Dropsy Of The Testicles In Newborn Boys - Symptoms And Treatment, Surgery

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Dropsy of the testicles in newborn boys

Hydrocele, or dropsy of the testicles, is an accumulation of serous fluid in the membranes of the organ. Most often, such dropsy is unilateral (90% of the total number of all cases), it is usually diagnosed in newborns, although there is a possibility of hydrocele developing in older children.

Content:

• What is testicular dropsy?
• The main causes of dropsy of the testicles
• Classification
• Symptoms of dropsy of the testicles in boys
• Treatment methods for dropsy of the testicle
• Surgery to eliminate dropsy of the testicles
• Complications of the postoperative period

What is testicular dropsy?

The formation of the boy's genitals begins in the womb. The location of the testicles of the fetus is determined in the vicinity of the kidneys. In the process of development, the testes gradually descend from the abdominal cavity into the scrotum along the vaginal process through a special opening. Sometimes, going down the inguinal canal, the testicles carry along a part of the peritoneum - the very process of the vaginalis.

Over time, the canal overgrows, turning the cavity inside the testicle into a closed space. The fluid from the peritoneum that has entered the scrotum does not find a way out. In this case, the scrotum increases, the swelling reaches the groin. Most often, the child does not experience any pain or discomfort.

In some cases, when an infectious process joins, the skin of the scrotum turns red, touching it gives the baby painful sensations. Pathology is accompanied by restless behavior of the child, frequent crying. If these symptoms appear, you should immediately seek medical attention.

Classification of hydrocele depending on the period of formation:

• Congenital dropsy of the testicle - diagnosed up to 3 years old, formed during the prenatal period, can be detected during screening of pregnant women by ultrasound;
• Acquired dropsy of the testicle - develops due to testicular torsion, tumor, trauma, as a complication of a viral disease (ARVI, parotitis), inflammation, hernia repair.

Congenital dropsy occurs in every tenth newborn, is present in 9% of infants, in 1% of adult men. Hydrocele should be differentiated from inguinal hernia, lymphocele (accumulation of lymph in the testicular tissue) and funiculocele (dropsy of the spermatic cord).

The main causes of dropsy of the testicles

The causes of hydrocele depend on which form of dropsy is being considered - congenital or acquired.

Reasons for the formation of congenital dropsy:

• The threat of termination of pregnancy;
• Chronic diseases of a pregnant woman that affect the course of the gestational period;
• Fetal infection;
• Premature birth;
• Birth injury;
• Genetic predisposition;
• Peritoneal dialysis for kidney failure
• Increased intra-abdominal pressure with excitability of the child.

Reasons for the appearance of acquired dropsy:

• Orchitis (inflammation of the testicle);
• Epididymitis (inflammation of the epididymis)
• Tumors of the testicle and its appendages;
• Cardiovascular failure.

We should also mention physical factors as a possible cause of hydrocele in boys of any age:

• Peritoneal defects;
• Testicular torsion;
• Scrotal injury
• Complications after hernia repair operations, varicocelectomy;
• Diseases of the lymphatic system.

All of the above reasons, both mechanical and inflammatory, affect the imbalance between the release and absorption of serous fluid from the vaginal membrane of the testicle.

The use of a diaper does not in any way affect the formation of a hydrocele, nor does the method and duration of wearing. This external factor is not capable of leading to the development of pathology, the real causes of which are changes in the anatomy and physiology of internal organs.

Classification

Types of hydrocele, depending on the connection of the peritoneum with the watery cavity:

• Communicating (primary) dropsy - the processus vaginalis does not completely close, leaving a connection between the peritoneum and the cavity of the vaginal membrane.
• Isolated dropsy - the connection between the peritoneum and the testicular cavity disappears, and the fluid accumulated in the testicular membrane does not find a way out.

Communicating dropsy is more dangerous, as it can be complicated by the appearance of an inguinal hernia. Infringement of an inguinal hernia is a condition that is dangerous to the life and health of a child. It requires an urgent operation.

Classification of dropsy depending on the pressure of the serous fluid inside the cavity:

• Tense form when fluid pressure is high enough;
• Relaxed form when it is absent.

With a tense form of hydrocele, there is a danger of expansion of the inguinal canal and abdominal pocket, threatening the appearance of intestinal disorders and the development of an inguinal hernia.

Symptoms of dropsy of the testicles in boys

Most often, the hydrocele does not give the child significant discomfort. Signs of dropsy of the testicle are detected by the parents of the baby during hygiene procedures.

What can be seen on visual inspection:

• Scrotal asymmetry or bilateral enlargement;
• Swelling in the groin.

A child who is able to express his feelings may complain of heaviness or pain, discomfort in the genital area.

Symptoms of a hydrocele with the addition of inflammation of the testicular tissue:

• Soreness in the groin area;
• Hyperemia of the skin;
• Chills, weakness;
• Increased body temperature;
• Nausea, vomiting.

Adolescents may develop false shyness about genital diseases. They hide the problem that has appeared, inform their parents about the disease when it goes into an advanced stage, and is complicated by tissue infection. For a child to trust loved ones, you need to try to talk delicately on such topics from a young age.

Treatment methods for dropsy of the testicle

To clarify the diagnosis of "hydrocele" in a boy of any age, you need to visit a pediatric urologist. The doctor will take a medical history and conduct a visual examination. Dropsy of the testicle must be differentiated from an inguinal hernia. There is a technique that allows you to distinguish between these diseases - when the inguinal hernia is repositioned by the doctor, a kind of "gurgling" sound is heard. This effect is not observed with hydrocele. In both cases, after manipulation, a decrease in the volume of the scrotum is noticeable, although with dropsy, the edema decreases more slowly.

Methods for diagnosing hydrocele in children:

• Diaphanoscopy (transillumination) - transillumination of the scrotum with a directed beam of light allows detecting violations of its structure, with inflammation, the contents of the testicle are not translucent;
• Ultrasound of the scrotum - the method makes it possible to identify such causes of dropsy as an inguinal hernia or cyst of the spermatic cord;
• Laboratory tests (General analysis of blood and urine) - will clarify the presence or absence of concomitant diseases or complications of the process.

In children under 2 years of age, uncomplicated dropsy of the testicle is not operated on, carrying out dynamic monitoring of the child's health status by a pediatric urologist. During this period, if the volume of the testicle is greatly increased, the accumulated fluid is aspirated. In children from one to three years of age, the observation continues, and if there are complications, surgical treatment of the hydrocele is planned.

Indications for surgery:

• Fluctuation of the size of the scrotum to its increase and vice versa;
• The presence of an inguinal hernia;
• Severe soreness in the groin;
• Accession of inflammation.

There are several methods of surgical treatment for hydrocele in young children:

• Ross's operation - the inner groin ring is excised and tied, the method is used for communicating the form of a hydrocele;
• Bergman's operation - a 6 cm long incision is made on the scrotum, all the membranes of the organ are excised layer by layer, the testicle is brought out onto the wound, after pumping out the fluid, the vaginal membrane is excised, the testicle is returned to its place, catgut is applied to the membrane;
• Winckelmann's operation - performed similarly to the previous method, but the final plastic is performed in a different way - the testicle shells are turned outward and sutured in this position, performed under general anesthesia;
• Lord's operation is the least traumatic method, which involves cutting the water sac, corrugating the testicle membrane around it without turning it inside out.

There is such a method as sclerosing the watery cavity by introducing alcohol, a solution of Tetracycline, Doxycycline into it. In this case, the opening formed by the vaginal process is "sealed", the fluid ceases to accumulate in the testicular cavity.

Surgery to eliminate dropsy of the testicles

Despite the fact that surgical intervention for the treatment of hydrocele takes only 20-30 minutes and is considered a simple operation, preparation for it should be thorough.

Training. So that the operation is not complicated by the infectious process, the development of pneumonia, the main requirement in preparation for the intervention is the good health of the child. He must fully recover from the illness, that is, after the flu, acute respiratory infections must go for at least a month to fully restore immunity. You must first pass a general blood and urine test. Before the operation, a complete refusal to eat is required for 6 hours, you cannot drink water either.

Types of anesthesia. In most cases, general anesthesia is used for surgical intervention in children. This choice is justified, because it allows you to avoid enormous stress for the baby, delivered by unfamiliar surroundings, specific smells and sounds, and the type of surgical instruments.

General anesthesia will help relieve tension, relax the child, and relieve him of unpleasant impressions and memories. For anesthesia, a nitrous oxide mask is used, and after the child falls asleep, an additional intravenous catheter is installed. Throughout the operation, the anesthesiologist monitors the child's blood pressure and heart rate. At the end of the operation, nitrous oxide no longer enters the child's respiratory tract, he wakes up.

Postoperative period in the clinic. Drinking will be allowed within a few hours after the intervention, eating - a little later. The child is discharged home the next day, provided that the operation took place without complications. Pain in the area of the surgical wound is usually insignificant, they can be stopped by taking NSAIDs (Paracetamol, Ibuprofen). After 2-4 days, the pain does not bother the child at all.

Postoperative period at home. Within a month, a limitation of physical activity is required, both for the baby and for the older child. The boy should not touch the wound so as not to infect it and not to provoke bleeding. Modern surgeries are performed using absorbable suture material, so it is not necessary to visit a doctor for suture removal. Redness and swelling of the tissues around the wound within 2-3 days is the norm, but if such symptoms last longer than 3 days, the wound may become infected, an urgent visit to the surgeon is required.

When bathing a child, you need to carefully protect the wound from getting wet for a week in order to prevent infection.

Complications of the postoperative period

Although complications after a carefully performed and prepared operation are extremely rare, they cause negative consequences with a difficult prognosis.

• Complications of anesthesia;
• Infectious lesion of testicular tissue - it is required to take antibacterial drugs for 7-14 days after surgery;
• Bleeding - it is caused by pressure in the area of the operating field, less often - by irrational surgical technique;
• Recurrence of hydrocele is diagnosed according to the following criterion: the testicles in the child are located higher than before the operation. In the presence of such a sign, an urgent consultation with a pediatric urological surgeon is required.
• The risk of infertility - damage to testicular vessels or spermatic cord during surgery can disrupt the reproductive function of the future man or make him completely infertile.
• The formation of postoperative scars and cords, which tightly fix the testicle in one position.
• Testicular atrophy with damage to the organ's circulatory system.
• Pain and discomfort in the groin area.

To avoid complications, you need to scrupulously follow the doctor's recommendations for the treatment of postoperative wounds, keep calm, and avoid physical exertion.

Many male health disorders have their origin not from congenital pathologies, but from a banal non-observance of the rules of personal hygiene. Laying the foundations of hygienic body care begins in the family, it is most productive before the age of 5.

Prevention of dropsy of the testicles in newborns involves the observance of the following rules by pregnant women:

• Refusal from the toxic effects of alcohol, nicotine;
• Limiting visits to crowded places to prevent infection with rubella, mumps, ARVI, influenza;
• Timely detection and treatment of STDs to exclude congenital fetal abnormalities;
• Limiting contact with allergens in the presence of this disease;
• Strengthening immunity by hardening, fortifying the diet, limiting stress.

An attentive attitude to the boy's health, adherence to the doctor's recommendations, and rational treatment will help to avoid complications and maintain reproductive health.

The author of the article: Sokolova Praskovya Fedorovna | Pediatrician

Education: Diploma in the specialty "General Medicine" received at the Volgograd State Medical University. A specialist certificate was immediately received in 2014.