Dropsy of testicular membranes
Immediately introduce you to the course of signs and symptoms of hydrocele.
The main symptom of hydrocele is bloating or a significant increase in the size of any area of the scrotum (right, left, bilateral). The main symptoms of dropsy of testicular membranes are: fever, discomfort in this area, difficulty urinating.
The liquid in the shell accumulates slowly during hydrocele, in children, it can occur spasmodically (at night the fluid is not produced, but only absorbed).
With a large amount of accumulated fluid, the skin of the scrotum is taken in folds and the testicle cannot be probed.
If the volume of liquid is small, then you can feel the formation of a pear-shaped or hourglass shape. An hourglass shape is present when fluid enters the inguinal canal.
Know about treating varicocele at home: how can this be done?
Here you can read about the capitate form of hypospadias.
Classification of testicular dropsy (hydrocele) and its causes in adult men, children (including newborn boys)
Like most diseases, hydrocele (dropsy of the testicle) may be congenital and acquired. Congenital dropsy of the testis is associated with the development of the child in the womb.
During embryogenesis, the testicle passes from the abdomen to the scrotum. With the passage of the inguinal canal, it captures part of the peritoneum.
In the second case, fluid enters the scrotum, which leads to congenital dropsy of the testicle. The cause may also be a genetic inheritance.
Very often, congenital dropsy of the testicle takes place in the first year of a child's life, which is associated with independent closure of the vaginal process.
Acquired dropsy usually associated with mechanical effects on the scrotum.
This can be scrotal injuries in men and boys, complications after operations to remove hydrocele (dropsy) of the testicle, inflammatory processes near the testicle, and tumors.
The mechanism of acquired dropsy of the testicle membrane is associated with circulatory disorders. At the same time, the shells of the testicles are compacted and fluid accumulates between them.
Also, in the form of the disease, dropsy of the testicle may be acute or chronic.
Chronic dropsy of the testis does not cause pain and has a constant volume. The amount of fluid may vary, depending on the degree and time of the disease. Medicine knows cases when this volume reached more than two liters.
Diagnosis of the disease
To pinpoint the cause, extent, and type of illness, need to go through a series of diagnostic studies.
The first thing to do is go to the doctor and conduct an examination with palpation of the genitals (palpation). Further, the doctor may be referral for further examination. For example, diaphanoscopy.
Diaphanoscopy (literally from the Greek Diaphanes - transparent, skopia - watching) - this transillumination of the scrotum of the penis with a narrow beam of light. This procedure is as follows: a light source is applied to the back of the scrotum, closer to its bottom.
If the light through the scrotum does not penetrate well, the cause of swelling will be the appearance of a testicular tumor or inflammation.
However, in our time such a method is used less and less, they came to replace it ultrasound examinations (ultrasound). Ultrasound more accurately allows you to determine the type of disease, in our case, the structure of the testicles, the volume and color of the liquid, the presence of any foreign objects in the scrotum.
Same, Other research methods may be required to clarify or confirm the disease..
Hydrocele treatment (how to treat dropsy of testicular membranes in men and children?)
If the disease occurred due to inflammatory processes of the testis and its appendages, then the following treatment is prescribed: antibiotic therapy and rest. When undergoing this therapy, doctors recommend using about three different drugs. Semi-synthetic applications have proven themselves penicillins, cephalosporins and fluoroquinolones.
Properly selected by the doctor daily doses of the drugs and the modes of their use quickly relieve pain and remove inflammation in the scrotum.
The disadvantage of this treatment method is the possibility of infection when the drug is injected into the hydrocele cavity.
The essence of Winkelmann’s operation for hydrocele - part of the inner shell of the desired testicle is cut, turned inside out and sutured.
The essence of the operation of Bergman with dropsy of the testicle in a child or in a man - part of the inner shell of the desired testicle is removed, the rest is sutured. In the postoperative period after such an operation with hydrocele (dropsy of the testicle), antibacterial drugs and the wearing of a suspension (special supporting underwear or dressing for the scrotum) are prescribed.
The essence of Operation Lord - a part of the inner shell of the desired testicle is dissected, the hydroponic fluid is released and the corrugation of the vaginal membrane around the testicle is done. In this operation, the testicle does not relieve the surrounding tissues and is not turned inside the incision, which eliminates the risk of injury to the tissues and vessels of the scrotum.
Treatment of dropsy of testicular membranes in boys and men (hydrocele) by folk methods and (without surgery)
- Just drink hemp chaff infusion three times a day before meals.
- A decoction of bearberry leaves: 100 milliliters of cold water per one teaspoon of grass. Let the infusion stand for about five hours. You need to drink 3-4 cups a day, preheating the infusion.
- To prepare this medicine you will need: take about a hundred grams of ordinary pulp, put it in a saucepan, pour one liter of natural grape wine, put the container on low heat and warm for ten minutes.
Next, the infusion should be allowed to stand for about an hour and strain. A gauze dressing should be dipped in this solution and applied to the sore spot for several weeks.
Consequences of testicular dropsy disease
If for a long time you do not take any measures to eliminate the dropsy of the hydrocele, the risk of complications. This as well as further fluid growth in the scrotum, and the possible formation of inguinal hernia.
With a large volume of fluid in the scrotum occurs strong pressure on the shell of the testicles, which leads to a change in its shape (flattening) or squeezing of blood vessels. Blood that is not suitable in the genital organ causes a violation in spermatogenesis, which, if complicated, can lead to impotence.
Learn about cryptorchidism and make sure that you or your child does not have this disease. And also, what if there are suspicions?
And here are the treatments for varicocele.
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Testicular dropsy prophylaxis
To avoid a possible disease or prophylaxis after an illness, you need to: try not to injure the scrotum in any way, monitor hygiene, prevent various inflammatory processes and do not hesitate to go to the doctor (urologist). Adults need to check your baby’s genitals daily.
Same men should always keep their genitals warm during the cold season, since the testes are very sensitive to temperature changes and function normally only in a narrow thermal range.
In the next video, the urologist E.N. Nagorskaya talks about the dropsy of the testicles.
Normally, testicular laying occurs in the retroperitoneal region, then the formed testicle migrates to the scrotum under the influence of male hormones with the participation of a “gunter” cord surrounded by the vaginal process of the peritoneum. The lumen of this process by the time of the birth of the child should be completely closed. In the event that there is a violation of the processes of obliteration (closure), a communicating dropsy of the testicle or inguinal hernia occurs, depending on the diameter of the process.
In this case, fluid from the abdominal cavity through the duct freely enters the testicle. Sometimes only partial closure of the vaginal process occurs. In this case, the vaginal process of the peritoneum is obliterated at different levels of the inguinal canal and testis. This leads to diseases such as isolated dropsy of the testicle (testicular cyst), isolated dropsy of the spermatic cord (cyst of the spermatic cord) and isolated dropsy of the testis and testis (cyst of the spermatic cord and testicle).
The vaginal membrane of the testicle produces fluid, which serves as a lubricant for the testicle and contributes to its free movement inside the scrotum. Normally, a balance is maintained between the production of this fluid and its reverse absorption.
A violation of this mechanism is associated with the so-called physiological dropsy. It occurs in approximately 10% of newborns and in more than half of cases it disappears on its own by the end of the first year of a child’s life. The reason for its development is the imperfection of the lymphatic apparatus of the inguinal region in newborns and infants, which leads to delayed reverse absorption (absorption) of the resulting serous fluid between the shells of the testicle. As the child grows, it is possible to complete the obliteration of the vaginal process and increase the absorption properties of its membranes, which in a significant part of children leads to an independent cure of dropsy.
Acquired dropsy occurs with acute or chronic inflammation of the testicle, with testicular injury, with cardiovascular failure, with neoplasm of the scrotum. Genital surgery can also lead to hydrocele. This is the so-called reactive "symptomatic" dropsy, which disappears as the underlying disease is treated.
The development mechanism is associated with the compaction of the testicles, which violates the lymphatic outflow with inhibition of microcirculation (circulatory disorders). As a result of this, fluid accumulates between the shells. Dropsy of testicular membranes develops without pain and without any disorders. The accumulation of fluid proceeds slowly and imperceptibly, sometimes spasmodically. The enlargement of the scrotum may be small, but sometimes it reaches the size of a goose egg and even the head of a child. With dropsy of the testicle shells of very large sizes, difficulties arise during urination and sexual intercourse. The hydrocele has a smooth surface and a dense-elastic consistency, painlessly on palpation, fluctuation is determined. The skin of the scrotum is free to fold. The testicle usually cannot be probed, and only with a small dropsy can it be determined below the swelling. With diaphanoscopy, translucence of the entire formation is noted. The symptom of transillumination is negative only in those cases where the testicle shells are sharply thickened, there are hematocele or piocele (blood or pus in the testicles), or a testicular tumor. A hematocele is a hemorrhage in the dropsy cavity of the testicular membranes, which may occur as a result of trauma, with hemorrhagic diathesis, after unsuccessful hydrocele puncture. Purulent dropsy of the testicle occurs more often with orchitis and epididymitis as a result of infection with an abscess of the testicle or epididymis.
Diaphanoscopy and ultrasound
The diagnosis of dropsy of the testis is established using ultrasound examination of the testicles and diaphanoscopy. An ultrasound examines the accumulation of fluid between the shells of the testicles and the unchanged testicle, assesses the volume of fluid and its cerebrospinal fluid structure. Diaphanoscopy (from other Greek: διαφανής “transparent” and σκοπέω “observe”) is a method based on transmission. With hydrocele, the entire formation is transmitted evenly. However, the method is not always informative. After the inflammation of the membranes of the testicle or hematocele, the transillumination can be uneven. Diaphanoscopy also allows for differential diagnosis with hernias (intestines, a lock of the omentum) when a violation of the passage of light through swelling is detected.
The causes of congenital dropsy of the testis are as follows. The testicle in the prenatal period descends into the scrotum along the inguinal canal, along with the testicle, the part of the peritoneum, which is called the vaginal process of the peritoneum, also moves. Then the lumen of the vaginal process of the peritoneum overgrows. If this lumen does not heal, fluid collects from the abdominal cavity. In addition, the cells of the inner membrane of the peritoneum, which covers the appendix of the peritoneum from the inside, are themselves capable of producing fluid. The vaginal process can communicate with the peritoneum or be blind. If it communicates with the peritoneum, fluid can sometimes circulate from hydrocele to the abdominal cavity. If hydrocele is found in a newborn baby, treatment does not begin. Such dropsy of the testicle may disappear itself when the process of the peritoneum is infected and the fluid is absorbed from the hydrocele cavity.
Acquired dropsy of the testicle occurs with inflammatory diseases of the scrotum, injuries of the scrotum and perineum, impaired lymphatic outflow from the scrotum. Sometimes dropsy of testicular membranes can be reactive in inflammatory processes in the testicles or in the epididymis or in testicular torsion. Such dropsy of the testicle disappears with the disappearance of the underlying disease.
What is hydrocele
Hydrocele, dropsy of the testicle or dropsy of the membranes of the testicles is an andrological pathology characterized by the accumulation of fluid in the scrotum, which can lead to impaired reproductive function and serious complications. Depending on the cause of the development of hydrocele, the accumulated fluid may turn out to be blood, purulent exudate of inflammatory origin, lymphatic fluid, fluid effusion after excision of a hernia, effusion (a pathological process of accumulation or appearance of biological fluid in a body cavity) of a fluid after surgery for varicocele, etc. Most often, this pathology occurs in newborns and people from 20 to 30 years old.
According to the international classification of diseases, the ICD hydrocele has the code N43 and is divided into types:
At the place of localization, hydrocele is divided into:
- non-communicating (this is an isolated process, fluid accumulates only around the right or left testicle),
- communicating (dropsy extends to the abdominal cavity),
- dropsy of the family cord (hydrocele is localized in the area of the family cord.
For reasons of occurrence of hydrocele can be:
- idiopathic (primary hydrocele, it is impossible to establish the cause),
- symptomatic (dropsy of the testis as a complication or symptom of another disease).
Acute and chronic, unilateral and bilateral forms of hydrocele are also distinguished. The doctor makes a diagnosis, for example: “acute, palpable hydrocele on the right”, “chronic hydrocele on the left of an inflammatory nature”, or “bilateral hydrocele of unspecified origin.”
Before you figure out how to treat a disease, you need to find out how it appeared. So, the following factors are the causes of the appearance of a congenital hydrocele:
- a pregnancy in which the chance of a possible miscarriage is high,
- childbirth injuries
- the birth of a premature baby (term - less than forty weeks),
- hectic behavior
- resuscitation of a newborn (using the artificial respiration technique, as well as indirect heart massage).
Acquired hydrocele has other causes, namely:
- inflammation of not only the testicle, but also the soft tissues behind it,
- a change in the position of the testicle (for example, it was rotated around an axis). It disrupts the blood circulation in it,
- physical damage to the testicle,
- removal of a hernia in the groin or expansion of the veins in the testicle.
Secondary causes of hydrocele in men
- infection of the genitourinary system,
- nonspecific inflammatory process in the testicles and its appendages (orchitis, orchoepididymitis, epididymitis, inflammation of the spermatic cord),
- violations in the outflow of lymph from the inguinal and pelvic lymph nodes,
- with liver failure and cirrhosis, when ascites is formed,
- complication after surgery.
The main cause of dropsy in men of reproductive age is sexually transmitted diseases, that is, STDs (gonorrhea, syphilis, etc.).
Causes in children
The pathology considered in this article develops for various reasons. As a rule, if we talk about children suffering from dropsy, then there is no mention of injuries or the development of infection, although these options should not be completely excluded.
The main factors causing the development of testicular hydrocele in young boys are the following factors:
- diseases that developed in the womb,
- early birth
- pathology when carrying a boy,
- increase in intra-abdominal pressure,
- genetic heritage from parents and other blood relatives.
If problems arise with the lymphatic system of the testis (lymphocele) after a surgical operation to remove a hernia from the groin or the development of varicocele, doctors decide to perform the operation six to eighteen months after the detection of fluid in the testicle shell.
As mentioned earlier, there are two types of testicular dropsy - congenital and acquired. Each of them appears for its characteristic reasons. Below we will consider these pathologies in more detail.
There are two types of congenital dropsy of the testis. As a rule, they are both equally dangerous, as they can affect other places and organs. In general, this type of disease can be cured due to the characteristic features of its course, as well as the growth of the body in a child.
Table No. 1. Types of Congenital Dropsy
|Communicating||In the womb through the canal in the groin, the testicle of the baby enters the scrotum. Besides him, part of the peritoneum also goes there. At this point, the testicle has only one purpose - to close the gap between one of the processes and this part. An anomaly is the opening of a given lumen through which part of the fluid passes from the abdominal cavity. This is what is called the communicating congenital hydrocele of the testis.|
|Unreporting||The vaginal membrane of the peritoneum is capable of independent release of fluid. If its appearance in the testicle is explained not by the opening of the lumen, as in the past case, but by increased reproduction from the cells of this process, then this form of the disease is called non-communicating.|
The lumen referred to in the table above is open in most boys after birth. It overgrows, as a rule, by one and a half years.
According to the unwritten rules of modern practice of urology, if a boy has ovarian dropsy, treatment is not allowed until he is three years old. This is explained by the possible disappearance of the problem itself, provided that the process of the peritoneum grows and the fluid dissolves.
The second type of disease is acquired. It can be detected in adults with a disturbed balance in the production and absorption of fluid secreted by the testicle.
The imbalance does not appear by chance. It is the result of injuries, various tumors (benign or malignant), as well as pathologies that affect the scrotum and its surrounding areas. In addition, improper lymph outflow from this place also leads to the appearance of a hydrocele of the testicle.
General pathology information
Hydrocele (dropsy of the testicle) is a pathological process during which serous fluid collects inside the scrotum between the shells of the testicle.
The testicles are the most important organ of the reproductive system in which spermatozoa mature. For normal spermatogenesis, a temperature below body temperature is needed, so the boy’s testicles shortly before birth come out of the abdominal cavity and descend into the scrotum for better cooling. Outside, they become less protected and more vulnerable, so nature took care of them, hiding them under seven layers of shells. Fluid builds up in the deepest of them. The disease is most often observed in children.
With a congenital hydrocele in a boy, the testicle descends through the inguinal canal into the scrotum together with part of the peritoneum (vaginal process) and is filled with fluid
Usually, hydrocele is one-sided in nature, although in clinical practice there have been clinical cases of bilateral dropsy. The disease is not particularly common: in childhood, hydrocele is observed in 9% of boys, men after 42 suffer from this disease 9 times less.
- At times, dropsy passes spontaneously, although it takes at least 12 months.
- But more often, untreated hydrocele progresses over several years, developing into more severe forms.
- With advanced development, swelling of the scrotum can reach up to 12 centimeters.
- The presence in the scrotum cavity of volumetric fluid accumulations threatens with rupture, which will cause additional difficulties.
The disease has two forms of development - acute and chronic. In the first form, the patient experiences severe pain in the scrotum, as well as an increase in its volume. In addition, body temperature rises, since all the conditions for the development of hyperthermia have appeared.
The chronic form of this disease is the result of prolonged therapy of the acute stage of the disease or inflammation in the testicle and in its appendage. With this form of pathology, the patient feels heaviness in the same area where the pain is.
The chronic stage develops over time. There is no pain, no problems with urination, which is surprising. The liquid does not accumulate immediately, but gradually, although an instant change in the situation is entirely possible. The scrotum in size, as a rule, grows slightly. It becomes the size of a ball only in exceptional cases.
This disease complicates the process of intimacy and creates problems for normal urination. Pathology leads to an imbalance in the nutrition of the inguinal region, as well as problems in spermatogenesis.
Interestingly, in a newborn with congenital dropsy of the testicle, the scrotum is unstable in terms of size. It can change upwards all day, and then downwards in the process of sleep. In adults, its size is stable.
Testicular dropsy, according to WHO (World Health Organization), occurs in 1-3% of adult men. Specialists separately distinguish congenital hydrocele in 10% of boys, which in 80% of cases passes independently in the first years of life.
Professor Umberto Botta (Sant Anna Clinic, Italy) in his studies found that the incidence of dropsy of the testicle is directly proportional to the survival of premature babies, and in adults the frequency of interventions in the abdominal cavity (organ transplantation, staging shunts).
Diagnosis and differential diagnosis of dropsy of the testicle
The doctor’s diagnosis of hydrocele is usually straightforward. Diagnostics and treatment are usually carried out by a urologist or surgeon. Based on the patient’s complaints, the history of the disease (how it proceeds, whether it is associated with an injury) and life (the presence of acute or chronic inflammatory diseases of the reproductive system, trauma or surgical interventions on the scrotum organs), the doctor will suspect the patient has a dropsy testicle. After that, he will conduct an objective examination of the patient.
Visually draws attention to the increase in half of the scrotum or the entire organ in size (the degree of increase depends on the particular course of the disease and the causes that caused it in a particular patient). On palpation, the formation of a pear-shaped, dense-elastic consistency, fluctuating, is determined. If fluid enters the inguinal canal, the formation takes the form of an hourglass. The skin of the scrotum above the hydrocele is not visually changed, it is easily taken into the fold.
Palpation of the chronic formation of discomfort does not deliver to the patient - it is painless, when probing the acute form of hydrocele, the patient feels pain of varying intensity.
If the amount of fluid between the membranes is small, the testicle is palpated in the lower part of the formation. In the case of large dropsy, the testicle palpation is inaccessible or not felt at all.
After an objective examination, 2 additional research methods are required to confirm the diagnosis: diaphanoscopy and ultrasound of the scrotum.
- Diaphanoscopy (examination of the formation of the scrotum in transmitted light) is an express method for the diagnosis of hydrocele. If the fluid that is between the shells of the testicle has a serous character, then the light passing through the scrotum is uniform, in the case when the basis of the formation is, for example, any organs (intestinal loops, lock of omentum), that is, there is a hernia, light does not pass through them.
- Ultrasound examination (ultrasound) of the scrotum is the most accurate method for diagnosing the disease we describe. With its help, it is possible to determine the fact of the presence of fluid from the enlargement of the scrotum, to approximately estimate its volume, if the nature of the hydrocele is secondary, ultrasound can establish the reason why it occurred (inflammation of the testicle or appendage, testicular tumor).
Hydrocele should be differentiated from such diseases:
- varicocele (varicose veins of the spermatic cord),
- inguinal, inguinal-scrotal hernia,
- orchitis, epididymitis, epididyimorchitis,
- tumors of the spermatic cord and testis.
Diagnosis of the disease
Before starting treatment for this pathology, a man should go to the doctor. He will conduct a visual examination, on the basis of which he decides where to send the patient. Every self-respecting doctor will not give an accurate diagnosis without a comprehensive examination.
You can see the most important diagnostic methods in the table below.
Table No. 2. Diagnostic procedures.
|Diaphanoscopy||This procedure allows you to identify the presence of neoplasm in the scrotum of men and boys. It, as a rule, is fully visible. The amount of fluid, possible changes in the structure of the scrotum - all this, unfortunately, can not be seen. A negative examination result indicates the presence of signs of the following pathologies: pio- and hematocele, testicular membrane growth in thickness or its tumor. There are several causes of fluid there. This may be hemorrhagic diathesis, physical trauma or improper puncture. If the latter goes into piocele, then this indicates the presence of orchitis or purulent epididymitis.|
|Ultrasound (ultrasound)||Doctors consider this method to be the most reliable and giving consistently accurate readings. Thanks to ultrasound, a specialist will determine the presence of a neoplasm, assess the condition of the scrotum, examine its anatomical structure for possible changes and be able to approximately determine the amount of fluid. Having figured out all this, he can confirm the diagnosis.|
|Palpation||The doctor, feeling the area of the scrotum and testicles, conducts a search for a neoplasm. Feels like it is usually dense, but at the same time it can be elastic. The shape may resemble a pear, the base of which is facing down. The form, however, may undergo changes. In most cases, the apex of the neoplasm is limited to the inguinal canal. But there are times when liquid enters there. The swelling becomes like an hourglass. In general, the palpation procedure is painless, since the skin of the scrotum does not undergo any changes, and the scrotum itself is quite easy to fold. With a pronounced form of hydrocele, however, this procedure is very difficult or impossible to complete.|
Interesting! If there is little fluid, then the testicle can be felt in the lower part of the tumor.
All three procedures are necessary if the patient wants to find out the root cause of the disease for himself, and the doctor wants to determine the complexity of the situation and find the best way out of it.
Attention! If accumulation or densification of the neoplasm is detected during the ultrasound, several more additional studies will be required to confirm or cut off the version with malignant tumors.
Causes of dropsy in men
Dropsy in the vast majority of cases develops only on the left or right side of the scrotum. Testicular fluid in men builds up for a variety of reasons. The most common are mechanical injuries of the testis and various infections, trippers, trichomoniasis, chlamydia are the leaders. The consequence of injuries in men more often is dropsy in acute form, and bacterial diseases - a chronic ailment.
In addition, dropsy of the testicle in men sometimes becomes a complication of such diseases and pathological conditions:
- heart failure,
- damage to lymph nodes during operations with inguinal hernias, varicocele (varicose veins of the spermatic cord),
- cirrhosis of the liver.
Without adequate treatment, hydrocele can cause severe complications. It:
- inguinal hernia,
- testicular atrophy and male infertility,
At the moment, three causes of the pathology have been established:
- fetal developmental disorders,
- perineal injuries
- chronic systemic diseases (vascular pathology, decompensation for heart disease, ascites), in which there are violations of water metabolism and the accumulation of excess fluid in the body.
Congenital hydrocele occurs as a result of such complications of pregnancy and fetal development:
- the threat of interruption and the birth of a premature baby,
- birth injuries
- application of measures for resuscitation of newborns,
- hectic behavior of infants.
Acquired hydrocele manifests itself due to:
- inflammatory diseases of the testicles and appendages,
- testicular torsion, resulting in a spasm of smooth muscles and an increase in intrathecal pressure,
- injuries of the testicles, scrotum or perineum, which are accompanied by impaired lymph exchange,
- surgical injuries of lymphatic vessels with plastic inguinal ring, inguinal hernia, varicocele, pathologies of the vas deferens.
Strokes below the waist increase the risk of hydrocele and other genital pathologies.
Diagnosis of dropsy of the testicle
The diagnosis of hydrocele is made on the basis of diagnostic measures and a survey of men about the causes of dropsy of the testicles.
Diagnosis of hydrocele begins with an examination and palpation of the scrotum in two positions - lying and standing. It is also important that, according to the patient, the doctor receives information about when, how, and after which the disease began to develop.
For a more accurate diagnosis, the doctor can resort to transillumination of the scrotum with a special lamp (diaphanoscopy). According to the results of this examination, it is possible to establish the nature of the contents in the scrotum - blood, pus or inflammatory fluid.
The most informative research method today is ultrasound with hydrocele, which allows you to assess the condition of the testicle itself and determine the exact volume of fluid in its shell. If an infectious process is suspected, it may be necessary to donate blood and urine for accurate diagnosis and treatment. In advanced cases, other research methods can be used.
Testicular hydrocele should be distinguished from varicocele. If the first problem is a benign formation that is not easily treated, then the second pathology leads to the appearance of a hernia, which is easier to return back to the abdominal cavity.
Testicular hydrocele should be distinguished from the following diseases:
- cysts of the spermatic cord.
The results of the action of the disease called varicocele - hernia, which is quite possible to correct.
If the patient has a testicular tumor, then on palpation it can be defined as a dense and tuberous neoplasm, in which there is no fluctuation.
What it is?
Dropsy of the testicles, or hydrocele, is a disease accompanied by an accumulation of serous fluid between the leaves of the visceral and parietal testicular lining. The volume of fluid varies widely and ranges from 20 to 200 ml, in some cases - up to 3 liters. Both children and adults suffer from this pathology.
In childhood, congenital hydrocele is diagnosed - this is a physiological condition inherent in the vast majority of newborns that develops in connection with intrauterine prolapse of the testicles into the scrotum. In adult men, this disease is acquired - this is what will be discussed in our article.
If patients are not taken to cure a dangerous pathology, then the disease leads to the following results:
- pressure on the testicle or both, with further impaired sperm production and the appearance of signs of infertility,
- poor circulation
- testicular atrophy,
- decreased attraction to women and impotence,
- premature ejaculation,
- tissue necrosis due to squeezing with fluid. This leads to amputation of one testicle or both,
- the growth of the scrotum in size, which is visible even through clothing.
Important! A timely visit to a specialist can improve the prognosis of pathology exponentially.
In young people suffering from dropsy and its consequences, the development of testicular hypotrophy is noted. In addition, sperm production is impaired.
More common hydrocele in newborns and infants of the first year of life. The cause of dropsy of the testicles becomes a small defect associated with the underdevelopment of the peritoneum.
The cavity of the scrotum remains open, and the fluid freely penetrates into it, accumulating in the deep layers of the membranes.
The cause of hydrocele can be:
- prematurity of the fetus,
- birth injury,
- pregnancy with the threat of miscarriage,
- resuscitation measures during childbirth.
Predisposition to the congenital form of hydrocele is inherited.
In this case, the psychosomatics of dropsy of the testicles is such that if this problem was encountered in the next of kin, there is a great risk that this pathology will also be detected in the baby.
Dropsy of the testis is not dangerous, treatment is not required in the initial stages.
Often with the development of the child, the septum develops on its own, and the ailment disappears during the first year of life, without causing the child anxiety.
What is the disease dangerous?
The accumulation of fluid in the area of testicles and scrotum leads to dangerous consequences:
- Changing the structure of the organ. A large amount of moisture puts pressure on the surrounding tissue.
- Inflammation contributes to the replacement of normal tissue with fibrous tissue. Fibrous tissue does not have the proper ductility. The natural movement of blood and lymph in the damaged organ is disrupted.
- Inguinal hernia. Pathology occurs due to the expansion of the channel, which connects the peritoneum with the vaginal membrane. Part of the intestine falls into this channel, forming a hernia.
- The gait is changing. Swollen testicles create inconvenience when walking. Rubbing causes pain.
- Atrophy is one of the most severe consequences of hydrocele. Fluid compresses blood vessels. Organ nutrition worsens or stops altogether. The testicle is reduced in size and loses its function.
- Necrosis is an extreme stage of atrophy. It is characterized by the complete death of all body tissues. Restoring functionality is not possible. The testicle is removed surgically.
- The gap. Tissues burst under the weight of accumulated moisture. A sharp decrease in the size of the testis will help determine the gap.
What else is dangerous testicular dropsy: a violation of the functions of the penis. The mechanism of the phenomenon is the partial or complete blocking of blood vessels. The less blood enters the body, the worse it performs its functions. Violation of blood flow leads to a weakening erection. In severe cases, dropsy of the testicle makes sexual life impossible.
About treatment in childhood
Little can be said about the treatment of this pathology in childhood. According to statistics, in eighty percent of patients in childhood, dropsy disappears after the inguinal ring is overgrown as a result of a natural process. The remaining twenty percent can be divided into two cases:
- the first ten percent are cases in which such a disease is not considered a pathology,
- the other ten are a difficult or completely incurable form of the disease.
In general, if you follow yourself, then the hydrocele of the testis cannot be called a dangerous or severe pathology. But ignoring her is extremely dangerous, because the previously listed complications will negatively affect the life of a man.
Conservative treatment effectively shows itself if the neoplasm appeared due to injuries, inflammation of the testicle or its displacement along the axis. In this case, they treat the main pathology, which caused hydrocele.
As a rule, fluoroquinolones (one of the types of antibiotics) are prescribed. These include Levofloxacin, Ofloxacin, Ciprofloxacin. Macrolides are also prescribed (a vivid example is Azithromycin). They not only kill pathogenic microorganisms, but also prevent the possible development of purulent deposits.
During surgery, you need to consider what can best help as an anesthetic. Doctors provide the use of local long-acting anesthesia (Naropin, Markain) and mask anesthesia (Sevoflurane).
How to treat dropsy of the testicle
In the case of a congenital form of the disease, the baby is usually left under medical supervision until he reaches one year. If by this age the problem does not go away on its own or an increase in dropsy is observed in the dynamics, then surgical intervention may be required.
In adult men, dropsy of the testicle is treated surgically, with the exception of the acute form of the disease against the background of testicular inflammation, the treatment of which is to eliminate the inflammatory process, anesthetize and wear bandages.
In old age
Testicular dropsy is more common in infants and young men. For the elderly, 2 variants of hydrocele are characteristic. The first is chronic hydrocele of the testicle shells, which may be due to an old trauma or congenital predisposition.
Dropsy of the testicle in older men develops over the years, symptoms can manifest themselves more vividly or almost disappear. If the pathology does not cause concern, they do not take radical measures, to ease the patient's condition, he is prescribed lung diuretics.
Folk recipes are also suitable: freshly squeezed vegetable and fruit juices, lingonberry and cranberry fruit drinks, decoctions of medicinal herbs: bear ears, lingonberry leaf.
A low-calorie diet helps with a large number of fresh and boiled vegetables and a low content of fats and salt, as well as a complete rejection of alcohol that retains fluid in the body.
For the elderly, another reason is characteristic - the consequences of the operation.
That is, dropsy occurs after varicocele or excision of an inguinal hernia, when lymph begins to accumulate between the membranes. Dropsy may also occur in bedridden patients.
The defect is caused by a congenital predisposition or insufficient skill of the surgeon. For treatment, you can use a puncture.
Excess fluid is sucked away with a thick needle, but after some time, the lymph can again accumulate in the cavity. Sclerotherapy will help to solve the problem; it is used only for men at the age who no longer plan to conceive children.
The identification of the pathology considered in this article leads to the question of alternative treatment as part of a conservative technique. If the man is in good condition and does not yet need surgery, then the doctor allows the use of folk remedies in order to treat such a disease.
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|Corn silk||Take honey, mix with corn stigmas (it does not matter, fresh or dry). Proportion - two tablespoons of honey per stigma. Take a mixture of a teaspoon from three to five times a day, depending on the severity of the situation.|
|Nettle||You need to use only the roots. They need to be brewed like regular tea. Proportion - a spoonful of dry roots in a glass of boiled water. Take up to half a liter of the resulting drink in essence.|
Naturally, a man is simply obliged to come to a consultation with his doctor and discuss the feasibility of treatment with folk remedies.
It is possible to treat dropsy of a testicle in a man without surgery in cases where it is not possible to carry out surgery. To do this, carry out the puncture of the cavity with the accumulated liquid and its extraction. However, the use of this method carries the risk of subsequently developing various complications.
Reviews of people
Some reviews of men who have experienced dropsy of the testis from personal experience:
- Cyril, 24 years old: I had a dropsy of a testicle in my childhood, from birth. At first they said inguinal hernia, but then it turned out to be dropsy. Doctors told their parents that they had to wait until I was 3 years old. This dropsy passed with me even earlier, by two years. Recently I got married, a daughter was born, nothing bothers me!
- Alexei, 27 years old: a year ago I drove a football and got a strong blow in the groin. In the evening, the temperature rose, the scrotum was swollen, I had to call an ambulance. The doctor said dropsy of the testicle. They offered to go to surgery, but I refused. A few days later it got worse. Then I agreed and regretted that I did not do it right away. I feel great now.
- Vladimir, 34 years: five years ago, I picked up a trepak. When the pain became unbearable, my friends advised me on antibiotics. It’s easier, and then the scrotum is so swollen that I still had to go to the doctor. It turned out dropsy of the testicle. They made me punctures, but the benefit from them is temporary - only the operation will help. I experienced it myself, it is better not to delay.
Indications for surgery for the child
Children of surgery to remove dropsy of the testicle are allowed to carry out if their age is two years or older. Previously, you can’t. The following cases are exceptions:
- a combination of dropsy and hernia in the groin,
- a clear change in the volume of the scrotum due to a certain posture,
- a dangerous increase in the size of dropsy, which brings pain and discomfort,
- infection develops.
A surgical operation, the cause of which is post-traumatic dropsy, is performed after a period of three to six months from the moment of injury.
Hydrocele Removal Surgery
There are several surgical treatments for hydrocele:
- Operation Winkelmanconsisting in the section of the testicles to the vaginal membrane, puncture of the vaginal membrane and pumping of pathological fluid. Then the shell is dissected, the testicle is examined, after which the shells are turned inside out and stitched.
- Operation Bergman - an effective method with significant sizes of dropsy. The essence of the method is to remove excess fluid after opening the testicle shell and removing part of it, and then stitching the remaining tissues.
- Operation Lord characterized by dissection of the bag of liquid and its elimination without releasing the testicle from the tissues located around.
How many testicles affect the disease?
In adult men, in most cases, dropsy affects one testicle.
Most often, the left testicle is affected, but sometimes severe edema occurs in the right testicle.
In very rare cases, the disease affects two testicles. According to statistics, the disease is diagnosed in men who are older than 40 years.
The disease may be acute or chronic. The acute form is characterized by the formation of tumors, the presence of an inflammatory process and the development of infections in the genitourinary system.
The chronic form occurs either with improper treatment, or with untimely treatment by a doctor.
Pain is most often observed in the right testicle, since most often all inflammatory processes occur on the right side, where the appendages are located.
Therefore, in dropsy, in most cases, only one testicle increases, which is located on the right side.
Most often, the impetus for the disease becomes epididymitis, which affects the right side of the genitourinary system. Next, we will show how dropsy looks, photos will help you understand if you have this disease or not.
Before you diagnose or suspect a hydrocele in yourself, you need to figure out what it is. The disease has a typical manifestation in the form of accumulation of excess fluid in the scrotum. Its amount accumulated inside the membrane of the external reproductive organ varies and varies from 1 ml to 1-2 liters.
There are cases when the hydrocele in men disappears spontaneously, but such a process lasts about 10-12 months. Most of the percentages face the consequences of a complication of the disease.
If the form of the ailment becomes neglected, then the consequences can be dire, for example, due to severe swelling of the scrotum (more than 12 cm), tissue rupture is possible, and surgery can not be avoided.
Not every disease can be treated conservatively. This is a well-known fact. If the hydrocele also did not disappear after conservative therapy, then it is necessary to get rid of the problem with surgery.
Surgery is an extreme way out of the situation, and they resort to it only if the therapeutic treatment is ineffective. Doctors examine the patient, his tests and the course of conservative treatment. After - they decide how to carry out the operation.
After testicular dropsy surgery
At the end of the operation, the patient should wear a special tissue bag, necessary to maintain the scrotum and relieve the load on the spermatic cord. The bag should be made of cotton material. Also in the postoperative period, it is important to take the medications prescribed by the doctor and comply with all the prescribed regimen measures - only in this case can we guarantee that the problem does not arise again.
Risks and Complications
Small dropsy does not cause discomfort. Asymmetry of the scrotum is often not considered a serious reason for seeking medical attention. In 30% of cases, several years elapse between the first symptoms of hydrocele and the examination in the clinic.
Delayed treatment of the disease causes male infertility, disorders in the genital area.
The likely complications of dropsy in men include:
- testicular atrophy,
- decreased potency
- delayed ejaculation,
- violation of urination
- piocele (purulent inflammation of the testicles).
In half the cases, men turn to a urologist for impaired reproductive function - impotence, decreased fertility. Erectile dysfunction leads to psychological discomfort, depressive states.
In most of the documented cases, a patient who has reported communicating dropsy is operated on using the Ross technique. During it, doctors must achieve the following goals.
- Remove the discharge in the spermatic cord.
- Excise and bandage the inguinal ring.
- Form a “space” in the testicles.
For all this, you first need to make only one small incision in the groin area.
An operation according to Ross’s technique is very delicate, since a good technique is required from the doctor and the ability to work extremely carefully “with delicate materials”. He needs to act “jewelry”, since he needs to maintain the normal functioning of the spermatic cord, vessels of the testis and nerve in the groin.
In some cases, a decision is made to conduct laparoscopy, but there are some “buts”:
- high chance of injury
- an almost one hundred percent chance of relapse and complications,
- anesthesia lasts longer.
Enough of these three reasons to show its low relevance to date.
Testicular hydrocele complications
Ignoring the treatment of hydrocele can lead to the following consequences:
- testicular atrophy with subsequent development of infertility,
- violation of potency, ejaculation,
Timely treatment of testicular dropsy in most cases leads to the complete disappearance of symptoms and a favorable outcome. However, a significant and prolonged accumulation of fluid in the testicle shells with its constant compression in young people can lead to a decrease in the testicle and impaired spermatogenesis.
Hydro and lymphocele are the primary indications for surgery according to the Bergman technique. According to it, doctors make an excision inside the membranes of the testicle from the scrotum. In severe forms of the disease, the patient remains drained. A pressure bandage is applied to the groin area.
The Winkelmann technique is a dissection of the shells in front with subsequent stitching behind. Now such an operation is rarely performed. This is due to the anatomical features of the structure of the scrotum in each person, as well as its changes in appearance and contours.
In hospitals, another method of surgical intervention is used - puncture aspiration of fluid. A doctor inserts a needle into the scrotum during its course. After it, the accumulated liquid is subsequently removed or a sclerosing substance is introduced to significantly reduce the production of liquid. The whole danger of this operation lies in the high chance of infection entering the body through the puncture site and in bleeding.
Attention! Aspiration is used very rarely due to its low efficiency. It is prescribed only in cases where other surgical methods are contraindicated to the patient for any reason, including because of anesthesia.
To avoid the development of hydrocele, it is necessary to protect the inguinal region from injury, and also to prevent the development of infectious diseases, often causing inflammation of the testicles and their appendages. For example, in more than 50% of cases, acute inflammation of the epididymis is associated with an existing chlamydial infection.
Which doctor should I contact
Dropsy of the testicle can lead to serious problems. If changes in the scrotum are detected, consult a doctor. Some patients are interested in the question: which doctor to contact. In the city clinic should visit a urologist. He will draw conclusions about possible treatments. If necessary, refer to a surgeon. If a person lives in a rural area where there are no narrow specialists, then they turn to a general practitioner or general practitioner. These doctors will evaluate the situation and refer you to the right specialist.
A mother who has noticed a malfunction in the baby’s body needs to pay attention to the pediatrician and the patronage sister. If possible, it is best to immediately visit a pediatric urologist.
- In general, the chance of complications after surgery is minimal. It is from two to eight percent.
- Relapses of dropsy in adults are rare (from five to twenty percent). In adolescents, they happen much more often. The chance grows in the presence of lymphocele - it reaches seventy percent.
- Infertility appears due to trauma received during the operation. The risk of this effect from two to five percent. The chance of occurrence directly depends on the method of operation.
One of the possible complications is the wrong location of the testicle. In most cases, it goes closer to the inguinal canal up, where it remains.
Testicular atrophy is due to impaired blood flow due to the movement of the peritoneal process further from the spermatic cord.
Hyperesthesia is another complication. It is associated with pinching of the nerve endings or the scar. It is enough to wait six months or a year, and she herself will disappear.
Complications can be prevented only with a high level of surgeon skills and timely surgery.
The pathology considered in this article has generally positive predictions. They consist in the fact that with surgical intervention, the chance of complications is only two percent. Moreover, the reliability of operations can confirm that for the entire time they were conducted there was not a single case that would lead to the death of the patient.
If you observe everything that the doctor says, be treated in the right way and maintain a positive emotional state, then it is quite possible to quickly recover from the disease and have a good prognosis for the future.
After surgical treatment of dropsy, complete rest is recommended for 2-3 days. To avoid complications, men should:
- change the bandage in the operated area 1 time per day,
- limit physical activity
- wear compression underwear,
- take antibiotics prescribed by a urologist,
- monitor body temperature and general well-being,
- refuse sports, having sex for at least 4-5 weeks.
During the week, it is undesirable to lie on your stomach. This is dangerous by increasing pressure in the pelvic organs, diverging seams. Urologists strongly recommend wearing loose cotton underwear. In the absence of discomfort in the groin, the sutures are removed on the ninth day after surgery.
In traditional medicine, there are also various recipes that can effectively deal with dropsy. They have long been used for such a male disease, and in some situations they even successfully cope with the task.
Consider the most popular examples of testicular hydrocele treatment at home.
If you have severe swelling, you can apply a compress. It can be made on the basis of any cereal, but most often peas or buckwheat are used.
You will need 50 grams of chopped cereal, which you pour a liter of boiling water. She insists for about an hour, and then cools down.
When the broth has reached room temperature, it is necessary to dip a clean cotton cloth in it, and then apply it to the swollen place for 20-30 minutes. Dressings should be changed as they dry.
The systematic implementation of such a procedure will help you get rid of the scrotum tumor for a long time.
The second, but no less effective recipe is to use a decoction based on parsley and milk mixed with it.
You need 800 grams of chopped parsley pour one liter of fresh milk.
After that, the mixture is put in the oven at a temperature equal to 50 degrees, and held until the liquid is ready to boil.
This liquid is used inside, each time after a meal, 30 milliliters.
Folk remedies can be used only if approved by your doctor, as self-medication can be fraught with various complications.
However, the effectiveness of folk methods has been proven for centuries, if you do not like the above recipes, you can find others. As a rule, dried flowers, as well as alcohol tinctures, participate in them.
With dropsy of the testicle in a child, sclerotherapy drugs are used for treatment without surgery. This method has a contraindication - with a reported type of ailment, it can not be used. This method of treatment involves the introduction of an antiseptic (Betadine or alcohol) into the scrotum.
If the vaginal duct is not closed, then the solution can enter the abdominal cavity. With isolated dropsy, this modern method can be used. It is one of the most modern and safest. In 98% leads to a complete cure. After administration of the drug, an aseptic inflammatory process occurs in the tissues of the scrotum. Subsequently, they completely merge, removing the cavity for the accumulation of fluid.
In some cases, medications are not able to cope with the disease, especially when it comes to idiopathic forms of the disease, when the cause is not known exactly. And sometimes doctors prescribe a hydrocele puncture.
This is a fairly simple and quick procedure, which is performed under local anesthesia. Using a syringe and special equipment, the doctor makes a puncture, and then removes the accumulated fluid.
By the way, this procedure is also diagnostic in nature - the obtained fluid is carefully examined in the laboratory, the presence of blood elements, purulent masses, bacterial microorganisms is determined in it.
It is worth saying right away that in most cases, puncture gives only a temporary effect, since the liquid begins to accumulate again. This procedure is carried out as an emergency measure.
Factors triggering the appearance of hydrocele
After it became clear what is dropsy of the testicle, you should familiarize yourself with the factors that contribute to the appearance of pathology.
There are many reasons that provoke hydrocele, but to cure dropsy, you need to find out the source of the problem.
When diagnosing hydrocele, the causes may be as follows:
- Inflammatory processes in the organs of the genitourinary system.
- Inguinal injury.
- Damage to the pelvic and inguinal lymph nodes.
- Cardiovascular pathology.
- Inguinal hernia.
- Surgical intervention. Any operation that is performed in the area of the reproductive organs of a man has a certain percentage of probability of causing a complication such as hydrocele.
There are several types of hydrocele.
Dropsy of the testicle in men, the cause of which was a groin injury, according to medical statistics, is most common.
Initially, the resulting injury can provoke the formation of a benign cyst, which in itself does not pose a threat.
Disruption of blood circulation or outflow of lymph can provoke a complication. This pathological condition occurs as a result of compression of the vessels that pass next to the cystic neoplasm.
In childhood, if dropsy of the testicle was detected, the cause of its occurrence, most likely, lies in the underdevelopment of the genitals and is not considered a pathology. This rule applies to boys under the age of one year. In most cases, hydrocele of the testis, as a congenital pathology, passes independently.
If a man has additionally swollen veins on the scrotum and penis, then this symptom indicates the presence of another pathology. This may be varicose veins - varicocele.
Only the urologist can determine the source of the pathological process -andrologist based on a number of special analyzes.
Lifestyle for such a disease
Treatment of dropsy without surgery implies that in addition to the fact that you need to comprehensively use medications, as well as folk recipes, you must partially change your lifestyle.
Very often, stress, an incorrectly drawn daily routine, affects the fact that the body weakens, becomes a target for the development of the disease.
Find your daily routine, namely, morning rise and going to bed. Review Your Nutrition. It should be balanced and useful, free from excess fats, and harmful substances.
Wear comfortable underwear or even a suspension. They will help you get rid of discomfort at first and prevent the development of the disease.
Particular attention needs to be paid to physical activity.. You should forget about heavy sports or athletics for a while, and long walks in the fresh air will be a great addition to treatment methods.
They play the main role in the diagnosis and treatment choice!
To diagnose dropsy of the testicular membranes, it is necessary to correctly collect an anamnesis of the disease, complaints, anamnesis of life (to find out past diseases, as well as the presence of injuries, operations, inflammatory processes in the inguinal region in the past), obstetric and gynecological anamnesis, and to find out the hereditary predisposition to this disease.
Diagnostic methods include hydrocele diaphanoscopy. Using a flashlight in a darkened room, it is estimated how the light passes through the scrotum. With dropsy of testicular membranes, the inguinal region in boys acquires a pink color. But if there is pus or hernia, there is no “pink glow”.
Diagnosis for a pediatrician, surgeon, urologist, andrologist is not difficult.
During the examination of the scrotum, it can be enlarged (swollen) on one or two sides, compacted, hyperemic (in the presence of an acute inflammatory process). The skin over the formation is mobile. The shape of the seal can be pear-shaped (elongated and slightly pointed), as well as in the form of an “hourglass” (when liquid enters the inguinal canal). A baby may have one or both testicles deformed.
Complaints such as discomfort, pain, and fever can be formidable symptoms, indicating an infection in the event of a testicular dropsy.
The diagnosis should be made exclusively by a doctor!
Instrumental diagnostic methods
In the modern world, diaphanoscopy has become quite rare, thanks to the advent of an ultrasound device and a magnetic resonance imager. The most reliable result is considered to be obtained precisely from these diagnostic studies.
An ultrasound diagnostic examination of the scrotum evaluates the localization of the disease, the volume of fluid, the condition of the testicles and their appendages.
Magnetic resonance imaging examination evaluates the organs and tissues of the scrotum in layers.
In the vast majority of cases, the prognosis of acquired hydrocele is favorable - it disappears either by itself or after surgery.
When removing large hydrocele, relapse is possible. There were no cases of death of patients as a result of surgical treatment of testicular dropsy.
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The period of preparation and the course of the operation
In the preparatory period, it is important for parents to monitor the condition of the child. There are several rules:
- after a cold or an infectious disease, at least a month should pass,
- blood and urine tests must be taken before hospitalization and intervention,
- 6 hours before the scheduled operation, the child should not be given food and any drink.
General anesthesia is used so that the child does not experience a psychoemotional shock from an unfamiliar environment, tools and doctors in bathrobes and masks. For the selection of drugs, an anesthesiologist is consulted, who monitors the reaction of the baby's body to the selected anesthesia. Additionally, by injecting into a vein, an analgesic is injected, which makes the postoperative period less traumatic.
First, anesthesia is given through the mask, and then a catheter is inserted to deliver the drugs. During the intervention, heart rate and blood pressure are monitored. Gas supply stops immediately after the completion of the work of surgeons, the child regains consciousness quickly. In a number of clinics, after a day, the baby with the parents is allowed to go home.
Intervention is carried out in accordance with the selected methodology. Parents are often interested in how long the manipulations last. Usually the procedure does not take more than half an hour.
Features of the clinical picture in the chronic form of the disease
If we talk about the chronic form of the disease, then the symptoms in this case are not so pronounced. The scrotum increases in size, but there is no fever and other symptoms of intoxication. Patients complain of pulling pains. Discomfort can also occur during walking, intercourse, and urination.
This form of the disease is very dangerous. In the absence of treatment, the skin on the penis and scrotum gradually changes, which is associated with the onset of maceration. If the disease is started, it is possible to retract the penis under the stretched skin of the scrotum.