What is Hydrocele?
The disorder is also known by the public as “water hernia”. There is double-layer protective membrane, which is called “tunica vaginalis”, covering the testes and its stem. There is a small amount of liquid secreted by the body between these two membranes. This liquid, which is continuously secreted and later discharged by the body, protects the testes against traumas and also preserve their sperm generation potentials. Any disorder of these membranes in terms of secretion and absorption causes an accumulation of excessive liquid between them. Hydrocele is the disorder caused by this excessive liquid accumulation. It’s mainly seen in children and adult men. Treatment for children and adults is entirely different. Our article will handle hydrocele in children and adults separately.
Adult Hydrocele
In adult hydrocele, a painless swelling occurs in the testis side of the patient. This swelling grows over time and can be seen even with clothes. It causes anxiety and social inconvenience for the patient. In adult hydrocele, there is no opening in the inguinal canal.
Diagnosis of Adult Hydrocele
Generally, physical examination and ultrasonography allow easy diagnosis. Another diagnosis method is differentiating the interior formations by shedding light on the scrotum from below. This is called “translumination” in medical language.
Causes of Adult Hydrocele
7% of adult hydrocele patients have undergone varicosele surgery. Trauma to the tests caused by impacts or testis cancer also leads to hydrocele in the patient. But a majority of hydrocele cases owes to unidentified causes.
Adult Hydrocele Surgery
The principle in adult hydrocele surgeries is to remove the membrane surrounding the testis called “tunica vaginalis”, which secretes excessive liquid. As opposed to children where incision is made from the inguinal canal, incision is made over the testis sac while operating adults. The tunica vaginalis is reached by a 4-5cm incision and the liquid therein is discharged. In some cases, liquid volumes up to 1-2 liters are discharged. Following liquid discharge, the testis is drawn outwards and the tunica vaginalis membrane is removed as much as possible. In this method, which is known as “standard hydrocele surgery”, a swelling occurs in the testis and a long recuperation period is needed as a large incision is made and the testis is drawn outwards. The operation is usually traumatic and causes inconvenience after the surgery. But the ONOL (Outpatient Novel Out-Leaf) Method developed by us, which is included in the Global Literature of Medicine, causes no such complaints in patients.
ONOL Technique in Hydrocele Surgery
In the ONOL Technique, which was developed in 2004 by Prof. Dr. Yavuz Önol, which was published in scientific journals upon admission into the Global Literature of Medicine in 2009 and which was presented during many international congress, the physician makes a 1-1.5 incision to the patient’s testis sac and reaches the tunica vaginalis. All hydrocele liquid is discharged by injector. The tunica vaginalis is peeled like an onionskin and completed removed by a precise procedure. This removes the membrane that causes hydrocele. The patient doesn’t experience any complaints or inconveniences after surgery and is discharged within the same day. The surgical incision that is 5-6cm in other techniques is only 1-1.5cm in the ONOL Technique. The ONOL Technique doesn’t remove the testes from the scrotum. This reduces the trauma that the surgery inflicts upon the patient. Patients can be discharged within the same day. The ONOL Technique has a higher success rate than other techniques.
Non-Surgical Treatment of Hydrocele
Hydrocele can be treated non-surgically. All hydrocele liquid discharged by an injector without incising the scrotum. But liquid generation continues as this method doesn’t remove tunica vaginalis. This procedure should be repeated at 6-12 month intervals. Materials that lessen liquid generation can be administered into the gap between the testis membranes in order to reduce liquid generation. This is a painful treatment method and can be applied in elderly patients. It doesn’t fully eliminate the disorder.
Child Hydrocele
The development of testes in mother’s womb begins with the kidneys. The testes descend as the child develops and over time, they pass through the inguinal canal and settle in the testis sac, meaning the scrotum. During this descend, they drag the abdominal membrane that is called the peritoneum. The abdominal membrane so dragged forms the protective membrane that surrounds the testis. If in the newborn, this membrane isn’t completely closed at the inguinal canal, then the liquid forming inside the abdomen flows into the area between the testis membranes. This connection, which can be seen in the newborn, generally closes itself over time. But excessive liquid accumulation occurs around the testes if it doesn’t closed within the first 1-1.5 year.
When should Hydrocele Surgery be Performed in Children?
The majority percentage of hydrocele occurring newborns usually disappears 1-1.5 years after birth. For this reason, one should wait for 1-1.5 without any operations. But if the inguinal canal is larger than 1-2mm in width, then the intestine segments also flow downwards from this canal. This means that the patient has hernia in addition to hydrocele. The patient can face intestinal knot at any moment. The patient should be operated immediately in such case.
Child Hydrocele Surgery
A 1.5 cm incision is made on the groin during the operation. The connection between the abdominal cavity and the testis is found and terminated. This seems simple in principle but it is indeed a sensitive operation. That is because in the region where the doctor operates, there is a tiny canal called ““Vas Deferens” that transfers sperm from the testes. One should never damage this canal, which transfers the sperm generated in the testes to the rear of the penis. Sperm transfer may be disrupted and the patient may suffer infertility if the contrary occurs. Unfortunately, the reason for infertility in the majority of adults is erroneous hydrocele surgeries priorly performed.
During this surgery, which seems simple in principle, solving the patient’s hydrocele problem is as much important as preventing damage on the canal called “Vas Deferens” that transfers sperms. We have performed these operations with 100% success rate until today and we ensure full success & transparency by also submitting the video records of the operation to our patient.