Diagnosis, treatment and dietary therapy for hydrocele

2. Diagnosis and Treatment of Hydrocele: Diagnosis of hydrocele is relatively easy. It presents as a unilateral or bilateral mass in the scrotum, gradually increasing in size without pain. The mass feels cystic and fluctuant upon palpation, and has a relatively smooth texture. Transillumination test is positive. If the fluid is purulent, bloody, or chylous, the transillumination test will be negative. B-mode ultrasound shows the mass as a hypoechoic area. Congenital (communicating) hydrocele and congenital inguinal hernia are coexisting conditions with the same cause. Treatment primarily involves surgery.

(1) Conservative treatment: Infantile hydrocele can usually be absorbed and resolve spontaneously, and no treatment is required. If the amount of hydrocele in adults is small and there are no obvious symptoms, or if it is a reactive hydrocele caused by acute inflammation, trauma, etc., scrotal support and other treatments can be given first.

(2) Simple puncture and aspiration: This method is only used for infants and young children whose effusion has not been absorbed, and some of them can be cured. After aspiration, the fluid is rinsed with alcohol. This method is suitable for non-communicating hydrocele.

(3) Surgical treatment: This is the main method for treating all types of hydrocele. Surgical indications include: significant symptoms, large amount of fluid accumulation, complications, or unclear diagnosis. The most commonly used procedure is tunica vaginalis inversion, which involves incising the tunica vaginalis to drain the fluid before inverting it. For larger hydroceles with thick walls, the excess parietal tunica vaginalis can be removed, then inverted and sutured. Communicating hydroceles should be treated with a high incision and ligation of the communicating part; if a hernia is present, hernia repair surgery should be performed simultaneously.

3. Dietary therapy for hydrocele

**Fennel Egg Pancake**

[Ingredients]15g fennel seeds, 1 duck egg, a pinch of salt.

[Dosage] Stir-fry fennel seeds and salt until charred, grind into a fine powder, add duck egg, and fry together to make a pancake. Take with warm rice wine before bedtime. One course of treatment is 7 consecutive days.

[Efficacy] Warms the middle jiao and dispels cold, eliminates dampness. Suitable for hydrocele and hernia.

**Water Inguinal Porridge**

[Ingredients]Astragalus membranaceus 15g, Cinnamomum cassia twig 10g, Luffa cylindrica sponge 10g, Scorpion 3g, Sorghum rice

[Administration] First, decoct the first four herbs in 800ml of water, then add the washed sorghum rice and an appropriate amount of water to cook into porridge. Take once daily for 5-10 days.

[Efficacy] Primarily treats hydrocele.

**Braised Kidneys**

[Ingredients]1 pork kidney, 15g of Corydalis rhizome, 10g of Morning glory seed.

[Preparation] Cut open the pig kidneys and remove the fascia. Rinse them with water to remove the fishy smell. Stuff the kidneys with corydalis rhizome and morning glory seeds, sprinkle with a small amount of salt, wrap them with mud, and simmer over low heat until cooked. Remove the mud, chew and swallow on an empty stomach. It can be taken with rice wine or light salt water.

[Efficacy] Tonifies the kidneys, promotes qi circulation, and eliminates water retention. Suitable for conditions such as hernia, hydrocele, etc.

**III. Nonspecific Epididymitis**

Nonspecific epididymitis is caused by Gram-negative bacilli and Gram-positive cocci, and can be acute or chronic. It is most common in young adults and children, often occurring as a complication of urinary tract infections and prostatitis/semi-vesiculitis. Retrograde transmission from the vas deferens is most common, while hematogenous transmission is rare. Patients undergoing prostatectomy often develop acute epididymitis, which can be prevented by bilateral vas deferens ligation.

1. Acute epididymitis has a sudden onset with obvious systemic symptoms, including fatigue and weakness, high fever, chills, significant swelling and heat in the affected scrotum, thickening of the spermatic cord, and significant tenderness and pain in the testis and spermatic cord. It can also cause urinary urgency and frequency. Differential diagnosis is necessary to distinguish it from testicular torsion, tuberculous epididymitis, and acute gonococcal epididymitis.

Acute suppurative epididymitis is a serious condition that requires aggressive treatment to prevent infertility caused by epididymal obstruction and the disruption of testosterone production. Absolute bed rest, scrotal elevation, and local cold compresses are necessary until the acute inflammation is controlled. Pain relief can be achieved with spermatic cord block and ice packs placed on the scrotum. If there is evidence of high fever, bacteriuria, pyuria, prostatitis, or other bacterial infection, broad-spectrum antibiotics should be administered immediately, such as cephalexin 250mg orally four times daily; ampicillin 1g every 6 hours, with a minimum course of 10 days. Depending on bacterial susceptibility, erythromycin 500mg every 6 hours or SMZ combination (with sulfonamide potentiator) 1g every 12 hours may be used. Sexual activity is prohibited.

2. Chronic epididymitis is more common than acute epididymitis. Some patients develop chronic epididymitis because their acute condition was not completely cured; many others develop chronic epididymitis without a history of acute attacks, often secondary to prostatitis. Clinical manifestations often include scrotal pain, swelling, and a feeling of heaviness, with pain radiating to the lower abdomen and the inner thigh on the same side. Examination reveals enlargement of the head and tail of the epididymis, which is hard or nodular and tender; the vas deferens is also thickened and tender.

This condition often coexists with chronic prostatitis and can be treated with local physical therapy, antibiotic iontophoresis, and spermatic cord block therapy. For cases with severe local symptoms that are difficult to cure, surgical removal of the epididymal mass, nodules, or the entire epididymis may be considered. Generally, it does not affect the testis and orchiectomy is not necessary.

3. Dietary therapy for epididymitis

**Toona sinensis and green pea porridge**

[Ingredients]100g fresh toon leaves, 30g green peas, 50g glutinous rice.

[Preparation] Cook green peas and glutinous rice together into porridge. When it is almost cooked, add chopped toon leaves and cook for another one or two boils. Take once a day for 5 to 10 days.

[Efficacy] Clears heat, detoxifies, and promotes diuresis. Used for acute orchitis, acute epididymitis, etc.

Three-Bean Soup

[Ingredients]20g red beans, 30g mung beans, 15g black beans.

[Preparation] Crush all three types of beans and place them in a clay pot. Add an appropriate amount of water and bring to a boil over high heat for 10-20 minutes. Take at any time of day for several consecutive days.

[Efficacy] Clears heat, detoxifies, and removes blood stasis. Used for acute epididymitis, etc.

**Stir-fried bitter melon with sliced ​​pork**

[Ingredients]250g bitter melon, 60g lean pork, appropriate amount of scallions and ginger.

[Preparation] Shred both the bitter melon and pork, add an appropriate amount of vegetable oil, and cook as usual. Serve with meals daily.

[Efficacy] Clears heat, detoxifies, and promotes diuresis. Used for acute epididymitis, acute orchitis, etc.