Hydrocele is an abnormal fluid accumulation in the scrotum, often congenital in infants and may be associated with other pathologies in older males. Diagnosis typically involves physical examination and possible imaging to confirm the presence of fluid, with treatment largely dependent on symptoms and age, ranging from observation in infants to surgical options for persistent cases. Most hydroceles resolve without treatment, and the condition does not generally affect fertility.

1. Hydrocele

2. INTRODUCTION
 Hydrocele is an abnormal fluid collection in the
scrotum between the visceral and parietal areas of
the tunica vaginalis.
 In infants is usually the result of incomplete closure
of the process us tunica 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. Structure

4. In rare cases, similar fluid
collections can develop in females
along the canal of Nuck.[2, 3, 4]See
the image below.

5. Hydrocele in female

6. TYPES

8. Epidemiology
 In endemic areas of lymphatic filariasis, hydrocele rates vary and can
reach as high as 50%. processus vaginalis, but most close
spontaneously within 18 months of age.
 The incidence of hydrocele is rising with the increasing survival rate of
premature infants.
 Most hydroceles are congenital and are noted in children aged 1-2
years.
 Chronic or secondary hydroceles usually occur in men older than 40
years.
 Noncommunicating hydroceles are the most common type of hydrocele
globally, affecting more than 30 million men and boys[
 In endemic areas of lymphatic filariasis, hydrocele rates vary and can
reach as high as 50%.

9. ETIOLOGY
 Idiopathic hydrocele, the most common type,
generally arises over a long period of time

10. ETIOLOGY OF HYDROCELE
• Primary
1. Congenital
2. Vaginal
3. Infantile
4. Hydrocele of the cord
• Secondary
1. Epididymorchitis
2. Torsion
3. Tumor
4. Post herniotomy

11. CAUSES
 Infectious disease of Epididymis.
 Local trauma
 Systematic infectious disease like Mumps.
 Imbalance in production and reabsorption of fluid
with in the tunica vaginalis.
 An opening between the peritoneum and tunica
vaginalis.

12. Structure

13. Risk factors
 Most hydroceles are present at birth (congenital),
and babies who are born prematurely have a higher
risk of having a hydrocele.
 Risk factors for developing a hydrocele later in life
include:
 Scrotal injury
 Infection, including sexually transmitted infections

14. SIGNS & SYMPTOMS
 A bulge in the groin
 Scrotal enlargement is the classic presentation of hernia or
communicating hydrocele.
 Pain is generally not a prominent feature but may occur if a
hydrocele expands quickly; tension in the wall may cause
milder pain.
 Hydrocele may become infected and cause pain.
 Frequently, parents report an intermittent bulge. The bulge
may reduce at night in the supine position. A history of
vomiting, colicky abdominal pain, or constipation
suggests bowel obstruction, which may occur with an
incarcerated or strangulated hernia.

15. Cont….
 Constant discomfort
 Embarrassment
 Impaired circulation
 Scrotal mass become large
 Tense swelling

16.  Although rare, large, noncommunicating
hydroceles may extend through the inguinal ring
and into the abdomen creating an abdominal
scrotal hydrocele. This condition is suspected
when abdominal extension of the hydrocele into
the abdominal cavity is present on examination
and confirmed by sonogram.

17. Abdominal Scrotal Hydrocele

18. Diagnosis
 The diagnosis of hydrocele can be made by physical
examination and transillumination of the scrotum
that demonstrates a cystic fluid collection.
Communicating hydroceles are often reducible;
noncommunicating hydroceles are not. Doppler
ultrasonography may be necessary to evaluate the
testicle and rule out a primary cause or to determine
if an abdominoscrotal hydrocele is present.

19. Diagnostic Evaluation
PHYSICAL ASSESSMENT:
 The exam may reveal an enlarged scrotum that isn't tender
to the touch. Pressure to the abdomen or scrotum may
enlarge or shrink the fluid-filled sac, which may indicate an
associated inguinal hernia.
 Because the fluid in a hydrocele usually is clear, doctor may
shine a light through the scrotum (transillumination). With
a hydrocele, the light will outline the testicle, indicating
that clear fluid surrounds it.

20. Cont….
 Blood and Urine tests may help determine whether there is an
infection, such as epididymitis.
 The fluid surrounding the testicle may keep the testicle from being
felt. In that case, Ultrasound imaging test is done.
 Role of ultrasonography ?
• Testis not palpable ; Vaginal hydrocele.
• Palpable but suspicious
• Acute hydrocele
 Trans-illumination
-This test can rule out a hernia, testicular tumor or other
cause of scrotal swelling.

21. TREATMENT
 Hydroceles usually improve without any treatment
within the first year of life. An operation is usually
only advised if the hydrocele persists after 12-18
months of age.
 In Adult: Treatment depends upon the age of patient
and the degree of discomfort caused by the
hydrocele.Surgical excision forms the definitive
therapy for hydroceles.
 When they are small and asymptomatic, hydrocele
require no treatment other than reassurance.

22. Pharmcological help

23.  Indication for surgery
1. Scrotal discomfort or pain
2. Cosmetic-disfigurement due to the sheer size of the
hydrocele

24. Surgery
Techniques include-
 Lords plication:used for small to medium hydrocele 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 and everted and sutured behind the testis,
associated with a reduced risk of recurrence,may have an increase risk of
hematoma.
 Subtotal excision or Hydrocelectomy.
 In case of large sac,where there is risk of a large redundant swelling post
operation, excision of the sac with 1cm margin around the testis and epididymis?
Filarial sac.
 Sharma and Jhawers technique
 Aspiration with/without injection sclerosing agent such as urea hydrochloride
into the scrotal sac
 Herniotomy.

25. Lord plication

26. Jaboulay procedure steps

27. Cont….
 Incision of Tunica Vaginalis:
> An incision made through the wall of the scrotum
down to the distanced Tunica Vaginalis.
> The sac is resected or after being opened, is sutured
together to collapse the wall.
 Hydrocelectomy:
> Excision of the tunica vaginalis to withdraw the fluid
collection from it.

28. Cont….
 The operation for a hydrocele involves making a very
small cut in the lower tummy (abdomen) or the
scrotum. The fluid is then drained from around the
testicle (testis). The passage between the abdomen and
the scrotum will also be sealed off so the fluid cannot
reform in the future. This is a minor operation and is
performed as a day case, so does not usually involve an
overnight stay in the hospital.
 There are no long-term effects of having a hydrocele.
Having a hydrocele does not affect the testicles (testes)
or a boy's fertility in the future.

29. Potential Complications from Surgery
1. Injury to vas deference
2. Injury to urethra.
3. Injury to testis/epididymis.
4. Reactionary Haemorrhage
5. Infection.
6. Sinus Formation.
7. Recurrent Hydrocele

30. Nursing diagnosis

31. Nursing Management
 A pressure dressing is applied on the scrotum which
is elevated.
 The patient should be observed carefully for any
symptoms of Hemorrhage and Bleeding may not be
external.
 The patient needs a scrotal support when he is up.
 Scrotum is elevated on a pillow or bride dressing.
 Ambulation is encouraged with scrotal support.

32. 
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