Hydrocele

introduction

As a hydrocele, or also Water break is in medicine an accumulation of water in the Testicular area designated. A distinction is made between different forms of hydrocele, which differ from both the localization, as well as the Emergence can distinguish.
A hydrocele is different from the edema - which also represents an accumulation of fluid - from Place of performance. While hydroceles in Scrotal compartment occur, edema is found by definition in Scrotal sheaths.
The accumulation of fluid is therefore found in the hydrocele around the testiclewhile in edema it is in the testicle.

One differentiates between different forms of the hydrocele, depending on localization:

• First, the Hydrocele testis, as which the initially described accumulation of fluid around the testicles is called.
• Second, the Hydrocele funiculi. This form represents an accumulation of fluid along the spermatic cord. The funiculus spermaticus, or also Spermatic cord is a structure that extends from the groin to the testicles. Among other things, the Vas deferens, Nerve fibers, and supplying the testicles Blood vessels.

root cause

Roughly speaking, there can be two causes of a hydrocele: It can be congenital - that is, it exists from birth - or it can be acquired.

To understand the innate form of the hydrocele, one must first look at the embryonic development of the testicle:
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 was created in the embryonic phase at the level of the kidneys.
During this descent into the scrotum, the testicle naturally pulls part of the peritoneum with it. The peritoneum is, so to speak, the inner lining of the abdominal cavity, which seals it off in an air and water-tight manner like a sack.
The part of the peritoneum that is drawn along with it usually becomes deserted and recedes so that the testicles and peritoneum exist separately from each other. However, if the connection does not become obliterated, there is still a connection between the abdomen and testicles.
Through this connection, water can now get from the abdomen to the testicle area and thus lead to a hydrocele.

Read more on the topic: Cryptorchidism

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

Read more about this under: Swollen testicles - what's behind it?

diagnosis

The Diagnosis of a hydrocele is relatively simple:
On the one hand give medical examination interview, and a detailed discussion of the problem a first hint. On the other hand, the attending physician can over Palpation - so Scan - of Testicle Determine fluid build-up.

A detailed examination can, however, be carried out very easily by means of Ultrasonic, often also called "Sono", or "Schall" for short. Be there Sound waves directed towards the bodywhich are then reflected differently by different body structures. This principle has been copied from the sonar of submarines and ships, which use the same principle for determining depth. So can too liquids, bone, and Tissue structures can be differentiated, which can answer the question of any fluid accumulation.
Advantages of ultrasound are its easy and quick to use, its low cost, and its harmlessness to the human organism.

Another, albeit somewhat outdated, examination method of the hydrocele is Diaphanoscopy. Besides the urology this method is also used in many other specialist areas. This is that Put on a light source on the part of the body to be examined - in this case the testicles. Due to the strong light, the structures under the skin are shown and can be assessed.
Since the Ultrasound, however, more precisely, and is no less time-consuming or expensive, this examination method is rarely used.

therapy

For the treatment of the hydrocele, it initially seems most sensible to use the Scrotum with a puncture sterile needleand drain the excess water.
However, this is only one symptomatic, and no causal therapy, that is to say, the Success is short-lived. The water will flow out of the abdomen again within a few days through the existing connection. In this respect, a puncture can only bring short-term relief, but it does no permanent solution represent.

The therapy options depend on the strength of the hydrocele: At less pronounced, acquired forms must not necessarily an operation respectively. As long as they do not, due to their size or their functional impairment Restriction represent, they can be left. If this is not the case, however, the hydrocele must surgically removed become.
Plus there is various surgical procedures. It is usually accessed via the Inguinal canal, or directly through one Testicle cut at the Testicles.
The same applies to a congenital hydrocele. Since here the Risk of breakage, with subsequent formation of a Intestinal prolapse (a protrusion of the bowel) through the junction, and there is entrapment of the bowel, surgical treatment should be performed.
At a Entrapment of a section of the intestine can lead to Stool retention and Death of the intestine come. This represents a danger in that the intestine can subsequently decompose and its contents emptied into the abdomen. This process is potentially life threatening.

forecast

That I congenital hydroceles often within the close by themselves for the first few months of life, there is usually no op during this time.
First from about 3 years of age should be a operative care should be considered. Up to this point in time, the connection between the abdominal cavity and the scrotum can usually still be closed.
If an operation is necessary, it has one high cure rate. In individual cases, however, relapses (recurrences) can occur, which then usually occur treated in the same way become.
The Recurrence rate after a hydrocele operation lies with 5% but comparatively low. In individual cases, a Bonding the connection: The protein-containing discharge from the abdomen sticks the opening shut so that no more fluid flows in. However, this is more likely to be the case with small connections and at a young age.

Complications

Every operation has its own Risks, this is inevitably the case with all surgical procedures.
As soon as the Skin cover is opened, a Target area for pathogensthat settle in the tissue and can multiply there under perfect conditions.
The consequences are Inflammationthat always with Swelling, redness, pain, and Loss of function are connected. One tries through the pathogen load sterile operating room conditions to keep it equal to zero, but infections can always occur.
Possible surgical injuries during surgery for a hydrocele include injury of Testicle, Epididymis, and des Vas deferens, which is why often a preoperative freezing of sperm is recommended in the event that you want to have children. The body can potentially do this loss of a (secondary) testicle, however Compensate on the opposite sideso it doesn't automatically go to Infertility comes. Usually it also occurs in the course of an operation on the hydrocele Hematomas, so Bruisingwhich, however, disappear within a few days. However, these can be painful at first and cause swelling.