The document discusses hydrocele, an abnormal collection of fluid in the processus vaginalis, detailing its types, characteristics, and causes, including primary and secondary hydroceles. It outlines diagnostic features such as transillumination, palpability of the testis, and conditions associated with hydroceles, as well as treatment options based on size and type. Additionally, it differentiates between similar conditions and discusses complications and the role of ultrasonography in diagnosis.

1. HYDROCELE
Dr. Ashok Kumar
Professor
Department of Surgery
LHMC & SSK Hospital

2. Why is it Hydrocele ?
• Can get above the swelling
• Fluctuation present
• Transillumination present
• Testis not palpable
• Non reducible swelling
• Impulse on coughing absent

3. Definition ?
• Abnormal collection of serous fluid in some
part of the processus vaginalis usually tunica.

4. TYPES OF HYDROCELE ?
• Primary
• Secondary

5. PRIMARY HYDROCELE ?
• Congenital
• Vaginal
• Infantile
• Hydrocele of the cord

6. SECONDARY HYDROCELE ?
• Causes :-
1. Epididymorchitis
2. Torsion
3. Tumor
4. Post herniotomy

7. Characterstics of secondary
hydrocele ?
1. Lax
2. Moderate size
3. Testis palpable

8. CHARACTERSTICS OF
HYDROCELE FLUID ?
• Amber colour
• Specific gravity – 1.022 – 1.024
• Water, salts , Albumin, Fibrinogen
• Cholesterol and tyrosine crystals

9. CYST WHICH CONTAINS
CHOLESTEROL CRYSTALS ?
• Vaginal hydrocele
• Branchial cyst
• Dentigerous cyst

10. Conditions in which we cant get
above the swelling ?
• Congenital hydrocele
• Infantile hydrocele

11. Can hydrocele present as purely
inguinal swelling ?
YES
Encysted hydrocele of the cord.

12. Conditions in which hydrocele
presents as inguinoscrotal swelling
?
• Congenital hydrocele
• Infantile hydrocele

13. Can hernia present as purely
scrotal swelling ?
• Herniation of hydrocele through dartos
muscle.

14. SWELLING WHICH REDUCE ON
LYING DOWN ?
• Reducible Hernia
• Varicocele
• Lymph varix
• Congenital hydrocele

15. Hydrocele in females ?
• Hydrocele of the canal of nuck.

16. Conditions in which there is loss of
testicular sensations ?
• Syphilitic gumma
• Lepromatous orchitis
• Advanced testicular tumor

17. SWELLINGS SHOWING CROSS
FLUCTUATION ?
• Plunging ranula
• Compound palmar ganglion
• Psoas abscess
• Hydrocele en bisac (Bilocular hydrocele)

18. SWELLING WHICH ARE
BRILLIANTLY TRANSILLUMINANT
?
• Vaginal Hydrocele
• Epididymal cyst
• Cysto hygroma
• Ranula
• Meningocele

19. ABSENT TRANSILLUMINATION ?
• Pyocele
• Hematocele
• Spermatocele
• Chronic hydrocele

20. INTERMITTENT HYDROCELE ?
• Congenital hydrocele

21. Role of ultrasonography ?
• Testis not palpable ; Vaginal hydrocele.
• Palpable but suspicious
• Acute hydrocele

22. How will you differentiate between inguinal
hernia and encysted hydrocele of the cord ?
• Traction test
• Reducibility
• Impulse on coughing

23. Edward Gibbon

24. COMPLICATIONS ?
• Pyocele
• Hematocele
• Testicular atrophy
• Rupture
• Herniation of hydrocele sac
• Infertility

25. Treatment ?
• Congenital hydrocele –
Herniotomy
• Acquired - VAGINAL HYDROCELE –
1. Small size – Lord’s Operation
2. Moderate size – Jaboulay’s Operation
3. Large size – Excision of sac + Jaboulay’s operation
4. Very Large size – Scrotoplasty + Excision of sac +
Jaboulay’s operation

26. LAYERS OF SCROTUM
1. Skin
2. Dartos
3. External spermatic fascia <- External oblique
4. Cremastic fascia <- Internal oblique
5. Internal spermatic fascia <- Fascia
transversalis
6. Tunica Vaginalis

27. Differences between epididymal cyst and
spermatocele ?
CYST OF EPIDIDYMIS
• Bilateral
• Behind the testis
• Irregular surface
• Multilocular
• Transillumination present
SPERMATOCELE
• Usually unilateral
• Behind and above the testis
• Smooth surface
• Unilocular
• Transillumination absent

28. How to differntiate between hematocele and
testicular malignancy ?
HEMATOCELE
• History of trauma present
• Long duration
• Non progressive swelling
• Weight loss absent
• Surface smooth
• Testicular sensation present
• Lymph node absent
MALIGNANCY
• History of trauma absent
• Short duration
• Progressive swelling
• Weight loss present
• Hard / Variable surface
• Testicular sensation absent
• Lymph node present

29. DISEASE and PARTS involved
• FILARIASIS – Epididymorchitis
• TUBERCULOSIS – Epididymitis
• SYPHILIS - Orchitis

30. Q 1. In reaching hydrocele sac
which of the following layer is not
incised ?
1. Dartos muscle and superficial fascia
2. Tunica Albugenia
3. Internal spermatic fascia
4. Cremastic fascia

31. Q 2. Which one of them is not a
recommended procedure for
hydrocele ?
1. Lord’s procedure
2. Jaboulay’s procedure
3. Herniotomy
4. Tapping / Aspiration

32. JABOULAY’S PROCEDURE