Hydrocele

Introduction

Introduction to hydrocele

Testicular hydrocele refers to the accumulation of excess fluid between the two layers of the testis, and most of the hydrocele has no obvious cause, called primary hydrocele. It occurs and develops slowly, and patients can be asymptomatic. Due to trauma of the scrotum, inflammation or tumor of the testis and accessory testis and hydrocele caused by filariasis, it is called secondary hydrocele. It often has symptoms of the primary lesion.

basic knowledge

The proportion of illness: 0.003%

Susceptible people: no specific population

Mode of infection: non-infectious

Complications: male infertility

Pathogen

Cause of hydrocele

(1) Causes of the disease

Infection (30%):

Infection is the most common cause. It is often caused by Mycobacterium tuberculosis, gonorrhea, and various non-specific bacteria such as Escherichia coli, Staphylococcus, Streptococcus, etc., caused by acute and chronic epididymitis, orchitis, spermatic inflammation, and meningitis. Mumps virus infection can also be caused. Parasitic infections such as filariasis, which is prevalent in the tropics, can also damage the lymphatic flow of the sheath, spermatic cord, and scrotum, resulting in hydrocele.

Damage (30%):

Injury is also a common cause of symptomatic hydrocele. Campbell reported that 6% of patients with hydrocele had a history of scrotal kick, injury, falls, and traction. The surgical operation in the abdomen, groin area, and scrotum is one of the causes recognized in recent years. There are reports of hydrocele in 67% of patients after renal transplantation, 35% after varicocele, 0.9%--2.28% after hernia repair, epididymal resection, inguinal lymph node dissection, etc. Suspension and damage to the lymphatic vessels cause hydrocele.

Congenital factors (15%):

The cause of congenital hydrocele is caused by the incomplete closure of the sheath tube in different parts before the birth of the fetus. The peritoneal fluid accumulates at a certain level through the closed abnormal sheath tube to form various types of hydrocele. .

Tumor (10%):

Cancers in the testis, epididymis, sheath, spermatic cord and other parts can invade the sheath, causing it to secrete, exude or block the lymphatic system and produce hydrocele. The rate of hydrocele formation in testicular tumors is 2% to 5%, which is a rare cause.

(two) pathogenesis

Relevant research indicates that the effusion is secreted by the wall of the sheath and absorbed by the wall of the sheath. When the amount of secretion is greater than the amount of absorption, hydrocele is produced. The wall of the congenital hydrocele is thin, smooth and soft. It is clear and easy to separate from the surrounding tissue, and is oval and translucent. According to relevant research, it is found that almost all of the pediatric hydrocele is connected with the abdominal cavity. The diameter of the sheath is generally about 2mm. The thicker ones can reach 5mm, and the longer the disease course, the wall of the sheath wall is obviously thickened, but the wall thickness is uniform, there may be multiple small nodule pseudotumor-like changes, and even calcification, adhesion to adjacent tissues, such as sheath When the protruding tube can accommodate the intestine, the inguinal hernia is formed. The effusion is generally yellow, clear, odorless exudate, and the liquid contains electrolyte, fibrinogen, cholesterol, monocytes and lymphocytes, and the specific gravity is 1.010~ 1.025, albumin content is 3 ~ 6g / dl, the amount of hydrocele is less than 10ml, up to more than 300ml, such as more fluid, long course, can press the testis and spermatic cord, affect testicular blood circulation, With interstitial edema and fine fine Changes in the tube can eventually lead to testicular atrophy.

Prevention

Hydrocele prevention

The incidence of hydrocele in the tropics is high and is related to the infection of blood worms. Therefore, anti-mosquito measures are important. Keep it clean.

Complication

Hydrocele complications Complications, male infertility

Generally no complications, but if the effusion is very serious, it may hinder the development of the testicles.

Symptom

Symptoms of hydrocele common symptoms Scrotal swelling and pain in one side of the scrotum gradually... Scrotal swelling

It can be expressed as one or both sides of the groin, scrotal mass, less fluid, no discomfort, with the increase of fluid in the capsule, you can feel the spermatic traction or dull pain, such as a large amount of testicular hydrocele The penis is retracted into the foreskin, which may cause difficulty in urinating, inconvenient walking, etc. In children with traffic hydrocele, the mass may disappear completely after lying down, and the mass gradually appears after standing.

The primary hydrocele is asymptomatic at the beginning, and its development is slower. When the patient grows to a certain extent, the patient discovers it. Excessive testicular hydrocele has a falling feeling due to its large weight. Sometimes the penis is embedded in the skin and affects urination. Congenital hydrocele in the supine, the mass disappeared quickly, although its characteristics, but sometimes the traffic channel is very thin, only slightly longer or slightly softer in bed, prone to misdiagnosis as testicular hydrocele. When asking about your medical history, you should specifically ask about the change in the size of the mass. The spermatic hydrocele often presents a field mass above the testicle. Similar to testicular size, it is often considered to be three testes. The testicular hydrocele is mostly pear-shaped, and the testicles are embedded and cannot be touched. The hardness of their cysts varies greatly. There is a large amount of liquid. It can be very hard, similar to a testicular tumor.

Examine

Hydrocele examination

Hydrocele is easier to diagnose and does not require special examination. However, if it is necessary to exclude testicular tumors, tuberculosis patients should have a corresponding B-ultrasound examination of the prostate, seminal vesicles, scrotum and penis, but if the scrotal mass is substantial, then It is not advisable to perform puncture examination. B-ultrasound can be seen as a liquid dark area. The sac can be puncture and effusion in the sheath cavity. Under normal circumstances, it is a clear liquid of egg yellow; if it is combined, it may be a turbid bloody or purulent liquid; Patients with filariasis can be chyle-like fluids.

Diagnosis

Diagnosis and identification of hydrocele

diagnosis

It can be diagnosed based on clinical manifestations, examinations, etc.

Differential diagnosis

The hydrocele is mainly distinguished from the inguinal hernia and testicular tumors.

The formation and anatomical relationship between the traffic hydrocele and the inguinal hernia are the same, but the diagnosis is different due to the different contents of the hernia capsule. When the patient stands, the mass is rapidly protruding along the inguinal canal, sometimes the intestinal type is visible. Intestinal sputum, it is sputum, which can touch the intestine during examination, the spermatic cord at the outer ring is thick, the scrotum is gradually enlarged by the traffic hydrocele, the inguinal canal is not obvious, the spermatic cord is not coarse, and the light transmission test is done. Attention should be paid to the infant's intestinal tube, although it is sputum, its light transmission is still positive, to be carefully examined, can not rush to puncture, so as not to accidentally hurt the intestine, to identify whether the spermatic hydrocele should check the spermatic cord at the upper end of the mass Whether it is thick or thick, if the mass is connected to the abdominal cavity, it is sputum. If it is not thick, it may be hydrocele. When the testicular hydrocele is occluded, the mass occupies all the scrotum, and the testicle cannot be touched. In addition to the contents of the sputum can still touch the testicles.

The characteristics of testicular tumors are heavy and hard, and there may be a small amount of hydrocele. B-ultrasound can be seen as substantial. In the examination, in addition to the hard mass of the mass, if the mass is touched, the external testis will touch the epididymis. , is a tumor, if there is no epididymis may be testicular hydrocele, the light transmission test tumor is negative, but thick-walled hydrocele can also be opaque, can be puncture to confirm the diagnosis.

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