What is a testicular hydrocele?
It is a condition where fluid builds up in the protective lining of the testicle. The cause of this phenomenon may be idiopathic (the causes are unknown) or reactive - as a response to the inflammatory or neoplastic process. Testicular hydration is the most common factor leading to an enlarged scrotum. To diagnose this problem, the following are used: ultrasound of the testicles, magnetic resonance imaging and computed tomography.
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Treatment for a testicular hydrocele
The main goal of treatment of the ailment in question is drainage of fluid by cutting the laminae of the testicle's own sheath. Most often, the procedure is performed by aspiration or surgery. The first one involves the percutaneous puncture of the scrotum and inserting it into the area of the needle nucleus sheaths in order to withdraw the fluid. After that, pharmacological agents are injected to induce fusion of the resulting cavity (sclerotherapy).
The surgical procedure, in short, consists in gaining access to the fluid reservoir constituting a hydrocele and its evacuation. Depending on the assessment of the urologist, the incision may be in the scrotum or in the inguinal canal. The procedure can also be performed using a minimally invasive method using a laparoscope. After the incision is made, the doctor separates the wall of the fluid reservoir from the scrotum. After making sure that the fluid reservoir has been dissected from the surrounding organs, the operator breaks the continuity of the hydrocele and drains its contents. The next step is to put stitches on the edges of the casing. Depending on the method, there are two methods of this treatment:
1.Winkelmann - "excess" of the casing after drainage is turned up and sewn together,
2.Bergmann - "excess" casing is removed.
At this stage, especially in children, the doctor also assesses the entire spermatic cord for the presence of a possible hernia. The last step in this procedure is to insert the testicle and the seminal cord back into the scrotum and sew these elements into it to avoid twisting the seminal cord. The final stage is suturing the scrotum. A drain is left at the incision site on the skin, through which blood is drained from the operated site, which reduces the risk of a hematoma after the procedure. Usually it is removed after 24 to 48 hours
These procedures are performed under general anesthesia. They are considered safe as serious complications are extremely rare. The procedure itself takes about 1 hour. It is possible to feel burning, pain and discomfort for up to a few days after the procedure. After a certain period of time, a follow-up visit takes place to assess the treatment results and healing. Heavy lifting and physical exertion are prohibited for approximately 4-6 weeks after treatment. Unfortunately, none of the methods of evacuating a hydrocele can guarantee that it will not relapse.
Source:
- Robbins Patologia, Kumar, Cotran, Robbins Elsevier Urban & Partners, Wrocław 2005, dodruk 2013, ISBN 978-83-89581-92-1
- ZOLLINGER’S ATLAS OF SURGICAL OPERATIONS, ISBN: 978-0-07-160227-3;
- 474-475.
- Bailey & Love's Short Practice of Surgery 27th Edition, ISBN: 9781498796507.1503-1505.
