HYDROCELE

Dr. Ashok KumarProfessorDepartment of Surgery LHMC & SSK Hospital

Why is it Hydrocele ?

• Can get above the swelling• Fluctuation present• Transillumination present• Testis not palpable• Non reducible swelling• Impulse on coughing absent

Definition ?

• Abnormal collection of serous fluid in some part of the processus vaginalis usually tunica.

TYPES OF HYDROCELE ?

• Primary• Secondary

PRIMARY HYDROCELE ?

• Congenital• Vaginal• Infantile• Hydrocele of the cord

SECONDARY HYDROCELE ?

• Causes :- 1. Epididymorchitis2. Torsion3. Tumor4. Post herniotomy

Characterstics of secondary hydrocele ?

1. Lax2. Moderate size3. Testis palpable

CHARACTERSTICS OF HYDROCELE FLUID ?

• Amber colour• Specific gravity – 1.022 – 1.024• Water, salts , Albumin, Fibrinogen• Cholesterol and tyrosine crystals

CYST WHICH CONTAINS CHOLESTEROL CRYSTALS ?

• Vaginal hydrocele• Branchial cyst• Dentigerous cyst

Conditions in which we cant get above the swelling ?

• Congenital hydrocele• Infantile hydrocele

Can hydrocele present as purely inguinal swelling ?

YES

Encysted hydrocele of the cord.

Conditions in which hydrocele presents as inguinoscrotal swelling ?

• Congenital hydrocele• Infantile hydrocele

Can hernia present as purely scrotal swelling ?

• Herniation of hydrocele through dartos muscle.

SWELLING WHICH REDUCE ON LYING DOWN ?

• Reducible Hernia• Varicocele• Lymph varix• Congenital hydrocele

Hydrocele in females ?

• Hydrocele of the canal of nuck.

Conditions in which there is loss of testicular sensations ?

• Syphilitic gumma• Lepromatous orchitis• Advanced testicular tumor

SWELLINGS SHOWING CROSS FLUCTUATION ?

• Plunging ranula• Compound palmar ganglion• Psoas abscess• Hydrocele en bisac (Bilocular hydrocele)

SWELLING WHICH ARE BRILLIANTLY TRANSILLUMINANT ?

• Vaginal Hydrocele• Epididymal cyst• Cysto hygroma• Ranula• Meningocele

ABSENT TRANSILLUMINATION ?

• Pyocele• Hematocele• Spermatocele• Chronic hydrocele

INTERMITTENT HYDROCELE ?

• Congenital hydrocele

Role of ultrasonography ?

• Testis not palpable ; Vaginal hydrocele.• Palpable but suspicious• Acute hydrocele

How will you differentiate between inguinal hernia and encysted hydrocele

of the cord ?

• Traction test• Reducibility• Impulse on coughing

Edward Gibbon

COMPLICATIONS ?

• Pyocele• Hematocele• Testicular atrophy• Rupture• Herniation of hydrocele sac• Infertility

Treatment ?

• Congenital hydrocele – Herniotomy

• Acquired - VAGINAL HYDROCELE –1. Small size – Lord’s Operation2. Moderate size – Jaboulay’s Operation3. Large size – Excision of sac + Jaboulay’s operation4. Very Large size – Scrotoplasty + Excision of sac +

Jaboulay’s operation

LAYERS OF SCROTUM

1. Skin2. Dartos3. External spermatic fascia <- External oblique4. Cremastic fascia <- Internal oblique5. Internal spermatic fascia <- Fascia

transversalis6. Tunica Vaginalis

Differences between epididymal cyst and spermatocele ?

CYST OF EPIDIDYMIS• Bilateral• Behind the testis• Irregular surface• Multilocular• Transillumination present

SPERMATOCELE• Usually unilateral• Behind and above the testis• Smooth surface• Unilocular• Transillumination absent

How to differntiate between hematocele and testicular

malignancy ?HEMATOCELE

• History of trauma present• Long duration• Non progressive swelling• Weight loss absent• Surface smooth• Testicular sensation present• Lymph node absent

MALIGNANCY• History of trauma absent• Short duration• Progressive swelling• Weight loss present• Hard / Variable surface• Testicular sensation absent• Lymph node present

DISEASE and PARTS involved

• FILARIASIS – Epididymorchitis• TUBERCULOSIS – Epididymitis• SYPHILIS - Orchitis

Q 1. In reaching hydrocele sac which of the following layer is not incised ?

1. Dartos muscle and superficial fascia2. Tunica Albugenia3. Internal spermatic fascia4. Cremastic fascia

Q 2. Which one of them is not a recommended procedure for hydrocele ?

1. Lord’s procedure2. Jaboulay’s procedure3. Herniotomy4. Tapping / Aspiration

JABOULAY’S PROCEDURE