Hydrocele

It’s an abnormal collection of serous fluid in the tunica vaginalis of the testis or with in some part of the processes vaginalis.
Types :
Primary
Secondary

Primary hydrocele : The cause of, which is unknown.
Secondary hydrocele: When hydrocele is secondary to a disease in the testis and/or in the epididymis its usually small and lux.
a) Vaginal hydrocele
b) Encysted hydrocele of the cord
c) Infertile hydrocele
d) Congenital hydrocele
e) Funicular hydroceleis
f) Hydrocele of the canal of nuck
g) Hydrocele of hernial sac
h) Hydrocele in bisac

Symptom :

Swelling of the scrotum
Discomfort
Pain

Differential diagnosis :
Inguinal hernia
Haematocele
Pyocele
Filariasis of the scrotum
Cyst in relation to the epididymis
Encysted hydrocele of the cord
Tumors of the testis


Congenital hydrocele:
Congenital hydrocele in children is due to patent processus vaginalis. The opening of the processus vaginalis into the general peritaoneal cavity is

generally too small for the development of a hernia.through an inguinal incision, the processus vaginalis is dissected off. It is ligated and divided at the

neck and at the upper pole of the testis. The portion of the processus vaginalis within the inguinal canal is removed and the portion with the testis as

remains as tunica vaginalis.

Tapping :
This operation through not a radical treatment, is often indicated in case of old patients, who can well be tapped, which is painless, for a few

times for the rest of their lives.
While tapping, the position of the testis is ascertained by fingers and pushed posteriorly.
A wheal of local anaesthetic solution is raised in an area of the scrotal skin that is free of visible vessels and rather dependent. A fine Trocar

and a cannula are then trust into the sac through the scrotal wall.
The fluid is evacuated slowly to avoid shock. Once all the fluid has been evacuated, the cannula is withdrawn and the wound in the scrotal wall is

sealed with tinc iodine.

Injection treatment :
This treatment is not much practiced nowadays after tapping the hydrocele fluid 10ml of scleroscent solution (formed by combination of quinine

hydrochloride 2gm, Urethane 1gm in 15ml of water for injection of sodium tetradecyl solution) is injected into the cavity of tunica vaginalis. Gentle massage

is given to disperse the solution evenly. The scrotum is supported with a suspensory bandage. This treatment is necessary, may be repeated.


Jaboulay’s method of eversion of sac:
This radical method of operation is mostly practiced nowadays for small and medium size hydroceles. An incision is made on the scrotal wall, on the

side of the hydrocele. The incision is gradually depended till the tunica vaginalis is reached. In this process one will come across a few vessels which have

to be ligated. As soon as the tunica vaginalis is reached the sac is separated from the rest of the scrotal wall by finger. The sac is held in one hand and

with another hand the tunica vaginalis is incised. As soon as the incision is made fluid will come out of the sac. The two margins of the incisions are held

with two pairs of artery forceps and held upwards. The incision is extended upwards and down wards to allow the testis to come out through this opening. The

testis is brought out through the opening and the two margins of the tunica vaginalis are sutured behind the testis, so that the secreting surface of the

tunica vaginalis will be lying outside. Care must be taken not to strangle the testicular vessels. The scrotal wound is now sutured.
After dressing the wound, the patient should be instructed to wear suspensory bandage. Proper antibiotics should be administered. The stitches are

removed from the scrotal wall after 6days.

Lord’s procedure of excision of sac:
This operation is mainly indicated for big size hydroceles. The steps of operation is upto opening of te tunica vaginalis are same as those of the

previous mention nature of operation. The tunica vaginalis is now sutured with 10 to 12 catgut or Dexon sutures from the testis and the epididymis. When

these sutures are tied, the whole tunica is bunched at the edge of the testis.

Subtotal excision:


Complications :
Infection
Atrophy of the testis
Rupture
Haematocele
Hernia of the hydrocele sac
Calcification of the sac