Hydrocele of the tunica vaginalis

　　The causes of the occurrence of hydrocele of the tunica vaginalis include:

　　Primary hydrocele of the tunica vaginalis has primary diseases such as acute orchitis, epididymitis, spermatic corditis, etc., which stimulate the tunica vaginalis to increase secretion, causing fluid accumulation. Cystic hydrocele due to lymphatic obstruction caused by scrotal surgery, fever, heart failure, ascites, and other conditions is manifested as acute hydrocele; chronic secondary fluid accumulation is common in chronic orchitis, epididymitis, syphilis, tuberculosis, testicular tumors, etc., causing increased secretion of the tunica vaginalis and fluid accumulation. In addition, filariasis and schistosomiasis can also cause hydrocele. The fluid often contains white blood cells.

　　The cause of primary hydrocele of the tunica vaginalis has not been fully clarified. It may be due to increased secretion and reduced absorption of the tunica vaginalis, possibly caused by an undiscovered or healed orchitis of the epididymis. It is also related to congenital factors, such as defects in the lymphatic system of the tunica vaginalis cavity, and the course of the disease progresses slowly.

　　When the testes descend from retroperitoneum to the scrotum, the peritoneum also descends to become the tunica vaginalis of the testis. The tunica vaginalis that envelops the epididymis is the tunica vaginalis propria, and there is also an outer layer known as the tunica vaginalis serosa. Between the two layers, there is only a small amount of fluid. The processus vaginalis that descends with the testes closes completely after birth, becoming a cord-like structure. If the processus vaginalis does not close completely, the peritoneal fluid (ascites) can flow along the unclosed cavity to the surrounding area of the testes or remain at a certain segment of the spermatic cord, forming a hydrocele known as congenital or communicating hydrocele. An excessive amount of fluid between the two layers of the tunica vaginalis propria of the testes is known as hydrocele of the tunica vaginalis.

　　In the early stage of normal fetal development, the testes are located retroperitoneally. By the 7th to 9th month, the testes descend through the inguinal canal into the scrotum. Accompanying the descent of the testes, the peritoneal processus vaginalis closes, forming a fibrous cord, and the part of the processus vaginalis of the testes forms a sac-like tunica vaginalis of the testis. Normally, there is only a small amount of fluid in the cavity, which is in balance between secretion and absorption. However, when pathological changes occur in the adjacent organs of the tunica vaginalis, such as inflammation, tumor, trauma, parasitic disease, etc., it causes a loss of balance between secretion and absorption, or incomplete closure of the peritoneal processus vaginalis, with fluid coming and going between the peritoneal cavity and the tunica vaginalis, thus forming hydrocele of the tunica vaginalis.

　　Under normal circumstances, the tunica vaginalis has the function of secretion and absorption of serous fluid, and maintains its capacity stable. If the tunica vaginalis itself and the surrounding organs or tissues develop abnormalities, causing an imbalance in the secretion and absorption functions of the tunica vaginalis, various types of hydroceles can form. Generally, the prognosis of this condition is good after treatment.

　　The scrotal skin of primary hydrocele of the tunica vaginalis is normal, with a large tension and can transmit light. If the tunica vaginalis tension is not large and is soft, it should be considered as possible secondary hydrocele, and be vigilant about the presence of lesions in the testicle and epididymis, such as tuberculosis, syphilis, inflammatory lesions, tumors, and filariasis. Hydrocele is manifested as a cystic mass in the scrotum or spermatic cord area, generally without discomfort, with a large difference in size, most of which are oval. Congenital hydrocele can be gradually reduced or even completely disappear when the fluid is compressed in the supine position, and most hydroceles are unilateral.

　　Hydrocele of the tunica vaginalis has a certain impact on male fertility, and the main reasons are:

　　(1) The hydrocele around the testicles compresses the testicles, affects blood circulation, and affects spermatogenic function.

　　(2) Large hydrocele of the tunica vaginalis can wrap the penis with scrotal skin, which is not conducive to normal sexual intercourse.

　　(3) Those secondary to tuberculosis, orchitis, and other diseases are not conducive to fertility.

　　It should be pointed out that the clinical importance lies in the long-term accumulation of fluid inside the tunica vaginalis, the increase in internal pressure, leading to ischemia of the testicles, poor spermatogenic function, and infertility. Normally, there is a small amount of serum in the tunica vaginalis of the testicles, which is similar in nature to the serum in the peritoneal cavity and has a lubricating effect, allowing the testicles to move freely in it. At the same time, a large hydrocele in adults can affect normal sexual life and also lead to infertility.

　　Hydrocele of the tunica vaginalis is clinically manifested as a cystic mass in the scrotum, with the size of the two testicles being different. From the characteristics of the mass, hydrocele can be roughly divided into communicating and non-communicating types: the former changes in size, often decreases during sleep or when pressed by hand, even disappearing, but when getting up to play or releasing the pressure, the mass returns to its original size; non-communicating hydrocele has a mass that does not change in size or gradually increases, feels harder when palpated by hand, and does not shrink when pressed.

　　Hydrocele and inguinal hernia are very similar and appear in the same location, so parents often mistake hydrocele for inguinal hernia. In fact, it can be distinguished by the light transmission test. The skin of the scrotum is thin, the muscles are thin, and the tissues are loose, making it easy for light to pass through. If a flashlight is shone from below the scrotum, the skin and tissues inside the scrotum can be seen as bright red, and the testicles appear as a black shadow, which is called the light transmission test. Since the hydrocele sac contains fluid and is also translucent, the light can pass through the cyst after the flashlight is turned on, and the scrotal skin remains bright red, indicating a positive light transmission test; while inguinal hernia, the sac contains intestines with turbid intestinal contents, which is not easy to transmit light, and the mass appears dark, indicating a negative light transmission test. In addition, when the hydrocele mass decreases, there is no 'gurgling' sound of intestinal gas as in inguinal hernia.

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

　　Hydrocele of the tunica vaginalis is a cystic lesion formed by the accumulation of fluid in the tunica vaginalis around the testicle, exceeding the normal amount, and is common in various ages, a clinical common disease. To prevent hydrocele of the tunica vaginalis, the following points should be noted:

　　1. The underwear worn by patients with hydrocele of the tunica vaginalis should be loose and soft to avoid rubbing the swollen scrotum. Patients with hydrocele of the tunica vaginalis should avoid eating cold fruits and spicy, fried foods, and moderate sexual activity.

　　2. Patients with hydrocele of the tunica vaginalis should adjust their emotions, maintain a pleasant mood, and avoid emotional excitement.

　　3. Patients with hydrocele of the tunica vaginalis can use a scrotal support or a bandage to support the swollen scrotum, which can relieve the sensation of sagging and pain, and is conducive to the absorption of the effusion. Patients with hydrocele of the tunica vaginalis should keep the scrotum clean and hygienic to prevent infection.

　　4. The incidence of hydrocele is high in tropical areas. It is related to filarial infection. Therefore, anti-mosquito measures in daily life are very important.

　　5. During the treatment period, patients with hydrocele of the tunica vaginalis should pay attention to rest, prevent overexertion, especially in the acute stage, it is advisable to stay in bed absolutely to avoid aggravating the condition.

　　6. Keep the scrotum clean and hygienic to prevent infection.

　　Hydrocele of the tunica vaginalis is a cystic lesion formed by the accumulation of fluid in the tunica vaginalis around the testicle, exceeding the normal amount, and is common in various ages, a clinical common disease. The auxiliary examination required for hydrocele of the tunica vaginalis is mainly the examination of hydrocele of the tunica vaginalis.

　　Hydrocele of the tunica vaginalis examination: hydrocele of the tunica vaginalis and spermatic cord hydrocele are generally spherical or oval.婴幼型鞘膜积液呈梨形，at the inguinal region, it gradually becomes thinner. Communicating hydrocele is spherical or pear-shaped, it can shrink or disappear when lying flat. Sometimes the communication channel is very small, it takes a long time to lie flat to slightly shrink, so it is easily misdiagnosed as infantile hydrocele of the tunica vaginalis or hydrocele of the tunica vaginalis. The surface of the mass is smooth, elastic, with a cystic sensation, and those with small tension can have a fluctuating sensation.

　　Hydrocele of the tunica vaginalis is a cystic lesion formed by the accumulation of fluid in the tunica vaginalis around the testicle, exceeding the normal amount, and is common in various ages, a clinical common disease. The following points should be noted in the diet of patients with hydrocele of the tunica vaginalis:

　　Foods that patients with hydrocele of the tunica vaginalis should eat:

　　For the diet of hydrocele of the tunica vaginalis, it is recommended to eat more high-protein, high-vitamin, easily digestible, and fiber-rich food to enhance the body's resistance and prevent constipation.

　　For the diet of hydrocele of the tunica vaginalis, it is best to take semi-liquid food as the mainstay, eat easily digestible food, and reduce the burden on the gastrointestinal tract. However, nutrition must be comprehensive.

　　Foods that patients with hydrocele of the tunica vaginalis should not eat: high-protein, high-vitamin, low-fat and low-salt diet, spicy and刺激性, greasy and thick, barbecue, pickled and other foods should be eaten as little as possible.

　　The routine method of Western medicine for treating hydrocele of the tunica vaginalis:

　　(1) Injection Treatment: After aspiration, inject irritant drugs such as silicon nitride, sodium lauryl sulfate, etc., into the tunica vaginalis cavity to cause inflammatory adhesion. This method is to eliminate the tunica vaginalis cavity. This method has a large reaction, incomplete adhesion, and the formation of multilocular hydroceles. This method is used less frequently. It brings more difficulties to surgical treatment.

　　(2) Surgical Treatment: Congenital hydrocele of the tunica vaginalis cannot be treated with the above two methods. Surgical treatment is the main method. The purpose of the surgery is to ligate the hernial neck at a high position at the internal ring to block the downward flow of peritoneal fluid. The following hernial sacs do not need to be treated. The hydrocele of the spermatic cord can have the fluid sac completely excised. If it is difficult to excise, the sac wall can also be cut open and an inversion suture technique can be performed. The effective surgical method for hydrocele of the tunica vaginalis is the excision and inversion suture technique of the tunica vaginalis.

　　1. Various hydroceles during the neonatal period have the opportunity to heal spontaneously, so no surgery is needed within the first 2 years. Small, asymptomatic adult hydroceles can also be treated temporarily.

　　2. Needle aspiration and injection of a sclerosing agent: puncture the anterior wall of the scrotum, aspirate the fluid inside the sac, and then inject 5% sodium lauryl sulfate, quinine hydrochloride (13.33%), tetracycline solution, or anhydrous alcohol, etc. Once a week, generally 2 to 4 times are needed. Sometimes injection can cause complications such as epididymitis, orchitis, etc. It is contraindicated for communicating hydrocele, and it is not applicable for thick-walled multilocular cysts or those with epididymal and testicular lesions. Therefore, it has not been widely accepted to this day.

　　Hydrocele of the tunica vaginalis, infantile hydrocele, and hydrocele of the spermatic cord can be treated with tunica vaginalis inversion or partial tunica vaginalis resection. Communicating hydrocele should be treated through an inguinal incision, ligating the peritoneal processus vaginalis near the internal ring and turning over or removing the distal tunica vaginalis sac. The primary disease must be treated for secondary hydrocele of the tunica vaginalis. For large hydroceles with obvious symptoms, tunica vaginalis inversion should be performed. The hydrocele of the spermatic cord should have the entire fluid sac removed. Communicating hydrocele should cut off the channel and ligate the processus vaginalis high up at the internal ring.

　　2. Injection therapy for extracting fluid and injecting a sclerosing agent. However, it is prone to recurrence and infection.

　　1. Secondary hydrocele of the tunica vaginalis should be treated according to the cause. If it is due to traumatic hemorrhage, hemostatic agents and antibiotics should be used, and surgical removal of blood clots should be performed if there is a large amount of hemorrhage; if it is caused by filariasis, diethylcarbamazine should be taken orally and the tunica vaginalis should be inverted; if it is caused by testicular tumor, then the treatment should be targeted at the testicular tumor.