Hydrocele

Question 1

Defintiion

Answer 1

Asymptomatic fluid collection around the testicles (processus vaginalis) that transilluminates

Question 2

Pathophysiology

Answer 2

During descent of testis from the poasterior abdominal wall, it carries a fold of peritoenum (processus vaginalis) which normally forms the tunica vaginalis

If this connection is not obliterated, fluid can accumulate in any part of this peritoneum derived covering and a hydrocele forms

Question 3

Clinical Presentation

Answer 3

1. Very swollen scrotum, uniformly enlarged
2. Cannopt define testis well, not separable from testis
3. Firm, tense or lax
4. Transilluminable if acute
5. Can get above mass

Question 4

What is the classification?

Answer 4

1. Vaginal hydrocele - only in tunica vaginalis, does not extend into the cord
2. Hydrocele of the cord - mass around the cord, attached distally to testis; difficult to distinguish from irreducible inguino-scrotal hernia; traction of the testis causes a hydrocele of the cord to be pulled downwards
3. Congenital Hydrocele
   - Patent processus vaginalis filled with peritoneal fluid
4. Infantile Hydrocele
   - between hydrocele of cord and congenital
   - processus vaginalis is obliterated at the deep ring and so the hydrocele does not communicate with the abdomen but remains patent in both cord and scrotum

Question 5

What are causes of 2’ hydrocele?

Answer 5

1. Testicular Tumours
2. Torsion/Trauma
3. Orchitis
4. Following Inguinal Hernia Repair

Question 6

What is the management?

Answer 6

1. Conservative
   - Congenital hydrocele resolves by itself; if unresolved by 2.5-3yo, surgical closure
   - Watch and wait or Aspiration
   - Exclude 2’ cause via U/S scrotum
2. Surgical
   - Lord’s plication of the sac - for small sac with thin wall
   - Jaboulay’s Operation to evert the sac - for large sac with thick wall (subtotal excision of the tunica vaginalis sac - not total as the TV is reflected onto the cord structures and epididymis posteriorly, with the cut edge of the sac everted and sutured behind the testis instead of plication.

Question 7

Complications

Answer 7

1. Hematoma in Jaboulay esp
2. Wound infection = pyolocele
3. Injury to spermatic cord