What Is a Hydrocele Repair?

A hydrocele is a cyst formed by the accumulation of fluid in the lumen of the sheath beyond a normal amount. The disease can occur at any age. When the sheath itself or the testicles, epididymis, etc. are affected, the secretion and absorption of fluid loses balance, forming a hydrothorax. Long-term effusion in the sheath, such as increased internal pressure, can affect blood flow and temperature regulation of the testes, causing atrophy of the affected testes. According to the closed position of the sheath, it can be divided into testicular hydrocele, spermatic hydrocele, mixed type hydrocele, testicular spermatic fluid (infant type), and trafficic hydrocele Wait for five types.

Basic Information

English name

hydrocele

Visiting department

Surgery, urology

Common symptoms

Cystic mass in the scrotum

Contagious

no

Causes of hydrocele

There are two types of hydrocele: primary and secondary. The primary cause is unclear and the course is slow, which may be related to trauma and inflammation. Secondary patients have primary diseases, such as acute orchitis, epididymitis, spermatic cord inflammation, trauma, hernia repair, scrotal surgery, or secondary systemic symptoms such as high fever, heart failure, and peritoneal effusion. Membrane effusion. Chronic hydrocele is found in testicular epididymal inflammation, syphilis, tuberculosis, and tumors. In the tropics and the south of China, effusions of the sheath caused by filariasis or schistosomiasis are common. Infant type hydrocele is related to the late development of the lymphatic system. When the lymphatic system of the sheath is fully developed, the fluid can be absorbed by itself.

Clinical manifestations of hydrocele

The clinical manifestations of hydrocele are more common on one side, and there are cystic masses in the scrotum, which are gradually increasing in pain. A small amount of effusion may be asymptomatic; when the amount of effusion gradually increases, the affected scrotum may have a feeling of falling, pulling, or pain. If the fluid is huge, the penis retracts into the foreskin, affecting urination, sex life, and walking.

When examining the hydrocele, there are different types and different performances:

Testicular hydrocele

There is more fluid in the testicular sheath cavity, which is oval or spherical, with a smooth surface, cysts, no tenderness, unclear touch between the testis and epididymis, and a positive light transmission test.

2. spermatic cord effusion

Cystic effusion is located above the testes in the scrotum or in the groin, and is oval or spindle-shaped. The surface is smooth and moves with the spermatic cord. The light transmission test is positive, and the testes and epididymis can be touched below.

3. mixed type hydrocele

The testis and spermatic cord fluid are present at the same time and do not communicate with each other, and may be complicated by inguinal hernia or undescended testes.

4. Testicular seminiferous fluid (infant type)

The sheath-like process is closed at the inner ring and not closed at the spermatic cord. It communicates with the testicular sheath cavity and is mostly pear-shaped. It is located in the scrotum. The testicles and epididymis cannot be clearly touched. Not connected.

5. Traffic effusion

The amount of fluid accumulation is related to body position. The amount of fluid accumulation in the supine position decreases or disappears, and it increases in the standing position. The testicles and epididymis can be touched, and the light transmission test is positive. If the channel between the sheath process and the abdominal cavity is larger, the field tube or greater omentum can enter the sheath process and the inguinal hernia appears.

Hydrocele

B-ultrasound showed a liquid dark area, which is helpful to distinguish it from testicular tumors and inguinal hernias.

Differential diagnosis of hydrocele

According to symptoms and signs, the diagnosis of hydrocele is usually not difficult, and it should be distinguished from the following diseases:

Inguinal hernia

The mass can be touched in the scrotum or groin, sometimes bowel type, smell of bowel sounds can be seen, the mass can be absorbed in the supine position (unless incarceration occurs), the inner ring has a sense of shock when coughing, and the light transmission test is negative.

Testicular tumor

A solid mass in the scrotum with a hard texture and a heavy feeling in the affected testicle.

3.Semen cyst

Located above the testis, the epididymis head is mostly round and small in size, usually about 2 cm. The testis can be clearly felt. The diagnostic puncture can extract milky white liquid containing dead sperm.

4. Shedding fluid

A scrotal puncture can draw fluid, usually a pale yellow liquid. If caused by filariasis, the fluid may be milky white chyle.

5. Hemorrhage

If the hydrocele due to trauma or hemorrhagic disease, the fluid is bloody, or all blood, the light transmission test is negative.

Hydrocele

Follow-up observation

It is suitable for those with slow disease course, little effusion, low tension, no long-term growth without obvious symptoms. Infant type hydrocele often disappears by itself before the age of 2 and is not rushed to treatment. The effusion caused by systemic disease can be gradually absorbed after the systemic disease is cured.

2. Puncture fluid extraction and injection of sclerosing agent

Simple puncture and aspiration are easy to relapse. After the aspiration, the sclerosing agent is injected into the sheath cavity, and the communication between the sheath cavity and the abdominal cavity must be excluded. Due to its complications such as local formation of lumps and secondary infection, its application is still controversial.

3. Surgical treatment

(1) sheath inversion is the most commonly used clinically, with simple operation and good surgical effect.

(2) Sheath cyst resection is mainly applied to spermatic cord sheath cyst.

(3) Traffic effusion is ligated and cut off the unclosed sheath-like process at the inner ring mouth, and the sheath is inverted.