created by dr.Nitin Alapure

1. Shalya Tantra
Student name – Dr. Nitin V Aalapure
PG 2ND Yr (Shalya tantra department)
Topic name :- Scrotal Diseases

2. Scrotum Anatomy
• Scrotum in male reproductive system , a thin external sac of skin that
divided in two compartments.
• Each compartments contains one of the two testes
• The gland that produce spearm

3. LAYERS OF THE SCROTUM:
Trick :-“Some Dangerous Englishmen Called It The Testis”
S-Skin
D-Dartos muscle and fascia
E- External Spermatic fascia
C- Cremasteric fascia
I- Internal Spermatic fascia
T- Tunica vaginalis
T- Tunica albuginea

4. Descent testes:-
At embryonic age Testis develops in the abdominal cavity. Followed
they Descent in to scrotal sac
Sequence:-
• Loin to iliac fossa – 3rd month of IUL.
• Deep inguinal ring – 4th – 7th IUL.
• In the inguinal canal – 7 th IUL.
• External Inguinal ring – 8th IUL.
• Scrotum –9th month.

6. Clinical Anatomy:
Scrotal
swellings
Cystic
Hydrocele
Epididymal
cyst
Hematocoele
Solid
Tumor(Benign/
Malignant)
Neither
Varicocoele
Hernia

10. Hydrocele
Definition :-
A collection of serous fluid in the tunica vaginalis or
some part of processes vaginalis is know as hydrocele.
• Hydrocele common in newborns and usually disappears
without treatment by age 01 year
• In infants is usually the result of incomplete closure of the
processus vaginalis. It may or may not be associated with
inguinal hernia.

11. Classification :-
Normally the testicles descend from the developing baby's abdominal cavity into the
scrotum sac (processus vaginalis) each testicle, allowing fluid to surround the testicles.
1) Communicating Hydrocele :-
• It’s a type of hydrocele which is communicating Processes vaginalis with
peritoneum.
• Descended testes sac remains open and communiting with peritoneum.
• Found in neonates and children
2) Non communicating Hydrocele :-
• Which is not communicated with peritoneal cavity.
• Caused due to Truma to testis , Infection , excessive secretion of fluid , reduced
absorption
• Mostly found in adults.

13. According to Anatomy :-
1. Congenital Hydrocele
2. Funicular hydrocele
3. Infantile hydrocele
4. Bilocular Hydrocele
5. Encysted hydrocele of cord
According to Etiological Factor:-
1. Congenital Hydrocele
2. Traumatic Hydrocele
3. Inflammatory (Tuberculosis / Epididymitis)
4. Neoplastic (Carcinoma of testis)
5. Miscellaneous

14. Congenital Hydrocele :-
• Also called communicating Hydrocele
• Tunica vaginalis sac communicates with peritoneal cavity.
• Seen in neonates & mostly due to tuberculosis
Encysted Hydrocele of cord:-
• Hydrocele of spermatic cord
• Confirmed with Traction test.
• Differential Diagnosis – Inguinal Hernia
Funicular Hydrocele:-
• Process vaginalis is closed just above the testis
• Sac continues with peritoneal cavity
• DD – Inguinal hernia

15. Infantile Hydrocele:-
Sac from scrotum to deep inguinal ring.
Primary Hydrocele Secondary Hydrocele
Defective absorption of fluid Excessive production of fluid
Swelling is big Swelling is small
Testis is not palpable Testis is palpable
Tapping fluid clear Fluid is not clear
Trans-illumination test +ve Trans-illumination test is -ve
Unknown etiology Known etiology
Progress slowly Progress rapidly
Occurred in old age Generally old age

16. Investigations :-
• Blood investigation
• USG
• Trans illumination test
• Fluctuation test
Complication of Hydrocele :-
• Calcification
• Hernia ( through dartos muscle)
• Sac rupture
• Infection
• Infertility ( hampered spermatogenesis )
Treatment :-
• Aspiration of fluid
• Lords plication
• Partial excision of sac

17. 1) Tapping
Indications
• patient is unfit for surgery or refuses the surgery
• Diagnosis is not confirm
Disadvantages
• Recurrence is max
• Hematoma
• Infection
02) Injection Sclerotherapy :-
Aspiration of fluid followed injection of sclerosing agent such as
tetracycline – fibrosis form

18. Lords Plication :-
Indication :- medium to big size Hydrocele
Anesthesia :- spinal or Genral anaesthesia
Pre operative :-
• Blood investigation
• Fitness for surgery
• Written consent
• Part preparation
• Bowel preparation
• Pre medication

19. Operative procedure :-
Types of incision
A) Vertical incision
• Parallel to blood vessels
• Advantages - less hemorrhage , less pain , less chance of infection
• Disadvantage - dartos muscle may be cut and delay wound
healing
B) Transverse incision :-
• Transvers to blood vessels
• Advantage – dartos muscle preserved and rapid healing
• Disadvantages- more hemorrhage , more chance of infection
C) Oblique incision –
• Quick healing and less bleeding

20. Operative steps :-
• Check anesthesia
• Incision
Vertical incision – cut dartos muscles open layer by Layer upto sac
• Identify Sac – Bluish colour known as tyndall effect
• Introduce trocar and canula into tunica vaginalis
• Hold margin of cut sac
• The sac is plicated behind the testis in fold form
• 6-8 plicated sac margin stitches
Plicating sac put visceral layer directly in contact of S.C layer which
increases absorption
• Put testis into normal position
• Close layer by layer with suturing material
• Dressing and scrotum support

21. Post operative :-
• Scrotal bandage for 24 hr which reduce heamatoma and
oedema
• Analgesic &anti inflammatory
• Antibiotic
• Antacids
• Wound care

22. Varicocele
Defination :- It is a dilatation of pampiniform plexus.
Etiology:-
• Any tumor
• Any malignancy
• Congenital absence of valves
• Constipation
Clinical features:-
• Common in left side
• More incidence in thin and tall persons
• Swelling felt as bag of worms
• Mild pain in scrotum but non-tender.

23. Complications :-
• Oligospermia
• Infertility
Treatment :-
• Excision of pampiniform plexus through inguinal approach

24. Testicular torsion
• Testicular torsion occure when a testicle
rotates , twisting the spermatic cord .
• Testicular torsion most common in age 12
to 20 yr
• It can to extremaly painfull
• It need urgent medical attention to restore
blood flow and prevent loss of testical.
• Etiology-
• Trumatic injury
• Heavy weight lifting

25. • Treatment :-
• Surgical approach to resolve twisting and restore
blood supply
• Fix the testis to scrotal wall with the help of one
stitch for preveting future twisting
• Some time need to excision of testis (Orchiectomy)