Hydrocele (water break)
What is a hydrocele?A hydrocele can manifest itself with very different symptoms. Typical of the disease is a swollen testicle.
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A hydrocele can only occur on the testicle, and / or on the spermatic cord. There is both a primary, ie an innate hydrocele, as well as a secondary so acquired hydrocele. This can therefore arise in the course of life due to different causes.
The primary hydrocele may be unilateral or bilateral and often decline without treatment during the first few months of life. Such an innate water break is not uncommon.
There is also a special form of hydrocele, the acute water breakage. It can be caused by a trauma, a hemorrhage or an infection. This form differs from the other two in the form of severe pain.
The causes of the hydrocele are of different kinds. In the primary hydrocele, the cause is due to a developmental phase in the womb. The peritoneum inverts in a funnel shape into the scrotum, takes place in the body of the unborn child and later regresses. There, water can accumulate, creating a hydrocele.
The testes of the child come down shortly before birth or within the first year of life of the abdominal cavity in the scrotum. They must slide through the mentioned protuberance, which usually closes afterwards. If this is not the case, a hydrocele may form there or, in the case of complete absence of occlusion, even a inguinal hernia (inguinal hernia).
The secondary hydrocele can affect male children or adults throughout life. There are several triggers for this, such as an inflammation of the testes or epididymis (see epididymitis). In addition, injuries or testicular tumors can lead to hydrocele. Even after surgery for the removal of varicose veins on the testicles (varicoceles) hydrozelen may result as a result.
Symptoms, complaints & signs
A hydrocele can manifest itself with very different symptoms. Typical of the disease is a swollen testicle. The extent to which the testis is swollen depends primarily on the localization and expression of fluid accumulation.
In the early stages, the hydrocele usually causes no further complaints. Only with the enlargement of the testicle, other symptoms occur, such as throbbing pain or a pressure or heaviness. In severe cases, an acute scrotum occurs, which is associated with severe pain. An acute water break can lead to a strong swelling of the testicle.
There is also an increased risk of infertility. Many sufferers also notice a throbbing sensation in the area of the scrotum. Externally, a hydrocele is primarily recognized by the swelling of the testicle. In severe cases, it can also lead to bleeding, which is manifested by a partial red color of the scrotum.
An innate hydrocele occasionally returns on its own. However, it can also lead to a water break or a hernia, which can cause serious complications. In the worst case, the affected testicle dies.
Diagnosis & History
The hydrocele is diagnosed by means of various examinations, for the first with a scan by the doctor. It is determined if the scrotum is swollen and other external abnormalities are present. Mostly, an ultrasound examination is performed as confirmation of the hydrocele.
The course of a hydrocele is generally positive, since it is a benign change in the testicle. The primary hydrocele can usually self-regress and no treatment is necessary. For the secondary, however, the cause should be treated. Surgery may also be necessary if the hydrocele persists. The prognosis is nevertheless positive.
In most cases, the water break does not cause any special complications or complaints. The change in the testis is benign and usually there is no pain in the patient. The testicles are relatively swollen and fill with water. Without treatment, it may come in the further course of this disease to testicular pain, which does not occur in the first place, however.
Testicular pain is a very unpleasant symptom for the male and can severely limit the quality of life. The person affected is knocked off by the water break and no longer actively participates in social life. Furthermore, it can also lead to the development of mental illness and depression, if the water break is not treated. Resting pain can also lead to sleep disturbances at night.
In many cases no treatment is necessary. However, if the water rupture does not recede by itself, surgery can be performed to resolve the condition. There are no special complications. The life expectancy of the patient is not affected by the water breakage.
When should you go to the doctor?
A hydrocele must always be examined by a doctor. Since the degeneration can also turn into a malignant tumor, early diagnosis and treatment of the disease always has a positive effect on the progression and can prevent complications. A doctor should be consulted with the hydrocele always, if it comes to a swelling on the testicles. This swelling occurs especially without a special reason and permanently.
Pain usually does not occur. The testes also show accumulations of water. Only in rare cases it comes to the testicles to pain or other unpleasant feelings. If the symptoms of hydrocele occur over a longer period of time and do not disappear on their own, a visit to a urologist is definitely necessary. The treatment also takes place mostly at the urologist and can completely restrict the hydrocele. The life expectancy of the patient is not adversely affected by this disease.
Treatment & Therapy
If there is no inguinal hernia in the congenital hydrocephalus, the affected child does not need any treatment at first because the accumulation of water regresses automatically. If the water break did not recede until the end of the first year of life, surgery becomes necessary.
This is just a minor procedure in which a cut is made on the groin to close the connection between the peritoneum and the scrotum. In the worst case, a hydrocele forms again after a few months, but this rarely happens. Secondary hydrocele therapy is used to treat the cause. As a result, the accumulation of water can often regress.
If the water break still persists or there is no clearly identifiable cause, an operation is also advised here to eliminate the symptoms. A special technique is used to prevent new formation of the hydrocele.
Outlook & Forecast
The majority of patients diagnosed with hydrocele can expect improvement. Statistically, it has been found that nine out of ten patients experience a decline in typical symptoms. A life without restrictions is the rule. A distinction is made between two risk groups: infants up to the age of two and all others. The disease of babies usually heals by itself. The others need surgical therapy.
Infants are in constant evolution. As a result, the origin between the testicles and the abdominal cavity closes on its own. This often happens around the fourth month of life. From the age of three remains only a surgical procedure. This usually runs without complications. Possible difficulties are also known from other interventions: infections, swellings and others. Only rarely does the water break return.
If no surgery takes place, complications occur regularly. For example, a permanent inability to conceive is possible. Fluid in the scrotum then squeezes the blood circulation. Also conceivable is testicular torsion, in which the testicle disturbs the blood circulation. The genital area is very sensitive in every case. Pain occurs increasingly in everyday life.
You can not prevent a hydrocele directly; it can only be attempted to minimize the risk of their occurrence. For example, anyone who suffers from or has suffered from testicular or epididymal inflammation should treat it consistently with medical advice. Those who exercise certain sports that are at increased risk of genital injury should be adequately protected. For example, there are genital protectors for athletes that could be created.
Following surgery, the patient usually stays in the clinic for one to two days to provide the necessary follow-up care. This is to remove the wound drainage tube the day after the procedure and to control the surgical wound. Occurring wound pain can be discussed in the course of the visit with the doctor and treated accordingly medically.
Affected individuals must be careful in the first two weeks after discharge and avoid physical exertion. Hot baths or generally full baths are taboo at this time, instead, the shower is to use. Even sauna sessions or the use of hot water bottles or heating pads are contraindicated within this timeframe.
If there is no redness, swelling or pain, wound healing progresses according to plan. Nevertheless, the patient is required to arrange a follow-up appointment with his urologist shortly after his release and to hand over the discharge letter to the clinic. This contains all information about the treatment and medication administered.
The sutures begin to dissolve after two weeks and gradually fall off over a period of up to three months. If irritation occurs through the suture or if remnants of the wound remain after this time, contact a doctor.
You can do that yourself
A hydrocele usually needs to be treated surgically. Some home remedies and tips support the treatment.
First of all, those affected should wait and see. Sometimes the blockage on the testicles dissolves after some time and the fluid can flow off by itself. This process can be supported by a bath with Epsom salts. The warm water in conjunction with the salts ensures that the fluid flows through the skin from the body and the swelling subsides. In addition, Epsom salt is rich in magnesium, which relaxes the muscles and relieves pressure sensitivity. However, if the hydrocele is aching, an Epsom salt bath can cause further inflammation. In case of pain, medical help is best taken.
After the convalescence, it is recommended to take care and warmth. Children should spend as much time in bed as possible during the first two days after treatment. Men should not engage in sexual activity for at least one week. Finally, the scrotum and especially the area around the water break should be spared. Protective underwear or bandage protects the irritated area from further stress and helps with recovery.