Describes about Hydrocele, Etiology, Pathogenesis and Management

1. ASI CHENNAI CITY
Prof. R. Nanjunda Rao
SURGICAL CME for UG’s
Hydrocele of Testis
Dr. D. Pradeep, MS, MRCS Edinburgh
Surgery Faculty for PGMEE
Assistant Professor, SSSMC & RI

2. OUTLINE
• Definition
• Applied Anatomy
• Etiology
• Classification
• Features
• Management
• Complications

3. Definition
Collection of serous fluid between the layers of Tunica
Vaginalis in Testis.

4. Embryology

5. Abnormalities
Normal Patent Processus Vaginalis Funicular Hydrocele Hydrocele of Cord

7. Etiology
• Processus Vaginalis abnormalities
Mostly congenital anomaly
• Increased fluid secretion
Secondary to any Inflammation, Injury or Tumor
Increased Aquaporin channels in Tunica vaginalis
• Decreased absorption
• Lymphatic drainage obstruction
Due to lymphatic drainage obstruction either by infections or injury
during surgeries or proximal lymphatic vessel obstructions

8. Classification

9. Congenital Hydrocele
• Patent Processus Vaginalis
• Usually resolves by 1 year of age
• Inverted ink bottle effect
• Silk glove sign
• Herniotomy is the treatment

10. Other Varieties
Funicular Infantile Vaginal Encysted Hydrocele

11. Rare Varieties
Hernia of hydrocele Hydrocele of hernial sac Hydrocele en bisac

12. Secondary Hydrocele
Infection Inflammation Trauma/Injury Tumor
Filariasis Epididymoorchitis Injury to testicular
vessels & lymphatics
during Hernia Sx
Testicular tumors
Tuberculosis Intermittent
testicular torsion
Injury to lymphatics
during renal
transplant
Epididymal
Tumors
Syphilis Trauma Mesothelioma of
Tunica vaginalis

13. Features
• Cystic swelling
• Limited to Scrotum (Able to get above swelling)
• Skin stretched, Rugosities lost
• Transilluminant
• Testis may or may not be palpable
• May or may not be fluctuant
• No cough impulse

14. Differences
PRIMARY HYDROCELE SECONDARY HYDROCELE
Middle aged men or even later Same
Decreased absorption of fluid Excessive production of fluid
Attain large size Tend to be small
Tensely cystic Lax
Testes not palpable owing to
large size
Testes palpable
Rugosities lost Present
Transillumination positive Usually negative

15. Complications of Hydrocele
• Infection
• Pyocele
• Hematocele
• Testicular atrophy
• Hernia of hydrocele
• Infertility

16. Investigations
• Clinical Examination
• High Frequency USG of Scrotum in suspicious cases

17. Treatment for Congenital
• Herniotomy

18. Management
Indications for Intervention
• Increasing pain
• Disturbing size
• Sensation of heaviness
• Long standing
• Multiloculated

19. Treatment
Hydrocele
Treatment
Surgery
Plication Excisional
procedures
Sclerotherapy
Tetracycline
2.5% Phenol
Ethanolamine oleate

20. Surgical Technique

21. Surgical Technique

22. Lord’s Plication
Small and Thin walled hydroceles

23. Andrew/Bottle neck operation
• Only EVERSION OF SAC

24. Jaboulay’s/Winkelman Operation
Large, Thick walled Multiloculated sac

25. Complications d/t intervention
SURGERY SCLEROTHERAPY
Hematoma Scrotal Pain
Infection Recurrence
Recurrence Hematoma
Chronic pain Infection
Injury to cord structures Chemical Epididymoorchitis causing
infertility
• Overall success rate and satisfication higher for surgical procedures in more than
90% whereas in sclerotherapy cases its less than 75%.
• Plication procedures have higher recurrence rates than Excisional procedures.

26. What’s This?

27. Spotter