HYDROCELE

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HYDROCELE
HYDROCELE
DEFINITION
• It is the collection of fluid
between the two layers of
tunica vaginalis of testis.
TYPES
• Congenital ™
• Acquired
• Primary
• Secondary
AETIOLOGY
• Defective absorption of fluid
by the tunica vaginalis,
probably due to damage to
the endothelial wall by low-
grade infection.
• Excessive production of fluid
as in secondary hydrocele.
• Interference with drainage of
fluid by lymphatic vessels of
the cord.
• Communication with the
peritoneal cavity.
FEATURES
• Hydrocele fluid is
amber-coloured with
specific gravity of 1.022
to 1.024.
• It contains water, salts,
albumin, fibrinogen.
• Per se, hydrocele fluid
does not clot, but if it
comes in contact with
the blood, fibrinogen
gets activated and clots
firmly.
• Often fluid contains TYPES
cholesterol and tyrosine PRIMARY VAGINAL
crystals. HYDROCELE
• Cysts which contain • Occurs in middle-aged,
cholesterol crystals ™ common in tropical
• Vaginal hydrocele ™ countries.
• Branchial cysts ™ Testis is not palpable as it
• Dentigerous cyst usually attains a large size
↓
(unlike secondary hydroceles
which are small, except in
filarial hydrocele).
 ↓ ↓
.
Fluctuant (elicited by, fixing (due to thickened dartos,
the hydrocele with hand thicke ned spermatic fascia,
↓ thickened hydrocele sac,
and feeling for the fluid infected content, chylous
movement using fingers placed fluid, often filarial hydrocele,
in two perpendicular haematocele).
directions). ↓
↓ Can get above the swelling
Initially transilluminant (you can feel only cord
(elicited in front of the swelling, structures
side to side) ↓
↓ and nothing else at the root of
but long-standing hydrocele is the scrotum, unlike in
nontransilluminant hernia).
 ↓ Infantile Hydrocele
Testicular sensation can be • Here tunica and processus
elicited in vaginal hydrocele vaginalis (hydrocele) are
↓ distended up to internal ring,
by transmitting the pressure but sac has no con nection
sensation through the fluid. with the general peritoneal
↓ cavity.
Swellings which are brilliantly
transilluminant
• Epididymal cyst ™
• Cystic hygroma ™
• Ranula ™
• Meningocele
Congenital Hydrocele ↓
• Processus vaginalis While lying down, fluid
communicates with the disappears gradually and
peritoneal cavity. while standing fluid recollects.
As this communicating orifice ↓
is too small, Hydrocele cannot be emptied
↓ by digital pressure as it causes
bowel does not descend “inverted ink bottle” effect.
↓ ↓
and so hernia usually will not Ascites, tuberculous
develop. peritonitis are the aetiologies
for the same
Encysted Hydrocele of the Cord DIFFERENTIAL
• It is the fluid collection in a DIAGNOSIS
portion of patent funicular • Epididymal cyst
process part of the tunica • inguinal hernia
vaginalis; • lipoma of cord,
• but closed above and below; varicocele.
located in TREATMENT
inguinal/inguinoscrotal/scro • Treatment is excision
tal part which is fluctuant under local
and transilluminant. anaesthesia
• On gentle traction to the
testis, the swelling becomes
less mobile (traction test).
Hydrocele-en-bisac (Bilocular
Hydrocele)
• Hydrocele has got two
intercommunicating sacs,
one above and one below
the neck of the scrotum.
• Upper one lies superficial
or in the inguinal canal or
may insinuate itself
between the muscle
layers—cross-fluctuant
Hydrocele of the Canal of Nuck
• It occurs in females, in
relation to the round
ligament, always in the
inguinal canal.
• Hydrocele of the Hernial
Sac
• It is due to adhesions of the
content of hernial sac.
• Fluid secreted collects in
the hernial sac and forms
hydrocele of the hernial
sac.
SECONDARY VAGINAL
HYDROCELE
Causes
• It is usually small, lax and
testis is usually palpable
(unlike primary hydrocele).
Exception is, secondary
hydrocele due to filariasis.
• It can be very large.
Infection:
• Filariasis Tuberculosis
of epididymis - have
secondary hydrocele
• Syphilis Injury:
Trauma
• Postherniorrhaphy
• hydrocele Tumour:
Malignancy
• Secondary hydrocele
rarely attains large
size
Postherniorrhaphy Hydrocele
• It is a secondary hydrocele
occurring after the surgery
for inguinal hernia.
• It is due to the damage to
lymphatic vessels of the
tunica vaginalis
• It is treated like any
hydrocele but usually after
about 6 months.
• Filarial Hydrocele and
Chylocele
• Occurs commonly in
coastal region, and in
and around the equator.
• Usually occurs after
repeated attacks of
filarial epididymitis.
• Hydrocele is usually of
large size and the sac is
thickened.
• Fluid contains fat, rich in
cholesterol, and is derived
from ruptured lymph
varix into the tunica.
• It is often difficult to DIFFERENTIAL DIAGNOSIS
differentiate from primary • Inguinal hernia ™
hydrocele. • Epididymal cyst ™
COMPLICATION • Spermatocele ™
• Hydrocele • Testicular tumour ™
• Infection ™ • Scrotal oedema
• Pyocele ™
• Haematocele ™
• Atrophy of testis ™
• Infertility ™
• Hernia of hydrocele sac
(rare)
TREATMENT
Surgery
• Sub-total excision ™
• Partial excision and
eversion (Jaboulay’s opera
tion) ™
• Evacuation and eversion ™
• Lord’s plication
• Surgeries for hydrocele ™
• Subtotal excision of the
sac ™
Jaboulay’s operation ™
• Evacuation and eversion ™
• Lord’s plication ™ Sharma
and Jhawer’s technique
COMPLICATION OF SURGERY
• Reactionary haemorrhage
• Infection ™
• Pyocele ™
• Sinus formation ™
• Recurrent hydrocele
• Conditions which cause loss
of testicular sensation
i. Testicular tumour
ii. Lepra orchitis
iii. Syphilitic orchitis
iv. Chronic haematocele
 REFERENCE
• Conditions where 1. SRB's Manual of Surgery
orchidectomy is done in by Sriram Bhat M
hydrocele ™ 2. A Manual on Clinical
• Pyocele with testicular Surgery by Das
destruction ™ 3. A Concise textbook of
• Clotted haematocele with Surgery by Das
testicular destruction
 A
Special Thanks
To A Very
Special Doctor