method is diaphanoscopy. To do this, you just need to take a flashlight and enlighten them on the back of the scrotum. If volumetric formation is caused by the accumulation of fluid, then the rays of light will penetrate the scrotum and the gnae will uniformly shine through. If the formation of tissue structures or blood, then the symptom will be negative.
Another method of instrumental diagnosis is ultrasound examination of the scrotum. This method allows you to accurately determine the contents between the testicles or to determine additional tissue structures in other pathologies. If you use a Doppler study, you can also determine the blood flow in the vessels and exclude other pathologies.
Differential diagnosis of dropsy testis should be carried out primarily with pathologies that are signs of an "acute scrotum". Such diseases as a torsion of the testicle or appendages, scrotal injury, testicular ischemia are very serious pathologies that require immediate surgery to avoid complications. The main differential symptom of these pathologies is the scrotal hyperemia and sharp soreness, to which the child will react in any movements.
Also it is necessary to carry out differential diagnostics between a dropsy of a testicle and a hernia. When the hernia organs of the abdominal cavity go through the weak spots in the scrotum. This is also accompanied by an increase in its size. When it comes to a hernia, it can freely recur into the abdominal cavity when palpating, and unlike this, it does not occur with dropsy.
Treatment of the dropsy of a testicle in a newborn
Treatment for dropsy with medicinal products is not used, because it is a surgical pathology.
Most often in children up to one year with a dropsy of eggs, simple observation is used, since up to this point the vaginal process can still be liquidated independently. After reaching one year, this is considered unlikely and the issue of surgical treatment is being considered.
In the period of such expectant management, some parents may use alternative methods of treating this pathology. Such alternative methods include:
Pumpkin and celery juice has pronounced diuretic properties, so it can reduce the severity of the hydrocele. For treatment, you need to make fresh juice from the plant celery and pumpkin and mix in equal quantities. It is recommended to give the child at the age not earlier than half a year on half a teaspoon eight times a day. For children younger it is necessary to start treatment with one drop to avoid allergic manifestations.
Often for treatment at home use infusion of birch buds or the birch juice itself. If the season of pure birch juice, then it should be diluted 50% with warm boiled water and give the child one teaspoon up to five times a day. If there is no possibility to drink fresh juice, then it is possible to prepare an infusion of fruits. To do this, take 20 grams of birch buds and insist in one glass of boiling water boils. Dosage for the baby is the same as when using birch juice.
Cowberry and elderberry have good dehydration properties in a similar 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 you need two drops four times a day.
The use of any compresses and ointments when dropsy is prohibited, as it can cause complications.
Operative treatment can be performed by the puncture method. In this case, after the treatment of the field, a puncture of the scrotum is performed with the suction of the liquid. This method can be used in the form of a dropsy, when there is no connection with the abdominal cavity. With a combined dropsy, this method is inefficient, since the fluid accumulates again.
Surgical treatment of dropsy is the most effective method using a special method of excision of the vaginal process. This operation is performed by children after one year under general anesthesia. The essence of the operation is the excision of the membrane and the bag where the liquid was. After this, the vaginal process is bandaged and the operation is considered complete. Recurrence with correct tactics is not observed.
Prophylaxis of dropsy is non-specific and consists only in preventing complications.
The prognosis of dropsy is favorable with the right expectant management and further surgery. There are no complications in physiological dropsy also.
The testicle in the 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.
Last update: 25.06.2018
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
Surgical intervention on testicles - operations on testicles (testes) - are carried out to eliminate defects in their development and the consequences of injuries, as well as as a method of getting rid of other pathologies of the male sex glands.