The document defines hydrocele as a fluid collection between the layers of the tunica vaginalis of the testis, discussing its types (congenital and acquired), causes, distinguishing features, and diagnostic methods. It describes the characteristics of the hydrocele fluid, provides details on various hydrocele types, their causes, and treatment options, including several surgical interventions. Differential diagnoses and possible complications associated with hydrocele are also addressed.

1. en love da Homoeopathy
HYDROCELE

2. HYDROCELE

3. HYDROCELE
DEFINITION
• It is the collectionof fluid
betweenthe two layersof
tunica vaginalis of testis.
TYPES
• Congenital ™
• Acquired
• Primary
• Secondary

4. AETIOLOGY
• Defective absorption of fluid
by the tunicavaginalis,
probably due to damage to
the endothelial wall by low-
grade infection.
• Excessiveproductionof fluid
as in secondary hydrocele.
• Interference withdrainage of
fluid by lymphaticvessels of
the cord.
• Communicationwiththe
peritoneal cavity.
FEATURES
• Hydrocele fluid is
amber-colouredwith
specificgravity of 1.022
to 1.024.
• It contains water, salts,
albumin, fibrinogen.
• Per se, hydrocele fluid
does not clot, but if it
comes in contact with
the blood, fibrinogen
gets activated and clots
firmly.

5. • Oftenfluidcontains
cholesterol and tyrosine
crystals.
• Cysts which contain
cholesterol crystals ™
• Vaginal hydrocele ™
• Branchial cysts ™
• Dentigerous cyst
TYPES
PRIMARYVAGINAL
HYDROCELE
• Occurs in middle-aged,
commonin tropical
countries.
Testis is not palpable as it
usually attains a large size
↓
(unlikesecondaryhydroceles
whichare small, except in
filarial hydrocele).

6. .
↓
Fluctuant (elicited by, fixing
the hydrocele with hand
↓
and feeling for the fluid
movement using fingers placed
in two perpendicular
directions).
↓
Initially transilluminant
(elicited in front of the swelling,
side to side)
↓
but long-standing hydrocele is
nontransilluminant
↓
(due to thickened dartos,
thicke ned spermaticfascia,
thickenedhydrocele sac,
infected content, chylous
fluid, oftenfilarial hydrocele,
haematocele).
↓
Canget abovethe swelling
(you can feel only cord
structures
↓
and nothing else at the root of
the scrotum, unlike in
hernia).

7. ↓
Testicular sensation canbe
elicitedin vaginal hydrocele
↓
by transmitting the pressure
sensation through the fluid.
↓
Swellings which are brilliantly
transilluminant
• Epididymal cyst ™
• Cystichygroma ™
• Ranula ™
• Meningocele
Infantile Hydrocele
• Here tunica and processus
vaginalis (hydrocele)are
distendedup to internal ring,
but sac has no con nection
with the general peritoneal
cavity.

8. Congenital Hydrocele
• Processus vaginalis
communicates with the
peritoneal cavity.
As this communicating orifice
is too small,
↓
bowel does not descend
↓
and so hernia usually will not
develop.
↓
Whilelying down, fluid
disappears gradually and
whilestanding fluid recollects.
↓
Hydrocele cannot be emptied
by digital pressure as it causes
“invertedink bottle” effect.
↓
Ascites, tuberculous
peritonitis are the aetiologies
for the same

9. Encysted Hydrocele of the Cord
• It is the fluidcollectionin a
portionof patent funicular
processpart of the tunica
vaginalis;
• but closed above and below;
located in
inguinal/inguinoscrotal/scro
tal part which is fluctuant
and transilluminant.
• On gentle traction to the
testis, the swelling becomes
less mobile (traction test).
DIFFERENTIAL
DIAGNOSIS
• Epididymal cyst
• inguinal hernia
• lipoma of cord,
varicocele.
TREATMENT
• Treatment is excision
under local
anaesthesia

10. Hydrocele-en-bisac(Bilocular
Hydrocele)
• Hydrocele has got two
intercommunicating sacs,
one aboveand one below
the neck of the scrotum.
• Upper one lies superficial
or in the inguinal canal or
may insinuateitself
betweenthe muscle
layers—cross-fluctuant
Hydrocele of the Canal of Nuck
• It occurs in females, in
relationto the round
ligament, alwaysin the
inguinal canal.
• Hydrocele of theHernial
Sac
• It is due to adhesions of the
content of hernial sac.
• Fluidsecreted collects in
the hernial sac and forms
hydrocele of the hernial
sac.

11. SECONDARYVAGINAL
HYDROCELE
Causes
• It is usually small, lax and
testis is usually palpable
(unlike primary hydrocele).
Exceptionis, secondary
hydrocele due to filariasis.
• It can be very large.
Infection:
• Filariasis Tuberculosis
of epididymis - have
secondary hydrocele
• Syphilis Injury:
Trauma
• Postherniorrhaphy
• hydrocele Tumour:
Malignancy
• Secondaryhydrocele
rarely attains large
size

12. Postherniorrhaphy Hydrocele
• It is a secondary hydrocele
occurring after the surgery
for inguinal hernia.
• It is due to the damageto
lymphatic vessels of the
tunica vaginalis
• It is treatedlike any
hydrocele but usually after
about 6 months.
• Filarial Hydrocele and
Chylocele
• Occurs commonlyin
coastal region, and in
and aroundthe equator.
• Usually occurs after
repeated attacks of
filarial epididymitis.
• Hydrocele is usually of
large size and the sac is
thickened.
• Fluidcontains fat, richin
cholesterol, and is derived
fromruptured lymph
varixinto the tunica.

13. • It is often difficult to
differentiatefromprimary
hydrocele.
COMPLICATION
• Hydrocele
• Infection™
• Pyocele ™
• Haematocele™
• Atrophy of testis ™
• Infertility ™
• Hernia of hydrocele sac
(rare)
DIFFERENTIAL DIAGNOSIS
• Inguinal hernia™
• Epididymal cyst ™
• Spermatocele ™
• Testicular tumour™
• Scrotal oedema

14. TREATMENT
Surgery
• Sub-total excision™
• Partial excision and
eversion(Jaboulay’s opera
tion) ™
• Evacuation and eversion ™
• Lord’s plication
• Surgeries for hydrocele ™
• Subtotal excisionof the
sac ™
Jaboulay’s operation™
• Evacuation and eversion ™
• Lord’s plication™
Sharma
and Jhawer’s technique
COMPLICATION OF SURGERY
• Reactionary haemorrhage
• Infection™
• Pyocele ™
• Sinus formation ™
• Recurrent hydrocele
• Conditions which cause loss
of testicular sensation
i. Testicular tumour
ii. Lepraorchitis
iii. Syphilitic orchitis
iv. Chronichaematocele

15. • Conditions where
orchidectomy is done in
hydrocele ™
• Pyocele with testicular
destruction ™
• Clottedhaematocele with
testicular destruction
REFERENCE
1. SRB's Manual of Surgery
by SriramBhatM
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

16. A
Special Thanks
To A Very
Special Doctor