Hydrocele

INTRODUCTION:
  1. Hydrocele is an abnormal collection of serous fluid in the tunica vaginalis covering the testicles or within some part of processus vaginalis.
  • Primary/idiopathic hydrocele cause not known (common)
  • Hydrocele is a type of Exudation cyst 
  • Secondary hydrocele secondary to a disease in testis or epididymis
  • Hernia with hydrocele is Gibbon's hernia 
  • Vaginal hydrocele remains in the scrotum
  • Funicular Hydrocele: Processus vaginalis remains patent up to the top where it is shut off from the tunica vaginalis.
Diagnostic features:
  • Funicular hydrocele is a communicating hydrocele 
  • The swelling is inguinal rather than scrotal.
  • The test is it can be felt separate
  • Other features are similar to those of congenital hydrocele.
Congenital Hydrocele:
  • In this condition the processus vaginalis remains patent so there is direct communication of the tunica vaginalis with the peritoneal cavity.
  • The communicating orifice at the deep inguinal ring is too small for the development of a hernia.
  • Congenital hydrocele is treated by Herniotomy
Etiology
  • Defective absorption of fluid by the tunica vaginalis
  • Excessive production of fluid within the sac
  • Lymphatic obstruction
  • Edema of foot and Hydrocele is caused by W.Bancrofti
  • Communication with peritoneal cavity
Symptoms
  1. In majority - swelling of the scrotum may be the only complaint. Occasionally patient may complain of pain (due to heaviness or complications)
  2. Acute hydrocele in a young man may be associated with testicular malignancy.
  • Swelling confined to scrotum (can get above the swelling, cf. inguinal hernia)
  • Fluctuation test positive (cystic swelling) Transillumination test positive (except in thickened, fibrosed and calcified sac)
  • Irreducible
  • Testis not felt separately (not in secondary hydrocele)
Complications
  • Infection
  • Rupture
  • Haematocele
  • Hernia of the hydrocele sac
  • In long standing hydrocele (calcification of the sac, atrophy of the testis may be present)
  • Skin excoriation due to in drawing of the penis and dribbling of urine.
  • Decubitus ulcer in the scrotum.
Treatment
  • Jaboulay's method of eversion of sac;
  • In this procedure the hydrocele fluid is let out after opening the sac through scrotal incision and then eversion of sac is done so that the secreting surface of the tunica vaginalis turned outside
  • Lord's procedure; in case of small hydrocele and thin sac, plication of the sac is done
  • Excision of the sac done in case of massive hydrocele with thickened sac.
Postoperative Complication
  • Hematoma - drain aseptically
  • Infection - treat conservatively/antibiotics after culture and sensitivity, if required
Exam Question of:
  • Funicular hydrocele is a communicating hydrocele 
  • Congenital hydrocele is treated by Herniotomy
  • Hydrocele are Brilliantly transilluminant swellings
  • Edema of foot and Hydrocele is caused by W.Bancrofti
  • Lord's Plication is done for Hydrocele 
  • Congenital hydrocele in infant showing inguinal swelling which is smooth, transparent, fluctuating &receives an impulse when the child coughs or struggles
  • Vaginal hydrocele remains in the scrotum
  • Hernia with hydrocele is Gibbon's hernia 
  • No-scalpel vasectomy is for contraception is contraindicated in Hydrocele
  • Lord's and Jaboulay's operation is done for Hydrocele
  • Hydrocele is a type of Exudation cyst
Don't Forget to Solve all the previous Year Question asked on Hydrocele