Filariasis can be of leg or scrotum alone as well as of both leg and scrotum

1. Scrotal

3. Introduction to filariasis
 Lymphatic filariasis (obstruction of lymphatic vessels or/and lymph
nodes), commonly known as elephantiasis.
 It is a secondary lymphedema(acquired). Caused by Wuchereria
bandicroft, Brugia malayi, Brugia timori (parasitic nematodes) of
superfamily filarioidae, transmitted by the mosquito:- Culex
fatigans.
 Scrotal filariasis is a painful and visible disfiguring manifestations
of the disease, lymphedema, elephantiasis and scrotal swelling
occur later in life and can lead to permanent disability.
 The nematodes invade the skin and then enters the lymphatics,
where they form nests and multiply.
 In Ayurveda it is correlated to shlipad.

4. Lifecycle of filarial worm

5. Secondary hydrocele is a later stage of scrotal filariasis
 A secondary hydrocele is secondary to either
inflammation or a neoplasm in the testis.
 Secondary hydrocele is also known as
acquired hydrocele because it develops in
higher ages with pathology from
environment, unlike primary hydrocele which
develops in newborn and infants(tunica and
PV distended upto internal ring but sac has
no connection with peritoneal cavity) that is
congenital(PV communicates with peritoneal
cavity).
 Both primary and secondary hydrocele can
be unilateral or bilateral.

6. Symptoms
 Swelling of genital skin that’s
filled with cholesterol rich
fluid.
 Fever.
 Epididymitis.
 Hydrocele.
 Chyluria (lymphatic fluids
leaks into kidneys and turns
urine milky white).
 Male infertility.
 Large size with thickened
sac.

7. investigation
 CBC:- to check the traces if eosinophilia (active
filariasis) only in chronic hydrocele development.
 Peripheral blood count:- for traces of
microfilariae.
 Urinalysis:- for chyluria, hematuria, proteinuria.
 Serum immunoglobulins:- to investigate
increased level of IgE, IgG4, along with
microfilarial infection.
 USG testis:- owls sign
 MRI

8. Physical examination
 Testis not palpable
 Fluctuations not felt
 Cannot get above swelling
 Transillumination:- positive
 Testicular sensation

9. Conservative management
 Diethylcarbamazine(DEC):-
 Ivermectin:-
 Albendazole:-

10. Surgical management
Surgery is only necessary if
hydrocele is present and
conservative management is
unresponsive
Lords plication
Evacuation
Evacuation and eversion
Subtotal excision
Jaboulay’s operation