Testicular hydrocele (hydrocele).

A testicular hydrocele is a medical condition in which fluid builds up around one or both testicles, creating an intramammary or extramammary buildup. Hydrocele is usually non-disease-causing and rarely poses a health risk. In most cases, hydrocele does not cause pain, but it may cause discomfort or inconvenience due to the increased size of the testicle.

Hydrocele can be of two types:

1. Intramammary hydrocele (testicular hydrocele): In this case, fluid builds up inside the shell of the testicle, called the greater shell. This form of hydrocele is the most common and can develop in men at different times of life, including childhood, adolescence, and adulthood.
2. External scrotal hydrocele (hydrocele of the spermatic cord): Here, fluid accumulates inside the spermatic cord, which lifts the testicle into the scrotum. This form of hydrocele is less common.

The main cause of a hydrocele is a disorder in the resorption of fluid or its accumulation in the testicular sheath or the spermatic cord. A hydrocele usually does not require treatment unless it causes pain or discomfort. However, in some cases, especially if the hydrocele causes discomfort or increases in size, surgical removal of the fluid or sheath may be necessary to correct the problem.

Causes of the testicular hydrocele

Some of the most common causes of hydrocele include:

1. Trauma: Trauma to the scrotum or testicle can cause damage to the blood vessels or ducts, which can cause fluid buildup and the development of a hydrocele.
2. Inflammation: Inflammation of the testicle, spermatic cord or scrotum can lead to obstruction of the ducts, resulting in fluid accumulation.
3. Congenital anomalies: Sometimes hydrocele can be associated with congenital anomalies or developmental abnormalities of the scrotum or testicle.
4. Infections: Infections of the scrotum or spermatic cord can cause inflammation and subsequent fluid accumulation.
5. Testicularcancer: Testicular cancer, although rare, can also be associated with the development of a hydrocele.
6. Unknown causes: In some cases, the cause of a hydrocele may remain unclear and be called "idiopathic."
7. Transudation: In some situations, a hydrocele can develop due to excessive transudation, which is the process by which fluid escapes from the capillaries and accumulates in the tissues.

Symptoms of the testicular hydrocele

Here are some of the symptoms of testicular hydrocele:

1. Increased testicular size: The main symptom of testicular hydrocele is an increase in the volume and size of the testicle itself. It can be mild or significant, depending on the amount of fluid that has accumulated.
2. Feelingof heaviness or pressure: Some men may feel discomfort or slight pressure in the testicle area due to testicular enlargement.
3. Testicular edema: A hydrocele may result in slight swelling of the testicle due to fluid buildup.
4. Pain or discomfort: In some cases, especially with a significant hydrocele, there may be pain or discomfort in the testicular area.
5. Feelingheavy in the scrotum: Some men may feel a heaviness or uncomfortable feeling in the scrotum due to enlarged testicle size.

Diagnostics of the testicular hydrocele

Diagnosis of a hydrocele, which is an accumulation of fluid in the testicular sheath (tunica vaginalis), may include the following methods:

1. Physical Examination:

   • The doctor may evaluate the testicles and scrotum to determine if there is an increase in the size or swelling of the testicle.

2. Ultrasound (ultrasound):

   • Ultrasound allows you to visualize the testicles and assess the presence of fluid in the testicular sheath. This method can also rule out other conditions such as tumors.

3. Transillumination (light test):

   • This method involves looking through the testicle with a special light source to assess the presence of fluid. This may be used in conjunction with a physical examination.

4. Examination of the level of tumor markers in the blood:

   • In some cases, your doctor may recommend blood tests to rule out the presence of tumors, especially if symptoms are ambiguous.

5. Additional research:

   • In some cases, your doctor may decide to perform other tests if symptoms are not clear or other medical conditions are suspected.

Treatment of the testicular hydrocele

Treatment of a hydrocele depends on its severity and symptoms. In most cases, a hydrocele is not an extremely dangerous condition and may not require immediate treatment. However, if a hydrocele is causing discomfort, pain, or other problems, the following treatments may be used:

1. Observation: If the hydrocele is small, without pain, and not causing discomfort, your doctor may recommend observation and regular physical exams to monitor changes.
2. Surgical removal: If a hydrocele causes severe pain, discomfort, grows in size, or interferes with normal activities, your doctor may recommend surgical removal. This procedure is called a hydrocelectomy. During the surgery, excess fluid is removed and the sac that contains the testicle may either be removed or stitched to prevent recurrence. This is usually done on an outpatient basis and does not require prolonged hospitalization.
3. Aspiration: A rarely used method in which fluid is removed from the hydrocele by puncture through a needle and syringe. This method is less popular because the hydrocele often recurs after aspiration.

After undergoing hydrocele removal surgery, the patient can usually return to normal activities within a short time. Surgery is usually effective in correcting the hydrocele problem.

Surgery to remove a testicular hydrocele

A hydrocelectomy is a surgical procedure performed to remove accumulated fluid and prevent recurrence of a hydrocele. The procedure is usually performed in a hospital or operating room.

Here is the general course of hydrocelectomy surgery:

1. Preparation: The patient undergoes preparation for surgery, including anesthesia (usually local or general, depending on the case).
2. Access: The surgeon makes a small incision in the scrotum to access the testicle.
3. Fluidremoval: The surgeon gently removes fluid from the testicular sheath by aspiration (sucking).
4. Removal of the shell (not always): Sometimes the surgeon decides to remove the testicular sheath (tunnel) to prevent further fluid buildup. This may be necessary if the testicular sheath is damaged or if there is a large hydrocele.
5. Wound closure: After removing the fluid and, if necessary, the sheath, the wound in the scrotum is closed with sutures or special glue.
6. Rehabilitation: After surgery, the patient is advised to rest and limit physical activity for several days or weeks, depending on the surgeon's recommendations.
7. Aftercare: The patient may also be given antibiotics to prevent infection and analgesics to relieve pain.
8. Follow-up: The patient will be scheduled for follow-up after surgery to ensure normal recovery and no complications.

Hydrocelectomy is a relatively simple and safe procedure, and most patients recover quickly from the procedure. However, as with any surgical procedure, there may be risks and complications that should be discussed with your doctor prior to the procedure.

Recovery and rehabilitation in the postoperative period

After hydrocelectomy (testicular hydrocele surgery), it is important to follow a proper rehabilitation period to speed up recovery and prevent complications. Here are some recommendations for the postoperative period:

1. Rest: It is important to rest after surgery. Maintain rest for a few days, avoid unnecessary exercise and heavy lifting. Patients are usually advised to avoid vigorous exercise for 2-4 weeks.
2. Pain Management: Take recommended analgesics as needed to relieve pain or discomfort. Be sure to follow your doctor's instructions on how to use the medication.
3. Cold: Use cold compresses (ice) on the surgical site for the first 24-48 hours to reduce swelling and relieve pain. Wrap ice in a soft cloth and apply it to the scrotum for a short time (10-15 minutes) several times a day.
4. Hygiene: Follow your doctor's recommendations for wound care. Generally, the wound should be kept clean and dry. Avoid getting water on the surgical site for the first few days.
5. Wearcomfortable underwear: Wear supportive underwear (such as tight underwear or special bandages) to support the testicle and reduce discomfort.
6. Watch your medications: If you are prescribed antibiotics or other medications, take them strictly as prescribed and complete the course of treatment.
7. Follow-upvisits: After surgery, the patient will have a follow-up visit with the doctor. It is important to follow all of the doctor's recommendations and attend the follow-up visit to make sure that recovery is normal and there are no complications.
8. Sexual activity: Your doctor usually recommends abstaining from sexual activity for a few weeks after surgery to avoid possible complications.
9. Review of biopsy results (as needed): If surgery was performed to diagnose testicular cancer, you may be asked to discuss the biopsy results and determine further treatment, if necessary.

Treatment of testicular hydrocele without surgery

May only be possible in some cases, especially if the hydrocele is small and does not cause discomfort. It is important to note that treatment without surgery usually does not eliminate the hydrocele completely, but rather aims to reduce symptoms and prevent them from getting worse. However, treatment without surgery can be temporary and may not always be effective.

Possible treatments for testicular hydrocele without surgery include:

1. Medical therapy: Some medications may be prescribed to reduce fluid buildup and decrease the volume of the hydrocele. This treatment method may be effective in some cases.
2. Use of a bandage or support: A bandage or support can help hold the testicle in place and reduce pressure on the blood vessels and tissues in the scrotal area. This can help reduce swelling and discomfort.
3. Puncture and aspiration: This is a procedure in which fluid is removed from the hydrocele using a needle and syringe. However, this is temporary relief as the fluid can build up again.
4. Sclerosing injection: This is a procedure in which a special substance is injected into the hydrocele to inactivate its walls and prevent further fluid accumulation. This method can be effective but may also require several sessions.

It is important to note that these treatments should be prescribed and administered under the guidance of a qualified medical professional, and their effectiveness may vary depending on the specific situation and the size of the hydrocele.

Forecast

The prognosis of testicular hydrocele is usually favorable. A hydrocele is a benign condition and usually does not pose a serious health risk. After successful hydrocele surgery, most patients make a full recovery and experience relief from the discomfort the symptom may have caused.

However, it is important to remember that hydrocele can recur (come back) in rare cases, especially if a complete extirpation of the testicular sheath (tunnel) has not been performed or if there have been other complications. In such cases, additional treatment or control measures may be needed.

If you have had hydrocele surgery, it is important to follow your doctor's recommendations for postoperative care and attend follow-up visits to assess your recovery. If you develop new symptoms or complications, be sure to tell your doctor.

Overall, proper treatment and follow-up with a physician usually provide a good prognosis for patients with testicular hydrocele.

Literature

Lopatkin, N. A. Urology: National Guide. Brief edition / Edited by N. A. Lopatkin - Moscow : GEOTAR-Media, 2013.