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HYDROCELE

DEFINITION:
The excessive fluid in the tunica
vaginalis testis.
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Type of Hydrocele
Embryology
 The testis descends into the scrotum from its
abdominal position, it carries with it a tongue of
peritoneum (the processus vaginalis).
 Normally, the processus is obliterated from the
internal inguinal ring to the upper scrotum, leaving
a small potential space in the scrotum that partially
surrounds the testis.
 During the normal embryologic processes that
involve descent of the testis and closure and
obliteration of the processus vaginalis.
 A number of embryologic misadventures may
occur that can result in commonly seen inguinal or
scrotal pathology (hydrocele, hydrocele of the
cord, and communicating hydrocele).
Anatomy of the Scrotal
Clinical:
1. Congenital (primary) hydrocele

2. Acquired (secondary) hydrocele – due to +


- due to ?
3. Hydrocele of the funiculus ( funicocele )
PATHOPHISIOLOGY:
A. Congenital hydrocele (primary)
The tunica vaginalis cavity is connected to the peritoneal
cavity, the peritoneal fluid can flow in and out.

B. Acquired Hydrocele (secondary)


Disturbance in the fluid production-reabsorption process
in the tunica vaginalis cavity.
Could be : a. Excessive production.
b. Defective reabsorption
c. Combination a + b.
The fluid circulating in the tunica vaginalis cavity function
as a heat transmitter, the temperature of the testicle,
remains optimal for spermatogenesis.
Diagnosis:
History :
* Mass (enlargement) of the scrotum
* Painless (except extremely large or
infected)
Diagnosis:
Physical examination :
* Cystic consistency / fluctuative.
* If large hard / tense.
* pain (-).
* transillumination (+).
* testis located behind / beneath the mass.
* If extremely large / tense the testis difficult to
palpate (sometimes necessary to aspirate first)
* Aspiration fluid clear light yellowish
(to be done in sterile condition).
THERAPY:
In the past ‘sclerosing therapy’
by instilling Na-morhuate/
(sclerosing agent) into the
tunica vaginalis
This method indevelopable due to necrotic
complications.
THERAPY:
Particularly in babies and children :
Operative therapy of congenital hydrocele
(primary) in the form of processus vaginalis
peritonei ligation similar to herniotomy in children.
THERAPY:
A. OPERATIVE
a. Bergman : - opening the sac & taking out the fluid/aspirate.
- simple but often reccurent .
b. Winkelman : - excision of the sac (tunica vaginalis testis)
c. Bergman-Winkelman : - combination of both methods.
- relatively simple and widely used
d.Jaboulay-Winkelman : - BW + herniotomy (children).
e. Lord : - plication of the sac without excision.
- often reccurent due to loosening of plication.
f. Andrew : - known as ‘bottle neck operation’.
- the sac not excissed, but inverted sutured
- often done on old people or in cases of
thickening of the sac.
Bergman-
Winkelman’s
Operation
Lord’s
Operation
Andrew’s
Operation
THERAPY:

B. FOR THOSE WHO REFUSED


OPERATION
- Observation only when small.
- When extremely large and painfull
repeated aspirations
(intermittently)
Aspiration
of
Hydrocele
T H E R A P Y:
C. SECONDARY HYDROCELE
Special therapy for the primary disease.
PROGNOSIS : Good
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