What are the effects of scrotal effusion?

Normally, there is a small amount of fluid (2-3 ml) in the sac of the testis, which is used for lubrication and protection of the testicles. If there is too much fluid, it is called hydrocele. The concept of hydrocele should include hydrocele, hemocele, purulent cyst and chyle of the sac. It has many causes, and inflammation, trauma, tumors and other scrotal and testicular lesions can all cause hydrocele. Among the hydrocele, testicular hydrocele is the most common, and it can occur in all age groups. The surgical treatment of hydrocele has a good effect. In recent years, there are also simple puncture and fluid extraction of the cyst of the testis followed by injection treatment without surgery, but the problem of postoperative complications is still controversial. So, let's take a look at this situation below!

Hydrocele is a cystic lesion formed by the accumulation of fluid in the vaginal cavity surrounding the testicle that exceeds the normal amount. It can be seen in people of all ages and is a common clinical disease. Clinically, hydrocele is divided into four types according to the location of the hydrocele and the degree of closure of the vaginal process: positive hydrocele, communicating hydrocele, caruncle hydrocele, and mixed hydrocele. The main clinical symptoms of the patients are: cystic masses in the scrotum. When the amount of fluid is small, there is no special discomfort. On the contrary, when the amount is large, the pulling of the semen in the upright position causes blunt pain and testicular heat. In severe cases, it can affect urination and normal daily life, such as giant testicular hydrocele.

The tunica vaginalis is a double-layer membrane covering the outside of the testicles. It is the peritoneum that brings the testicles into the scrotum during the descent of the testicles from the abdominal cavity. Under normal circumstances, after the testicles descend into the scrotum, the passage between the tunica vaginalis and the abdominal cavity closes automatically. If the closure is incomplete and ascites moves downward, hydrocele will occur.

2. Causes

Secondary hydrocele is caused by primary diseases, such as acute orchitis, epididymitis, spermatic cord inflammation, etc., which stimulate the increase of hydrocele exudation and cause hydrocele. Scrotal surgery damages lymphatic vessels, causing reflux obstruction, as well as high fever, heart failure, ascites, etc., which manifest as acute hydrocele; chronic secondary hydrocele is common in chronic orchitis, epididymitis, syphilis, tuberculosis, testicular tumors, etc., which cause increased secretion of the hydrocele and hydrocele. In addition, filariasis and schistosomiasis can also cause hydrocele. The fluid often contains white blood cells.

The cause of primary hydrocele is not completely clear, it may be due to increased secretion and reduced absorption of the hydrocele, or it may be caused by undetected or healed epididymitis. It is also related to congenital factors, such as defects in the lymphatic vascular system of the hydrocele, and the course of the disease progresses slowly.

When the testicles descend from the retroperitoneum to the scrotum, the peritoneum descends with it and becomes the tunica vaginalis. The tunica vaginalis that surrounds the epididymis is the visceral tunica vaginalis, and there is another layer outside it called the parietal tunica vaginalis. There is only a small amount of fluid between the two layers. The processus vaginalis that descends with the testicles is completely closed after birth and becomes a cord-like object. If the processus vaginalis is not completely closed, the fluid in the abdominal cavity (ascites) can flow along its unclosed lumen to the periphery of the testicle or stay on a certain section of the spermatic cord, forming a hydrocele called congenital or communicating hydrocele. If there is too much fluid between the two layers of the proper tunica vaginalis of the testis, it is a hydrocele of the testis.

In the early stage of normal fetal development, the testicles are behind the peritoneum. At 7 to 9 months, the testicles descend to the scrotum through the inguinal canal. The peritoneal processus vaginalis closes with the descent of the testicles, forming a fibrous cord, and the processus vaginalis of the testis forms a sac-like tunica vaginalis propria. Under normal circumstances, there is only a small amount of fluid in the cavity, which is balanced between exudation and absorption. When pathological changes occur in the organs adjacent to the tunica vaginalis, such as inflammation, tumors, trauma, parasitic diseases, etc., the exudation and absorption functions are unbalanced, or the processus vaginalis closes incompletely, and the fluid in the abdominal cavity goes back and forth in the tunica vaginalis cavity, thus forming testicular hydrocele.

3. Disease Pathology

1. Traditional Chinese Medicine Analysis

What to do with cold dampness in the body? The best strategy is to take care of both the symptoms and the root cause. Warming and transforming cold dampness should be treated first. Invigorating Qi and strengthening the spleen is the key. The kidney governs water, and the spleen transports and transforms water and dampness. Innate kidney Qi deficiency, or kidney Yang deficiency and decline, water cannot evaporate and become gas; or spleen Yang deficiency and coldness, weak transportation and transformation, water and dampness retention, leading to dysfunction of normal secretion and absorption of local water, is the basic cause of hydrocele. According to the symptoms, experts believe that it is a problem of body deficiency, cold dampness and stagnation in the lower part of the body, and it is appropriate to use Qi-invigorating and strengthening the surface, warming and transforming cold dampness, and supplemented with products that promote Qi circulation.

2. Western medicine analysis

The occurrence and development of testicular hydrocele are both slow and the patient may be asymptomatic. Hydrocele caused by scrotal trauma, inflammation or tumor of the testicle and epididymis, and filariasis is called secondary hydrocele. It often has the symptoms of the primary lesion. Long-term chronic hydrocele has an adverse effect on the blood supply and temperature regulation of the testicle due to the high tension. Severe cases may cause testicular atrophy. If the hydrocele is severe and affects both testicles, it is likely to affect the child's future fertility. Testicular hydrocele not only causes adverse symptoms, but also affects the vaginal function of the affected testicle, especially communicating testicular hydrocele. Therefore, patients with obvious symptoms should receive a clear diagnosis from a doctor and receive timely treatment.

1) When newborns have hydrocele of the testicle, it usually disappears by itself before the age of two, so there is no need to rush for treatment. If it still does not disappear after the age of two, many of them can recover by themselves at the age of four or five. If it still does not heal after the age of six, puncture and fluid extraction are performed. Most of them will not recur after aspiration. This method is not suitable for adults. Adults will grow up again in a short time after fluid extraction.

2) Injection therapy: After the fluid is drawn, irritating drugs such as silicene and sodium morrhuate are injected into the vaginal cavity to cause inflammatory adhesions and eliminate the vaginal cavity. This method has a large reaction, incomplete adhesions, and forms multi-chambered vaginal hydrocele. It brings more difficulties to surgical treatment. It is rarely used.

3) Surgical treatment Congenital hydrocele cannot be treated with the above two methods, and surgical treatment is the main treatment. The purpose of the operation is to make a high ligation of the hernia neck at the internal ring to block the downward flow of ascites. The hernia sac below can be left untreated.

4. Traditional Chinese Medicine Treatment

Chinese medicine experts believe that according to the symptoms, it is a disease of body weakness, cold and dampness stagnation in the lower part of the body, and it is appropriate to use Qi-boosting and exterior-strengthening, warming and transforming cold and dampness, and supplemented with Qi-moving products. Hydrocele is a disease of scrotal edema. Symptoms include swelling and pain in the scrotum, occasional sweating, or swelling and shiny crystal-like scrotum, not red or hot; or itching, rupture and discharge of yellow fluid; or water sounds when pressing the lower abdomen.

5. Clinical symptoms

Clinically, testicular hydrocele manifests as a cystic tumor in the scrotum with different sizes of testicles on both sides. Based on the characteristics of the tumor, hydrocele can be roughly divided into two types: communicating and non-communicating. In the former, the tumor changes size at times, and often becomes smaller or even disappears during sleep or when pressed by hand, but returns to its original state when the patient wakes up and goes to play or when the pressure-applying hand is relaxed. In non-communicating hydrocele, the tumor remains unchanged in size or slowly increases in size, feels hard when touched by hand, and does not shrink when pressure is applied.

Hydrocele and inguinal oblique hernia are very similar and occur in the same area, so parents often mistake hydrocele for inguinal oblique hernia. In fact, it can be distinguished through a transillumination test. The skin and muscles of the scrotum are thin, and the tissue is loose, so it is easy for light to pass through. If you shine a flashlight on the scrotum from below, you can see that the skin and tissue inside the scrotum are bright red on the surface of the scrotum, and the testicles are black shadows. This is called a "transillumination test." Since the hydrocele sac is filled with liquid and is also translucent, when a flashlight is used, the light can pass through the cyst and the scrotal skin remains bright red, which is called a positive translucency test. However, in an inguinal oblique hernia, the hernia sac contains the intestines and turbid intestinal contents, which makes it difficult to transmit light and the swelling is dark, which is a negative translucency test. In addition, when the hydrocele swelling shrinks, there is no "gurgling" intestinal sound.

Mild hydrocele may not affect fertility, but severe hydrocele may cause the penis to be hidden in the scrotal skin, affecting normal sexual life. In addition, long-term pressure on the testicles by the fluid may cause poor local blood circulation, leading to testicular dysfunction and affecting fertility. The impact of secondary hydrocele on fertility depends on the condition of the primary disease.

Under normal circumstances, the wall of the tunica vaginalis has the function of secreting and absorbing plasma and keeping its capacity stable. If the tunica vaginalis itself and the surrounding organs or tissues become diseased, causing the secretion and absorption functions of the tunica vaginalis to become unbalanced, various types of hydrocele will be formed. This disease generally has a good prognosis after treatment. The scrotal skin of primary testicular hydrocele is normal, has high tension, and is translucent. If the tension of the tunica vaginalis is not large and it is relatively soft, it should be considered that it may be a secondary hydrocele, and one should be alert to the presence of lesions in the testicles and epididymis, such as tuberculosis, syphilis, inflammatory lesions, tumors, and filariasis. Hydrocele manifests as a cystic mass in the scrotum or spermatic cord, which generally does not cause discomfort. The size can vary greatly, and most are oval. Congenital hydrocele can be squeezed out when lying flat, and the effusion can gradually shrink or even disappear completely. Most hydrocele are unilateral.

VII. Inspection Methods

Testicular hydrocele examination: Testicular hydrocele and spermatic hydrocele are generally spherical or oval. Infantile hydrocele is pear-shaped and gradually tapers in the groin. Communicating hydrocele is spherical or pear-shaped and may shrink or disappear when lying flat. Sometimes the communicating channel is very small and can only shrink slightly after lying in bed for a long time, so it is easy to misdiagnose as infantile hydrocele or testicular hydrocele. The surface of the mass is smooth, elastic, and cystic, and there may be a sense of fluctuation if the tension is low.

8. Diet adjustment

1. Fennel porridge: 10-15g fennel, 50-100g polished rice. First, boil the fennel with water, remove the residue from the juice, add polished rice and cook into porridge for consumption. It has the function of promoting qi and relieving pain, and is suitable for water hernia caused by cold and dampness.

2. Citrus aurantium egg soup: Citrus aurantium 60g, 2 eggs. First, fry the Citrus aurantium, remove the residue and take the juice, then put the whole egg into the juice and cook it, peel the egg skin, add appropriate amount of salt, eat the egg and drink the soup, once a day. It has the function of promoting qi and dispersing stagnation, and is suitable for water defects caused by liver depression and qi stagnation.

IX. Notes:

Patients with hydrocele should reduce their activities during treatment and actively treat the primary disease, such as filariasis, schistosomiasis, orchitis, epididymitis, etc. They should try to eat semi-liquid food as much as possible, eat easily digestible food, and reduce the burden on the gastrointestinal tract. However, the nutrition must be comprehensive, and high-protein, high-vitamin, low-fat and low-salt diet, spicy and stimulating, fatty and greasy, grilled, pickled and other foods should be avoided as much as possible. Eating should be regular and quantitative, and nutrition should be reasonable.