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hydrocele

introduction

As hydrocele, or water breakage in medicine is called an accumulation of water in the testicle area. Different forms of hydrocele are distinguished, which may differ both from localization and from development.
A hydrocele differs from the edema, which is also a fluid accumulation, from the site of occurrence. While hydrozelen occur in the scrotal compartment, by definition, edema is found in scrotal envelopes.
In the hydrocele, the fluid accumulates around the testicle while it is in the testicular edema.

There are different types of hydrocele, depending on the location:

  • First, the hydrocele testis, which is referred to as the initially described fluid collection around the testes.
  • Second, the hydrocele funiculi. This form represents a fluid accumulation along the spermatic cord. The spermatic funiculus, or spermatic cord, is a structure that runs from the groin to the testicles. In it run, among other things, the vas deferens, nerve fibers, and the testicles supplying blood vessels.

reason

Roughly speaking, there are two causes for a hydrocele: it can be innate - that is, it can be present from birth - or acquired.

To understand the innate form of the hydrocele, one must first consider the embryonic development of the testis:
The testicle sinks from the abdomen into the scrotum before birth. This process is called descensus testis, it takes place in the fetus after it has been created in the embryonic phase at the level of the kidneys.
In this descent into the scrotum the testicle naturally pulls a part of the peritoneum with him. The peritoneum is, so to speak, the inner lining of the abdomen, which closes it like a sack of air and water.
The entrained part of the peritoneum usually disappears and forms back so that the testicles and peritoneum are separated. However, if the connection does not become deserted, there is still a connection between the abdomen and the testicles.
Via this connection, water can now enter the testicle area from the abdomen and thus lead to a hydrocele.

The acquired form of hydrocele, however, has other causes: In addition to inflammation in the scrotum and epididymis, also force on the testicles and lower abdomen may play a role. However, the exact cause has not been finally clarified; a multifactorial event is suspected.

diagnosis

In the diagnosis of hydrocele especially the ultrasound examination plays a major role.

The diagnosis of a hydrocele is relatively simple:
On the one hand, medical examination, and detailed discussion of the problem give a first indication. On the other hand, the attending physician may determine fluid retention via palpation - that is, palpation - of the testicle.

An exact examination, however, can be done very simply by means of ultrasound, often also called "sono" or "sound" for short. Sound waves are directed at the body, which are then reflected differently by different body structures. This principle has been copied from the sonar of submarines and ships using the same principle of depth determination. Thus, also fluids, bones, and tissue structures can be distinguished, which can answer the question of any accumulation of fluid.
Advantages of ultrasound are its simple and quick applicability, its low cost, and its harmlessness to the human organism.

Another, but somewhat outdated examination method of hydrocele is diaphanoscopy. In addition to urology, this method is also used in many other fields. This is the placement of a light source on the body part to be examined - in this case the testicles. Due to the strong light, the structures form under the skin, and can be assessed.
However, since the ultrasound is more accurate, and no less expensive or expensive, this method of investigation is rarely used.

therapy

For the treatment of hydrocele, it makes sense first to puncture the scrotum with a sterile needle, and to drain the excess water.
However, this is only a symptomatic, and no causal therapy, that is, the success is short-lived. The water will flow back within a few days from the abdominal area, through the existing connection. In this respect, a puncture can bring only temporary relief, but does not provide a permanent solution.

The treatment options depend on the strength of the hydrocele: less developed, acquired forms do not necessarily require surgery. As long as they are not restrictive due to their size or their functional impairment, they can be left. If this is not the case, the hydrocele must be surgically removed.
There are various surgical procedures for this. Access is usually via the inguinal canal, or directly via a testicle section on the testicles.
The same applies to an innate hydrocele. Since there is a risk of breakage, with subsequent formation of a bowel prolapse (a protrusion of the intestine) through the junction, and entrapment of the intestine, an operative care should be made.
An entrapment of a bowel section can lead to stool behavior and the death of the intestine. This poses a danger in that the intestine can decompose in the sequence, and empties its contents into the abdomen. This process is potentially life threatening.

forecast

Since innate hydrozelen often close by themselves within the first months of life, there is usually no Op.
Only from the age of about 3 should an operative care be considered. Up to this time, a closure of the connection between the abdominal cavity and the scrotum can usually be done.
If an OP is necessary, it has a high cure rate. In some cases, however, it can lead to relapses (recurrences), which are then usually treated in the same way.
However, the recurrence rate after hydrozelen surgery is comparatively low at 5%. In some cases, after a successful puncture, the connection may be adhesively bonded: the protein-containing discharge from the abdominal cavity sticks to the opening, so that no further liquid flows into it. However, this is more likely to be the case with small connections, and at a young age.

complications

Every operation carries its risks, this is inevitably the case with all surgical interventions.
As soon as the skin surface is opened, it provides a surface for pathogens that attach themselves to the tissue, where they can multiply under perfect conditions.
The result is inflammation, which is always associated with swelling, redness, pain, and loss of function. Although the pathogen load is tried to be kept zero by sterile surgical conditions, infections can always occur.
Possible surgical injuries to the operation of a hydrocephaly include damage to the testis, epididymis, and the vas deferens, which is why preoperative sperm freezing is often recommended in case there is a desire to have children. Potentially, however, the body can compensate for the loss of a (minor) testicle via the opposite side, so that it does not automatically come to infertility. In the course of surgery of the hydrocele, hematomas, ie bruises, usually disappear within a few days. However, these can be painful at first, causing swelling.

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