Where does the fluid in the scrotum come from, and how should cryptorchidism be treated promptly?

Where does the fluid in the scrotum come from?

Fluid accumulation in the scrotum is quite common, medically known as hydrocele. How does water get into the scrotum? Where does it come from? Could it be from water getting in while swimming? Could it be from urine flowing back in while urinating? These are the questions that Xiao Li encountered.

One day, while bathing her baby, Ms. Li noticed that her baby's scrotum was much larger than other children's. Upon closer inspection, she observed that the baby's scrotum was larger in the afternoon than in the morning, but shrank significantly after the baby went to sleep at night, even shrinking to the same size as a normal child. Seeing her baby lively and seemingly in no pain, Ms. Li intentionally touched the baby's scrotum. The baby showed no pain, which brought the mother some comfort. After observing for several more months, seeing that the baby's scrotum continued to enlarge, Ms. Li became increasingly worried and took the baby to the hospital.

Upon seeing the doctor, Xiao Li described in detail the changes she had observed in her baby's scrotum. After listening, the doctor picked up a flashlight and rolled up a newspaper into a cylinder. He then shone the flashlight on the baby's scrotum, examining it through the newspaper cylinder like a kaleidoscope. After a while, the doctor told Xiao Li, "Your baby has fluid buildup in his scrotum." Xiao Li was shocked! How could there be fluid? The doctor explained that this was a congenital condition called communicating hydrocele, a result of developmental abnormalities. To further confirm the diagnosis, an ultrasound examination was needed. The ultrasound confirmed communicating hydrocele.

What is communicating hydrocele? During embryonic development, the testis is covered by peritoneum. As it migrates from the abdominal cavity to the scrotum, it drags the peritoneum along with it. Normally, shortly after birth, the portion of peritoneum that accompanies the testis into the scrotum adheres and closes itself, forming the tunica vaginalis, which separates the testis from the abdominal cavity. If, for some reason, this portion of peritoneum fails to adhere, a cavity forms between it and the tunica vaginalis attached to the testis. This cavity remains connected to the peritoneal cavity.

In its natural state, the abdominal cavity contains a considerable amount of lubricating fluid to ensure intestinal peristalsis. This fluid flows in and out of the scrotum through this unclosed cavity. When the baby stands, the scrotum is in a lower position, and the fluid in the abdominal cavity flows downhill into the scrotum, causing it to enlarge. When the baby lies flat, the fluid in the scrotum flows back into the abdominal cavity, and the scrotum gradually shrinks. This is an interesting phenomenon of communicating hydrocele. The tunica vaginalis sac in this type of hydrocele will expand further as the fluid accumulates, making the scrotum increasingly larger. Without secondary infection, there is generally no discomfort, but if the scrotum becomes too swollen, it can affect the child's walking.

After a baby is born, because the development of the tunica vaginalis has stopped, the passage between the tunica vaginalis cavity and the peritoneal cavity cannot close on its own. Surgery is often required to close this fluid passage. Therefore, curing this condition depends on surgery; waiting or relying on medication will be futile.

The fluid in the scrotum actually originates from the patient's abdominal cavity. It's not a disease caused by pathogenic microorganisms, but rather a congenital developmental abnormality. After birth, the body failed to properly "waterproof" the space between the abdominal cavity and scrotum, allowing fluid from the abdominal cavity to freely enter and exit the scrotum. In this case, surgery is necessary to drain the fluid from the scrotum and seal the fluid passage between the abdominal cavity and scrotum, preventing further fluid leakage.

Author: Zhong Wei, Department of Urology, Beijing Coal General Hospital

**Cryptocele should be treated promptly.**

Some young boys suffer from urological diseases, especially reproductive system diseases. If they can be detected and treated early, not only can the child's life be saved, but also the family and even the whole society can benefit.

Cryptorchidism occurs when one or both testicles fail to descend into the scrotum at birth and remain in the groin or abdominal cavity.

If left untreated, the following complications may occur: First, infertility. Normally, the scrotum temperature is 2-3°C lower than body temperature. This temperature difference is crucial for sperm production. In patients with bilateral cryptorchidism, the elevated temperature causes testicular epithelial atrophy, hindering sperm production and leading to infertility. Unilateral cryptorchidism can also damage the contralateral testis from the second year of infancy. Therefore, if left untreated, it can affect fertility. Second, testicular trauma. Testes located in the groin are easily injured due to their superficial location and the fact that the posterior wall of the groin is harder and less elastic than the scrotum, lacking cushioning. Third, malignant transformation. Cryptorchidism has a higher chance of malignant transformation than testes in a normal position. Fourth, psychological trauma. The absence of testes in the scrotum can cause psychological trauma and feelings of inferiority in patients.

If a child is diagnosed with cryptorchidism, they must immediately seek treatment at a reputable hospital's specialist department. Treatment methods include medication and surgery. However, regardless of the method chosen, it must be performed before the child is two years old. This is because after two years of age, pathological changes may occur in the child's testicular tissue.

Seven-year-old Bangbang was diagnosed with bilateral cryptorchidism during a physical examination. Although doctors performed an exploration surgery to remove the undescended testicles in time, the testicles had already undergone pathological changes due to the late discovery and prolonged retention in the abdominal cavity. This means that Bangbang has lost his fertility.

The surgeon was very sorry; if it had been discovered a few years earlier, both testicles could have been saved, and the boy's life could have been saved.

Medical experts urge parents to have their children undergo a health check-up at the urology department of a hospital before the age of two.

By Zhu Xiaomin, Special Correspondent for Health Times

Supporting Expert: Cao Qingming, Chief Physician of Urology, Xiangfan Central Hospital, Hubei Province