Dropsy in men
Hydrocele, or dropsy of the testicle, is an accumulation of serous fluid in the membranes of the organ. The volume of liquid usually ranges from 20 to 200 ml, but cases of huge dropsies (up to 3 liters) have been recorded. According to medical statistics, this disease occurs in about 1-5% of mature men. The danger of pathology is that it is one of the most common causes of male infertility.
- Causes of dropsy in men
- Symptoms of dropsy in men
- Consequences of dropsy in men
- Treatment of dropsy in men
- Postoperative period
Causes of dropsy in men
Dropsy in men almost always has an acquired character. The reason for its appearance is an imbalance between the secretion and reabsorption of serous fluid by the walls of the vaginal membrane of the testicle. Pathological processes lead to sclerosis of the parietal and visceral sheets of the peritoneum, the lumen between them is obliterated, the circulation of blood and lymph is disturbed. As a result of this, a cavity filled with serous fluid is formed.
Causes of dropsy:
- Traumatic injury to the scrotum;
- Chronic and acute inflammatory process, as a consequence of tuberculosis, gonorrhea, chlamydia, causing epididymitis, orchitis, epididymo-orchitis;
- Testicular tumors of any etiology;
- Side effects of radiation therapy;
- Testicular torsion;
- Complication of a viral infection that caused inflammation of the serous membranes of the whole body;
- Infection with filariasis, or "elephantiasis" - a parasitic disease common in the tropics;
- Heart and liver failure;
- Complication after surgery to remove an inguinal hernia, varicocelectomy.
When an infectious and inflammatory process joins, the clear liquid becomes cloudy due to purulent inclusions. In rare cases, an admixture of blood (hematocele) appears in it.
Symptoms of dropsy in men
The manifestations of dropsy of the testicle depend on the causes that caused it, on the prevalence of hydrocele in one or both testicles, on the form of the disease.
Symptoms of an acute form of hydrocele:
- Violation of urination;
- Sharp pain in the scrotum on one or both sides, radiating to the groin;
- Severe hyperthermia;
- Weakness, reaching loss of consciousness, limitation of movement.
Symptoms of chronic dropsy of the testicle:
- Enlargement of the scrotum;
- Unpleasant sensations that appear when walking, intercourse;
- Irritation of the epidermis, its maceration, the appearance of diaper rash.
Pain syndrome is not typical for the chronic course of hydrocele. In 7-10% of cases, dropsy affects both testicles.
Consequences of dropsy in men
In addition to the perceived discomfort and visual cosmetic defect, hydrocele is dangerous by the development of the following conditions:
- Disruption of blood and lymph flow leading to infertility;
- Unpleasant sensations during sexual intercourse and urination;
- The risk of developing a malignant process.
Symptoms of dropsy in men
Before carrying out a visual examination of the patient, the doctor collects an anamnesis of the disease, is interested in previous injuries, infections.
Methods for an accurate diagnosis of the disease:
- Diaphanoscopy, or transillumination, is the transillumination of the scrotum with a directed beam of light. When the cyst is filled with transparent contents, the glow has a red tint, the absence of glow is characterized by a turbid exudate.
- Ultrasound of the scrotum is a differential diagnosis that allows you to distinguish a hydrocele from an inguinal hernia, spermatocele, cysts of the spermatic cord.
- Doppler ultrasound - an assessment of the blood supply to the testicle is carried out, varicocele is diagnosed.
- General analysis of blood and urine - is carried out for differential diagnosis from diseases similar in symptoms.
- The study of the level of alpha-fetoprotein and chorionic gonadotropin is carried out to confirm or exclude a malignant process.
Treatment of dropsy in men
In most cases, surgical methods are used to treat dropsy of the testicle. An indication for surgery may be the danger of infertility, severe discomfort, the presence of tumor formation, torsion of the spermatic cord, suspicion of the presence of an inguinal hernia. Surgery is not performed in elderly men with severe heart failure, severe kidney and liver disease, or in patients with mental illness.
Therapy of a mild degree of hydrocele, which does not manifest itself as pain and discomfort, in patients who do not plan to conceive a child, is carried out with anti-inflammatory drugs.
- Operation according to Lord - a cyst is dissected, in which fluid accumulates, it is removed. In this case, the testicle is not removed into the wound, its shell is corrugated. The intervention is considered the least traumatic, it is not carried out in the chronic form of the disease.
- Operation according to Winckelmann - an incision is made on the scrotum in the projection of dropsy, the testicle is removed into the wound, fluid is aspirated from the cyst, the vaginal membrane is dissected, turned outward and sutured.
- Operation according to Bergman - the vaginal membrane of the testicle is opened, some of the tissues are excised after aspiration of fluid, the rest are sutured. The method is used for large cysts and non-communicating dropsy.
The consequence of the last two methods may be testicular hypotrophy, impaired spermatogenesis, hormone synthesis.
Modern methods of treating dropsy of the testicle are becoming an alternative to traditional surgical methods:
- Laser scalpel;
- Radio wave method using the "Surgitron" apparatus;
- Plasma or ultrasonic knife.
The use of these methods minimizes the consequences and complications after the intervention, there is no bleeding during their implementation.
The method of sclerotherapy in some cases replaces surgical treatment. It consists in removing the fluid accumulated in the cyst and sclerotherapy with alcohol, solutions of Tetracycline, Doxycycline. The method has a large number of complications, is dangerous by the development of epididymal obstruction, and is painful. If the cavity is not small, a small amount of alcohol is re-injected. The sclerosing substance, as it were, "seals" the hole, due to which fluid accumulates in the testicle, which reduces the risk of relapse.
Surgical treatment of hydrocele is carried out under local anesthesia and takes 20 to 40 minutes. After a few hours, if no drain was installed during the intervention, the patient can go home.
After the operation, a man should refrain from physical activity and sexual relations for 2 months. Sutures dissolve after 10 days. Complications of surgery can be edema, hematoma, inflammation of testicular structures. After using modern methods of treatment, complications are rarely diagnosed.
4 weeks after the operation, a significant deterioration in spermatogenesis indices is recorded, and then their gradual recovery:
- After applying low-traumatic methods - after 2-3 months;
- After invasive surgery - after 4-6 months.
All this time, an increased concentration of sedentary spermatozoa remains.
To minimize the risk of dropsy of the testicle, you need to protect yourself from sexually transmitted infections, protect the genitals from injury. A high level of immunity will slow down the rate of development of pathology and diseases leading to it. Therefore, you need to avoid the harmful effects of alcohol and nicotine, eat right, rationally build a regime of work and rest.
Author of the article: Lebedev Andrey Sergeevich | Urologist
Education: Diploma in the specialty "Andrology" received after completing residency at the Department of Endoscopic Urology of the Russian Medical Academy of Postgraduate Education in the urological center of the Central Clinical Hospital No. 1 of JSC Russian Railways (2007). Postgraduate studies were completed here by 2010.