PAS

HYDROCELES
 Definition :
An abnormal collection of serous fluid in some part of
the processus vaginalis, ussualy in the tunica

Types
Congenital Aquired
Vaginal Hydroceles a. Primary (idiopathic)
- Infantile hydrocele b. Secondary
- Congenital hydrocele
- Hydrocele of the cord
AETIOLOGY
 Hydocele can be produce in four ways :
 Excessive production of fluid within the sac (secondary
hydrocele)
 Defective absorbtion of fluid
 Interference with lymphatic drainage of scrotal structure
 Connection with hernia of the peritoneal cavity in
congenital variety
TREATMENT
 Congenital hydroceles :
 Special form of indirect inguinal hernia
 May resolve spontaneously
 Treated by herniotomy if unresolved
 Hydrocelectomy
 Inguinal Approach.
 High-resolution scrotal ultrasonography should be
performed in all men with hydrocele
 An inguinal approach to hydrocelectomy is indicated when
sonography or palpation suggests an intratesticular mass
 If no malignant disease is found, needless orchiectomy is
avoided. Hydrocelectomy is then performed by one of the
techniques described later in this section.
 Hydrocelectomy
 Scrotal approach
 May be safely performed when ultrasonographic examination
of the testis is normal
 Simple excision of the thick-
walled hydrocele sac and
oversewn edges
 Jaboulay’s procedure
 Large, thin, floppy sacs
 Bottleneck operation, in which
the sac edges are sewn together
behind the cord
 Lord’s Procedure
 Thin sacs
 Plication is quick and
relatively bloodless
COMPLICATIONS
 Hematoma  most common complication
 The use of a drain does not appear to change the
incidence of complications
 Fertile man, primary danger: injury to the
epididymis or the vas deferens
 If generalized oozing is present and the
possibility of postop hematoma is significant, a
Penrose drain may be placed for 24^ 8 h.