Hydrops of the testicle envelopes (hydrocele) and spermatic cord (funicolare)

Under this name refers to the accumulation of fluid between the outer (parietal) and internal (visceral) sheets own shell eggs (tunicae vaginalis propriae). There are two forms of hydrocele - acute and chronic.
Acute, or symptomatic, dropsy of membranes occurs in acute inflammation and injury of the testicle or epididymis. Shells accumulate serous exudate-purulent or serosanguineous nature.
Acute hydrops of the testicle envelopes accompanied by fever, pain in the testicle or epididymis. Leather appropriate half of the scrotum redness and edema.
Symptomatic of a hydrocele requires no special treatment. Therapy is the treatment of the main disease - epididymitis or orchitis.
Chronic form. Much more common chronic form dropsy shells - idiopathic where the testis and epididymis remain unchanged. It develops gradually without subjective sensations, the time and the reason of its appearance elusive. Gradually the amount of fluid in the membranes increases and can reach several hundred milliliters, and in rare cases and 2-3 L.
In the basis of idiopathic hydrocele lies a weak inflammatory process serous or sero-fibrinous character in both sheets own tunica vaginalis testis. In resected shells found inflammatory infiltrates, mainly around blood vessels. Sometimes the shell as a result of chronic inflammation sharply thicken, sklerosiruta, ossify. About the inflammatory nature of the process is said and significant content in gidrozolei liquid protein (from 3 to 5%), fibrin, often found villous expansion on the shells and adhesions between their leaves. The inflammatory process, on the one hand, causes a pericardial effusion in the cavity own tunica vaginalis, and on the other violates the absorption ability of the latter (paint, injected into the cavity dropsy, does not appear in the urine)that leads to the accumulation of fluid.
In the basis of the inflammatory process may lie flowing sluggishly infection. Has a value of trauma to the scrotum, particularly repetitive.
In children, the cause of a hydrocele is a birth trauma or cleft processus vaginalis. In the latter case, the cavity dropsy reported with peritoneal cavity - hydrocoele communicans.
If vaginal process obliteriruta not all over, and in some areas, between the latter can be formed cavity filled with a clear liquid, with size from hazel to chicken eggs, which are located along the spermatic cord, - funicolare (funiculocoele) or hydrops shells spermatic cord (hydrocoele funiculi spermatici) (Fig. 136).
At first, the disease is asymptomatic. As the increase testicular appear dragging pain along the spermatic cord, dropsy festers, with intercourse. For very large dropsy penis retracts under the stretched over her skin of the scrotum, which is irrigated released during urination urine, leading to irritation and ackzematosnye her.
The diagnosis. The corresponding half of the scrotum in varying degrees increased, has ovoid shape; upper pole it is clearly distinguished from external opening of the inguinal canal. The skin over the dropsy mobile, not changed, a smooth consistency tightly - or soft-elastic; it does not spravlyaetsya in the inguinal canal, except hydrocoele communicans at which the fluid in the supine position of the patient moves into the abdominal cavity, descending back in the transition to a vertical position. In transmitted light it shines, except in those cases when the shell sharply thickened or there is a haemorrhage in the abdominal dropsy (it does). Not to Shine through only signanini pole dropsy, where the testicle with the appendage.
Gidrosila liquid of light-yellow color, sometimes with a greenish hue, transparent or slightly opalestiruty. Vaginal sheath in early cases, subtle and brilliant, in late she thickened, with deposits of fibrin, lime, centers of hyalinosis and ossification. Sometimes fibrinous imposing detached and floating in gidrozolei fluid in the form of so-called rice Taurus. Dropsy even larger sizes small effect on the function of the testis.
Differential diagnosis dropsy with hernia based on its nepravilnosti, B.C., clear delimitation of the upper pole from the inguinal canal, stupid percussion sound on it. The tumor or gummy egg can be taken for hydrocele only if they are accompanied by effusion in the shells. After emptying fluid puncture of these diseases it is easy to recognize by their characteristic features (see the relevant sections).
Surgical treatment. It can be resection of shells - operation Bergman. Last shown at sklerozirovanie thickened walls of the bag. In other cases the operation of Winkelman: after longitudinal opening gidrozolei cavity in front of the shell and turn their edges sew behind the epididymis. Thus, their internal surface in direct contact with subcutaneous tissue, suction hidrocilindru liquid. The same principle is based operation Alferov: cut shells edging its edges, resulting in a box that connects cavity dropsy with subcutaneous tissue.
When funiculare enucleated or excised leading night cavity.