Hydrocele is an abnormal accumulation of serous fluid in the processus vaginalis or tunica vaginalis, which can be classified as primary/idiopathic or secondary. The etiology includes excessive fluid production, defective absorption, lymphatic drainage interference, or congenital connections to the peritoneal cavity. Diagnosis typically involves aspiration and ultrasound, with treatment varying by age, with hydrocelectomy being the gold standard for adults unless they are unfit for surgery.

1. HYDROCELE
SCH OF CLINICAL SCIENCES
Dr BM SESAY

2. • Abnormal collection of serous fluid in a part of the processus
vaginalis/ turnica vaginalis
• Acquired hydrocele : are primary or idiopathic or secondary to
testicular disease.

3. CAUSESPathophysiologyin4differentways:
• By excessive production of fluid within the sac. Eg. Secondary
hydrocele
• By defective absorption of fluid. This appear to be the
explanation for must primary hydrocele, although the reason
why the fluid is not absorbed is obscure.
• By interference with lymphatic drainage of scrotal structures.
• By connection with the peritoneal cavity via a patent
processusvaginalis [congenital].
• Filarial hydrocele is

4. • NOTE;
• Hydrocele fluid contains albumin and fibrinogen. If the
contents of a hydrocele are allowed to drain into a collecting
vessel, the liquid does not clot, however, the fluid coagulates if
mixed with even a trace of blood that has been in contact with
damage vessel.

5. TYPES
• Primary /idiopathic hydrocele
This is usually large and tense ,no disease of the underlying testes
.
They are subdivided into the following:
a. Vaginal hy. It the usual type that surrounds the testes and
separated from the peritoneal cavity. Present as cystic
transilluminable swelling in the scrotum, testes difficult to
palpate

6. b. Congenital hy. Is associated with a hernia sac, there is still
patent processus vaginalis . When elevated it empties .
c. Infantile hy. This entends from the testes to the deep inguinal
ring but does not pass into the peritoneal cavity
d. Hydrocele of the cord : it is rare, it lies of just distal to the
inguinal canal , separate from the testis and the peritoneum. The
upper and lower part are closed of the processus vaginalis .
Diagnosis is confirmed by downwards traction of the cord ,which
pulls the hy with it. It is equivalent to the female as hydrocele of
the round ligament .

7. • Secondary hydrocele. It is usually smaller and lax and the
testis is disease.
• Is when the serosal sac filled with exudate due to tumour or
inflamation.
• Causes ; epididymos-orchitis, torsion and tumour

8. CLINICAL PRESENTATION
• May be reduce or not depending on whether it is
congenital/communicating or non – communicating.
• Scrotal swelling painless if not infected.
• It is translucent.
• It is possible to get above the swelling on examination of the
scrotum, ie you can feel the spermatic cord.

9. INVESTIGATIONS
• Aspiration
• Ultra sound scan
• Tumor

10. TREATMENT
• Infant: left alone because most disappear spontaneously
unless if persist after 1yr then operative measures is advisable
.
• Adult: operative measures is the gold standard except the very
elderly who is unfit then aspiration is recommended.

11. • Hydrocelectomy ;
• 1.Lord`s
2. Jaboulay`s
3. Sac excision

12. COMPLICATIONS
• Rupture
• Transformation into a haemocele occurs often times or
bleeding into the sac
• Sac calcification
• Infection