Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
D R . H A R M A N D E E P S I N G H
G U I D E D B Y – D R . D . D . W A G H S I R
P R O F E S S O R & H E A D ,
D E P T . ...
INTRODUCTION
 Hydrocele is an abnormal fluid collection between
the visceral and parietal layers of the tunica
vaginalis....
DEVELOPMENTAL ANATOMY
Testis descends from the posterolateral genitourinary
ridge at the beginning of the third trimester ...
 At term, or within the first 1-2 years of life, the
processus vaginalis of the spermatic cord fuses,
obliterating the co...
Layers of Scrotum
 SKIN
 DARTOS MUSCLE
 EXTERNAL SPERMATIC FASCIA
 CREMASTRIC MUSCLE
 INTERNAL SPERMATIC FASCIA
 TUN...
Relevant Anatomy
Lymphatic Drainage
 Scrotal lymphatics drain into the corresponding
superficial inguinal lymph nodes.
Anastomoses to the ...
Risk factors
 Most hydroceles are present at birth (congenital),
and babies who are born prematurely have a higher
risk o...
CLASSIFICATION
 CONGENITAL
 ACQUIRED
I) PRIMARY
II) SECONDARY
CONGENITAL HYDROCELE
 NONCOMMUNICATING HYDROCELE - patent
processus vaginalis obliterates but fluid remains.
 COMMUNICAT...
CONGENITAL HYDROCELE:
PROCESSUS VAGINALIS
COMMUNICATES WITH PERITONEAL
CAVITY
INFANTILE HYDROCELE:
TUNICA &PROCESSUS
VAGINALIS DISTENDED UPTO
INTERNAL RING BUT SAC HAS
NO CONNECTION WITH
PERITONEAL CA...
ENCYSTED HYDROCELE OF
CORD:
PART OF FUNICULAR PROCESS
PATENT, & IS CLOSED FROM
THE TUNICA VAGINALIS BELOW &
PERITONEAL CAV...
HYDROCELE EN BISSAC
TWO INTERCOMMUNICATING
SACS ABOVE & BELOW NECK
OF SCROTUM
Hydrocele En Bissac
Operated at Midnapur Medical College, West Bengal (2008)
HYDROCELE OF CANAL OF NUCK:
OCCURS IN FEMALES IN RELATION ROUND LIGAMENT
ALWAYS IN THE INGUINAL CANAL
HYDROCELE OF HERNIAL
SAC:
NECK OF THE HERNIAL SAC
BECOMES CLOSED BY
ADHESIONS OR PLUGGED BY
OMENTUM.
RESULTS IS RETENTION ...
 INFECTIONS:
FILARIASIS
TUBERCULOSIS OF EPIDIDYMIS
SYPHILIS
 INJURY
POST HERNIORRHAPHY HYDROCELE
POST VARICOCELECTOMY HY...
ETIOLOGY
 In older men, any process that acts to stimulate increased production of
watery fluid by the tunica or decrease...
 COMMON IN COASTAL/TROPICAL REGIONS ,
ACCOUNTS FOR 80 % OF ALL HYDROCELES IN
TROPICAL REGIONS, CAUSED BY Wucheria bancrof...
Filarial Hydrocele
SIGNS & SYMPTOMS
 In the early stages hydroceles are usually asymptomatic. As they
enlarge they bulge out and can become ...
1. INFECTION
2. PYOCELE,HEMATOCELE/CLOTTED
HEMATOCELE
3. CALCIFICATION OF SAC (D/D FOR TESTICULAR
TUMOUR)
4. INFERTILITY
5...
PHYSICAL ASSESSMENT
 Smooth, cystic mass completely
surrounding the testis and not
involving the spermatic cord(Possible
...
 When the fluid in the hydrocele
is clear, Transillumination is
positive.
 Transillumination may be
negative in filarial...
 Hydroceles are generally painless. The presence of
pain, redness and edema with loss of the normal
scrotal rugae is sugg...
PRIMARY
 TESTIS NOT PALPABLE
 TENSE,FLUCTUANT
 TRANSILLUMINANT
 CAN GET ABOVE
SWELLING
FEATURES : PRIMARY VS SECONDARY...
LABORATORY STUDIES
 Laboratory evaluation is generally not essential to
the evaluation of hydroceles.
 Leukocytosis with...
IMAGING STUDIES
 Uncomplicated hydroceles do not require
radiographic studies. Findings from USG can help
evaluate for an...
1. TESTICULAR TUMOUR
2. EPIDIDYMAL CYST
3. SPERMATOCELE
4. SCROTAL EDEMA
5. IRREDUCIBLE INGUINAL HERNIA
DIFFERENTIAL DIAGN...
In Children,
 A Non-communicating Hydrocele usually resolves
spontaneously by the time the child reaches the age
of 1 yea...
TREATMENT
In Adults,
 Treatment depends upon the age of the patient and the
degree of discomfort caused by the hydrocele....
Principle of Surgery
Techniques include –
 LORDS PLICATION
used for small to medium hydroceles with thin sac. Benefits - ...
LORD’S PLICATION
JABOULAY’S PROCEDURE
JABOULAY’S PROCEDURE
 INJURY TO VAS DEFERENS
 INJURY TO URETHRA
 INJURY TO TESTIS/EPIDIDYMIS
 REACTIONARY HAEMORRHAGE
 INFECTION
 SINUS F...
COMPARISON
COMPARISON
Hydrocele Seminar - A comprehensive review of literature
Hydrocele Seminar - A comprehensive review of literature
Hydrocele Seminar - A comprehensive review of literature
Hydrocele Seminar - A comprehensive review of literature
Hydrocele Seminar - A comprehensive review of literature
Hydrocele Seminar - A comprehensive review of literature
Hydrocele Seminar - A comprehensive review of literature
Upcoming SlideShare
Loading in …5
×

Hydrocele Seminar - A comprehensive review of literature

1,324 views

Published on

A seminar on Hydrocele.

Published in: Healthcare
  • Hi there! Essay Help For Students | Discount 10% for your first order! - Check our website! https://vk.cc/80SakO
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Hydrocele Seminar - A comprehensive review of literature

  1. 1. D R . H A R M A N D E E P S I N G H G U I D E D B Y – D R . D . D . W A G H S I R P R O F E S S O R & H E A D , D E P T . O F G E N E R A L S U R G E R Y , D . M . I . M . S . , S A W A N G I ( M ) HYDROCELE
  2. 2. INTRODUCTION  Hydrocele is an abnormal fluid collection between the visceral and parietal layers of the tunica vaginalis.  In infants it is usually the result of incomplete closure of the processus vaginalis. It may or may not be associated with inguinal hernia. In older boys and men it may be idiopathic but more likely to be secondary to another pathologic process in the scrotum or adjacent structures
  3. 3. DEVELOPMENTAL ANATOMY Testis descends from the posterolateral genitourinary ridge at the beginning of the third trimester of fetal gestation, a saclike extension of peritoneum descends in concert with the testis. As descent progresses, the sac envelops the testis and epididymis. The result is a serosal-lined tubular communication between the abdomen and the tunica vaginalis of the scrotum. The peritoneum-derived serosal communication is the processus vaginalis, and the serosa of the hemiscrotum becomes the tunica vaginalis.
  4. 4.  At term, or within the first 1-2 years of life, the processus vaginalis of the spermatic cord fuses, obliterating the communication between the abdomen and the scrotum. The processus fuses distally as far as the lower epididymal pole and anteriorly to the upper epididymal pole. Failure of complete fusion may result in communicating hydroceles, indirect inguinal hernias, and the bell- clapper deformity of abnormal testicular fixation in the scrotum.
  5. 5. Layers of Scrotum  SKIN  DARTOS MUSCLE  EXTERNAL SPERMATIC FASCIA  CREMASTRIC MUSCLE  INTERNAL SPERMATIC FASCIA  TUNICA VAGINALIS
  6. 6. Relevant Anatomy
  7. 7. Lymphatic Drainage  Scrotal lymphatics drain into the corresponding superficial inguinal lymph nodes. Anastomoses to the lymphatics of the contralateral network across the median raphe occur.  Testicular lymphatics via the spermatic cord drain to the paraaortic nodes.
  8. 8. Risk 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)  Risk factors for developing a hydrocele later in life include: Scrotal injury (Traumatic/Iatrogenic), Infection including sexually transmitted infections, Tumours.
  9. 9. CLASSIFICATION  CONGENITAL  ACQUIRED I) PRIMARY II) SECONDARY
  10. 10. CONGENITAL HYDROCELE  NONCOMMUNICATING HYDROCELE - patent processus vaginalis obliterates but fluid remains.  COMMUNICATING HYDROCELE - the sac remains open in communication with the peritoneal cavity.
  11. 11. CONGENITAL HYDROCELE: PROCESSUS VAGINALIS COMMUNICATES WITH PERITONEAL CAVITY
  12. 12. INFANTILE HYDROCELE: TUNICA &PROCESSUS VAGINALIS DISTENDED UPTO INTERNAL RING BUT SAC HAS NO CONNECTION WITH PERITONEAL CAVITY
  13. 13. ENCYSTED HYDROCELE OF CORD: PART OF FUNICULAR PROCESS PATENT, & IS CLOSED FROM THE TUNICA VAGINALIS BELOW & PERITONEAL CAVITY ABOVE. SMOOTH,OVAL SWELLING ASSOCIATED WITH SPERMATIC CORD.  TRACTION TEST
  14. 14. HYDROCELE EN BISSAC TWO INTERCOMMUNICATING SACS ABOVE & BELOW NECK OF SCROTUM
  15. 15. Hydrocele En Bissac Operated at Midnapur Medical College, West Bengal (2008)
  16. 16. HYDROCELE OF CANAL OF NUCK: OCCURS IN FEMALES IN RELATION ROUND LIGAMENT ALWAYS IN THE INGUINAL CANAL
  17. 17. HYDROCELE OF HERNIAL SAC: NECK OF THE HERNIAL SAC BECOMES CLOSED BY ADHESIONS OR PLUGGED BY OMENTUM. RESULTS IS RETENTION OF FLUID SECRETED BY PERITONEUM OF HERNIAL SAC
  18. 18.  INFECTIONS: FILARIASIS TUBERCULOSIS OF EPIDIDYMIS SYPHILIS  INJURY POST HERNIORRHAPHY HYDROCELE POST VARICOCELECTOMY HYDROCELE TRAUMA  TUMOUR MALIGNANCY SECONDARY HYDROCELE
  19. 19. ETIOLOGY  In older men, any process that acts to stimulate increased production of watery fluid by the tunica or decrease the absorption of this fluid by the scrotal lymphatics or venous system will result in the formation of a hydrocele.  Increased production of fluid could be due to: Inflammation of the testis (orchitis) or epididymis (epididymitis) caused by tuberculosis and by tropical infections such as filariasis. Testicular torsion (rotation of the testis) may cause a reactive hydrocele in 20% of cases. Tumors of the testis, especially germ cell tumors or tumors of the testicular adnexa may cause hydrocele.  Decreased resorption of fluid could be due to: Surgery in the inguinal region or a renal transplantation can affect the lymphatics or venous system causing decreased absorption. Radiation therapy is associated with cases of hydrocele. Peritoneal dialysis and ventriculoperitoneal shunts.
  20. 20.  COMMON IN COASTAL/TROPICAL REGIONS , ACCOUNTS FOR 80 % OF ALL HYDROCELES IN TROPICAL REGIONS, CAUSED BY Wucheria bancrofti  REPEATED ATTACKS OF FILARIAL EPIDIDYMITIS  SIZE- LARGE SIZE WITH THICKENED SAC  OCCASIONALLY CONTAINS CHOLESTEROL RICH FLUID – CHYLOCELE DUE TO RUPTURED LYPMH VARIX WITH DISCHARGE OF CHYLE IN TO THE HYDROCELE  RESEMBLES PRIMARY HYDROCELE  MAY BE ASSOCIATED WITH FILARIAL ELEPHANTIASIS. FILARIAL HYDROCELE
  21. 21. Filarial Hydrocele
  22. 22. SIGNS & SYMPTOMS  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 the back.  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.
  23. 23. 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:
  24. 24. 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
  25. 25.  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
  26. 26.  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.
  27. 27. PRIMARY  TESTIS NOT PALPABLE  TENSE,FLUCTUANT  TRANSILLUMINANT  CAN GET ABOVE SWELLING FEATURES : PRIMARY VS SECONDARY HYDROCELE SECONDARY TESTIS MAY BE PALPABLE SOFT,FLUCTUANT, MAYBE TENSE IN CASE OF FILARIAL SCROTUM TRANSILLUMINANT CAN GET ABOVE SWELLING
  28. 28. LABORATORY STUDIES  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).
  29. 29. 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.
  30. 30. 1. TESTICULAR TUMOUR 2. EPIDIDYMAL CYST 3. SPERMATOCELE 4. SCROTAL EDEMA 5. IRREDUCIBLE INGUINAL HERNIA DIFFERENTIAL DIAGNOSIS
  31. 31. In Children,  A Non-communicating 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 a Communicating Hydrocele & requires Herniotomy TREATMENT
  32. 32. TREATMENT 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. Indications for surgery –  Scrotal discomfort or pain  Cosmetic - disfigurement due to the sheer size of the hydrocele.
  33. 33. Principle of Surgery 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  CONGENITAL HYDROCELE ARE TREATED BY HERNIOTOMY.
  34. 34. LORD’S PLICATION JABOULAY’S PROCEDURE
  35. 35. JABOULAY’S PROCEDURE
  36. 36.  INJURY TO VAS DEFERENS  INJURY TO URETHRA  INJURY TO TESTIS/EPIDIDYMIS  REACTIONARY HAEMORRHAGE  INFECTION  SINUS FORMATION  RECURRENT HYDROCELE COMPLICATIONS OF SURGERY
  37. 37. COMPARISON
  38. 38. COMPARISON

×