A brief presentation of Hydrocele

1. BY TLALI

3. WHAT IS HYDROCELE
A hydrocele is a collection of fluid in
the scrotum.
OR
A hydrocele is a collection of fluid in a
sac in your scrotum next to a testicle
(testis). It usually occurs on one side
but sometimes a hydrocele forms over
both testicles (testes).

5. PATHOPHYSIOLOGY
 The normal testis is surrounded by a
smooth protective tissue sac. You cannot
normally feel this. It makes a small amount
of 'lubricating' fluid to allow the testis to
move freely. Excess fluid normally drains
away into the veins in your scrotum. If the
balance is altered between the amount of
fluid that is made and the amount that is
drained, some fluid accumulates as
a hydrocele.

6. In infants it is
usually the
result of
incomplete
closure of the
processus
vaginalis.

7. CAUSES AND PREDISPOSING
FACTORS
 Most hydroceles are present at birth (congenital),
and babies who are born prematurely have a
higher risk of having a hydrocele.
 Incidence : 3.5 to 5.0% in full term infants and 44
to 55% in premature and Low birth weight babies
(Groff D, Nagaraj HS, Pietsch JB, Inguinal hernias
in premature infants who were operated on before
their discharge from the neonatal intensive care
unit Arch Surgery 1985)

8. Risk factors for developing a hydrocele
later in life include: Scrotal injury
(Traumatic/Iatrogenic), Infection
including sexually transmitted
infections, Tumours.

9. EXCESS ALCOHOL USE OR
ABUSE

10. CLINICAL PRESENTATION
 In the early stages hydroceles are usually
asymptomatic. As they enlarge they bulge
out and can become a cosmetic problem.
 Symptoms can develop, as the swelling
increases in size, which include: Heaviness,
fullness, or dragging sensations due to an
enlarged scrotum.
 There may be mild discomfort radiating
along the inguinal area to the mid portion of

11.  If pain develops in a Hydrocele it is usually
an indication of acute epididymal infection
or due to overstretched scrotal skin in huge
hydroceles.
 The size may decrease with recumbency or
increase in the upright position.
 Fever, chills, nausea, or vomiting indicate an
infection of a hydrocele.

12. DIAGNOSTIC TECHNIQUES
AND LAB TESTS

13. PHYSICAL ASSESSMENT
 Smooth, cystic mass completely
surrounding the testis and not
involving the spermatic
cord(Possible to get above the
swelling) is characteristic of a
hydrocele.
 The consistency of hydroceles can
vary with position. Sometimes a
hydrocele can become smaller and
softer on lying down and become
larger and tenser after prolonged
standing.
Getting above the Swelling

14. TESTIS MAY BE PALPABLE
SOFT,FLUCTUANT, MAYBE TENSE IN CASE OF
FILARIAL SCROTUM
CAN GET ABOVE SWELLING

15. TRANSLLUMINATION
 When the fluid in the
hydrocele is clear,
Transillumination is
positive.
 Transillumination may
be negative in filarial
hydrocele due to
prescence of chyle,
calcification or in
complicated
hematocele/pyocele

16. LAB TESTING
 Laboratory evaluation is generally not essential to the
evaluation of hydroceles.
 Leukocytosis with a higher percentage of neutrophils
suggests an infectious and/or inflammatory process
(eg, epididymo-orchitis).

17. IMAGING STUDIES
Uncomplicated hydroceles do not
require radiographic studies. Findings
from USG can help evaluate for an
underlying process, such as a tumour or
torsion.

18. DIFFRENTIAL DIAGNOSIS
Hydroceles are generally painless. The
presence of pain, redness and edema
with loss of the normal scrotal rugae is
suggestive of an inflammatory lesion
like epididymitis or epididymo-orchitis
or filarial relapses.

19. MEDICAL MANAGEMENT
 In infancy, Hydrocele usually resolves spontaneously by the
time the child reaches the age of 1 year.
 A hydrocele that persists longer than 12 to 18 months is
usually requires Herniotomy
In Adults,
 Treatment depends upon the age of the patient and the
degree of discomfort caused by the hydrocele. Surgical
excision forms the definitive therapy for hydroceles.
 When they are small and asymptomatic, hydroceles require
no treatment other than reassurance.

20. Surgical intervention
Indications for surgery –
Scrotal discomfort or pain
Cosmetic - disfigurement due to the
sheer size of the hydrocele.

21.  Techniques include –
 LORDS PLICATION
 used for small to medium hydroceles with thin sac. Benefits - reduced risk of
hematoma.. Some articles suggest a slight incidence of recurrence of the
hydrocele following this procedure.
 JABOULEYS OPERATION
 the sac & everted and sutured behind the testis, associated with a reduced risk
of recurrence, may have an increased risk of hematoma.
 SUBTOTAL EXCISION or HYDROCELECTOMY
 In cases of large sac, where there is risk of a large redundant swelling post
operatively, excision of the sac with 1 cm margin around the testis &
epididymis. ?Filarial Sac
 SHARMA & JHAWERS TECHNIQUE
 ASPIRATION WITH/WITHOUT INJECTION OF SCLEROSING AGENT
 HERNIOTOMY.

22. INJURY TO VAS DEFERENS
INJURY TO URETHRA
INJURY TO TESTIS/EPIDIDYMIS
REACTIONARY HAEMORRHAGE
INFECTION
SINUS FORMATION
RECURRENT HYDROCELE
COMPLICATIONS OF SURGERY

23. PHARMACOLOGICAL HELP
No pharmacological management
directed directly to Hydrocele,
But can be indicated towards problems
arising
However ANTIBIOTIC THERAPY IS
NECESSARY specifically Pre – and
Post-surgical invasion

24. NURSING DIAGNOSIS
TO BE DISCUSSED WITH
THE COLLEGUES

25. NURSING MANAGEMENT
TO BE DISCUSSED
WITH THE CLASS

26. 1. INFECTION
2. PYOCELE,HEMATOCELE/CLOTTED
HEMATOCELE
3. CALCIFICATION OF SAC (D/D FOR
TESTICULAR TUMOUR)
4. INFERTILITY
5. ATROPHY OF TESTIS
6. HERNIATION OF HYDROCELE SAC (rare)
7. RUPTURE (rare)
COMPLICATIONS OF HYDROCELE