Hydrocele (hydrocele) is a common disease, the incidence of which is at least 10% in newborn boys and 1-3% in adult men. If in children this disease is associated with a congenital disorder in the proper development of the vaginal process of the peritoneum, then at an older age it is due to secondary causes: injuries, infectious diseases, postoperative complications.
Treatments
In most cases, hydrocele develops imperceptibly, without causing any inconvenience at the initial stage. The fluid accumulates slowly, less often - spasmodically. The first sign is an increase in the testicle, which in advanced cases can reach several tens of centimeters. Gradually there is a feeling of discomfort when walking, physical activity and sexual intercourse.
The approach to eliminating dropsy can be different. Treatment of hydrocele without surgery is a wait and see approach, since there are no medications for this pathology.
Uin newborns, dropsy normally resolves on its own within the first year and a half of life. If serous fluid continues to accumulate, then this is an indication for surgical intervention. In adults, conservative therapy is carried out if the patient has inflammation of the epididymis, testis, or allergic swelling of the scrotum. Treatment includes bed rest, wearing a bandage to support the scrotum (suspensorium), and taking antihistamines or antibiotics.
Indications for surgery
In adult men, dropsy can also resolve on its own in some cases. Indications for surgery for testicular hydrocele are the following factors:
- significant enlargement of the scrotum causing pain or discomfort;
- cosmetic defect and the desire of the patient;
- inability to distinguish dropsy from a hernia in the groin;
- combination of hydrocele with other diseases - torsion of the spermatic cord, tumor;
- infertility.
Surgery is the only treatment for dropsy that has clinical evidence and proven efficacy. It is carried out in a planned manner, except in cases where the hydrocele is acute.
Can I cancel the operation?
In urology, there are 2 types of hydrocele:
- isolated non-communicating, when the accumulating liquid cannot move to other cavities;
- communicating - fluid flows from the testicle into the abdominal cavity and vice versa through the vaginal process of the peritoneum.
If a non-communicating hydrocele is found in a man, which does not cause discomfort, then observation can last a long time without an appointment for an operation to remove the hydrocele.
However, large fluid accumulation can lead to the following complications:
- difficulty urinating;
- discomfort during intercourse;
- suppuration of the testicular membranes when combined with its inflammation (or epididymis);
- hemorrhage into the cavity where fluid accumulates, in case of trauma or hemorrhagic diathesis.
Types of surgery
Traditional types of operations to eliminate dropsy are carried out according to 4 methods:
- according to Winckelmann;
- according to Bergman;
- by Lord;
- according to Ross.
There are also other minimally invasive methods:
- endoscopic;
- laparoscopic;
- sclerosing therapy.
In the acute course of a hydrocele, an emergency surgical operation is performed, which consists in puncture (puncture) of the contents and removal of fluid. After that, a pressure bandage is applied. The puncture can be performed repeatedly, on an outpatient basis. However, if the 3-fold procedure does not lead to the expected effect, and dropsy continues to recur, then active surgical treatment is preferable in this case.testicular hydrocele. The operation is performed in a hospital (urology department).
How is pain relief done?
Because the scrotum is a very sensitive and most vulnerable area in men, many patients are hesitant to undergo surgery due to fear of pain. As a result, the disease reaches a neglected state. An operation to remove excess fluid from the scrotum in children is performed under general anesthesia (intravenously or by inhalation). In this case, the child falls asleep for a certain period of time and does not feel anything. During surgery, breathing and heart function are continuously monitored.
In adults, local anesthesia is most often performed in the form of injections into the soft tissues of the scrotum. In some cases, do spinal or epidural anesthesia. The difference between them is that in the first case, a single injection is made, and in the second, a thin tube is installed through which the anesthetic is injected.
Spinal and epidural anesthesia allows you to reduce the sensitivity of the body to zero in the area below the injection. But with local anesthesia, the rehabilitation process proceeds faster. During the operation, the patient feels the ongoing manipulations and may feel mild, tolerable pain. If necessary, an additional volume of anesthetic is introduced. In the postoperative period, continue to inject painkillers or prescribe them by mouth.
Contraindications
Restrictions for surgery for testicular hydrocele in men arethe following:
- inflammatory and infectious processes in the acute stage;
- exacerbation of other chronic pathologies;
- during general anesthesia - diseases of the heart, lungs;
- low blood clotting.
There are no absolute contraindications for surgical intervention for dropsy, that is, if the above factors are eliminated, the operation is possible. For men at risk, fluid is aspirated (suction) with a needle. Expectant management is also indicated for patients who have only one of the testicles or are atrophied.
How to prepare for surgery?
Before surgery, standard preoperative preparation is carried out. It consists of the following medical examinations:
- UAC and OAM;
- biochemical blood test;
- chest x-ray;
- blood tests for hepatitis, HIV and other infections;
- ECG;
- special diagnostics of the scrotum - ultrasound, MRI, diaphanoscopy (transmission to detect formations, cysts);
- if necessary, consultations are held with narrow specialists - an endocrinologist, a cardiologist, a neurologist and other doctors.
The surgical area is prepared as follows:
- should take a shower the day before surgery;
- required to stop drinking alcohol in a few days;
- last meal the night before;
- beforecarrying out the procedure - emptying the bladder and shaving off the hair in the groin.
Treatment duration
Many patients are interested in the question of how long the operation for a hydrocele lasts. It refers to simple types of surgical intervention. The average duration of the doctor's manipulations is 20-30 minutes, in the presence of complications, more time may be required.
After the elimination of this pathology, several hours pass until the effect of anesthesia stops. They can be discharged from the hospital the next day, however, within 24 hours it is necessary to refrain from driving a car and other devices of increased danger due to a reduced reaction rate. General anesthesia in children may require longer inpatient rehabilitation.
Ross technique
This technique is used in pediatrics with communicating dropsy. The operation is performed in the following order:
- A straight or oblique incision is made at the base of the scrotum.
- Tie up the vaginal process.
- A hole is left in the testicular membranes through which the liquid is absorbed into the surrounding tissues.
- The wound is sutured and a sterile dressing is applied
The operating technique is almost the same as for inguinal hernia.
Winckelmann operation
A distinctive feature of the Winkelmann technique is that the testicular membranes are excised 4-5 cm along their anterior surface, which is then everted and sutured behind the testicle. Testicleis displayed in an open wound, a puncture of the dropsy sac is made and its contents are sucked off.
Winckelmann's plasty contributes to the fact that the fluid produced by the epithelium is quickly absorbed by the surrounding tissues. To prevent the appearance of a hematoma, a drainage tube is left, which is removed after a day. An ice pack is applied to the sutured wound, and the sutures dissolve on their own over the next 10 days. After the procedure, wearing a support bandage is indicated.
Bergman Method
Surgery for testicular hydrocele according to Bergman is similar to the Winckelmann technique. It is indicated in cases where the scrotum is greatly enlarged due to dropsy, as well as in children with a combination of an isolated hydrocele and a cyst of the spermatic cord.
The technique of carrying out is different in that the testicle membranes are carefully sheathed for their reliable sealing. The liquid is pumped out with a syringe. Access is made in the same way as in the previous case, after manipulations, the testicle is immersed in the scrotum and tightly sutured. Postoperative care - as per the Winckelmann method.
Lord's Technique
Lord's method of operation is less traumatic. The testicle is not brought into the wound, and the vaginal membrane is not everted, as is done according to Winckelmann. Elimination of fluid is followed by corrugation of tissues in the testicular area.
The advantage of this method is to reduce the risk of bleeding. There is also less damage to surrounding tissues.
Minimally invasiveoperations
The classical operating techniques described above are associated with the need to perform a fairly large tissue incision to release the testicle and hydrocele. This can lead to trauma to the membranes, damage to blood vessels and bleeding, impaired blood supply and lymph circulation in the postoperative period.
There are the following minimally invasive techniques, devoid of these shortcomings:
- Sclerotherapy. The operation consists in puncture and the introduction of an alcohol or aqueous solution, which contribute to the "gluing" of the testicular membranes. As a result, the area in which liquid can accumulate disappears. This method is an alternative option for traditional surgery. He did not find wide application, since the risk of blood accumulation and the development of suppuration is high.
- Laparoscopy. It is carried out mainly in children with communicating dropsy. In the area of the umbilical ring, a hollow tube-trocar with an optical device is installed to visualize the internal operating area. Working trocars with manipulators are inserted 2-3 cm below the umbilicus. After removing the fluid, the vaginal sac is sutured with absorbable sutures.
Rehabilitation period after hydrocele surgery
During the recovery period for 1-1.5 weeks, it is recommended to stay at home with the exception of physical activity. There are a few rules to follow:
- you can wash in the shower no earlier than 2-3 days after the operation, and go to the sauna,bath or swimming pool - not earlier than after 4-6 weeks;
- take painkillers, antibacterial and anti-inflammatory medicines as prescribed by a doctor, wear a support bandage to avoid possible complications;
- sports and sex life can be continued no earlier than after 1 month;
- perform daily antiseptic treatment and regularly change sterile dressings until healing or removal of sutures (10-12 days);
- Limit lifting weights over 10kg.
Surgical procedures usually use self-absorbable sutures that do not require subsequent removal.
After surgery for testicular hydrocele, the following complications may occur:
- inflammation, infection and suppuration of testicular membranes;
- damage to the spermatic cord;
- testicular torsion;
- recurrence of dropsy (particularly high risk in the first month after the procedure);
- divergence of the surgical seam;
- hematoma (internal hemorrhage);
- swelling of scrotal tissues;
- high standing testicles.
The number of complications, according to medical statistics, does not exceed 5% of the total number of operated patients. If pain or discomfort persists for a long time, you should consult a doctor who will prescribe a course of anti-inflammatory and antibacterial agents.
Hydrocele surgery: reviews
Patient feedback on dropsy surgery is generally positive. Within a few hours completelymotor activity is restored. Among the negative postoperative effects, patients note discomfort, slight pain in the scrotum and a pulling sensation in the suture area.
Within 2-3 days, some patients have a fever, which indicates the presence of an inflammatory process. In difficult cases, hospital stay takes 5-10 days.
