Hydrocele and Varicocele Flashcards
What is a Hydrocele
collection of fluid between visceral and parietal layers of tunica vaginalis
MCC is idiopathic
What inflammatory conditions are associated with a hydrocele
Epididymitis
Torsed appendix testis
-Hydrocele resolves by treating underlying condition
How does a hydrocele present
unilateral scrotal enlargement
What should the PE for a hydrocele include
palpation
transillumination
-Scrotal US (fluid around testis)
How do you treat an asymptomatic or minimally symptomatic hydrocele
Reassurance and monitoring
They are not emergent
How can you treat a bothersome hydrocele
Electively:
needle aspiration + sclerosing agent injection (doxy) to minimize recurrence
hydrocelectomy
What does a sclerosing agent do
induces an inflammatory reaction causing layers of tunica vaginalis to stick together
How is a needle aspiration (hydrocele Tx) done
in office, awake pt, with local anesthesia for spermatic cord block
after inserting needle into hydrocele and aspirating fluid, inject doxy into empty hydrocele sac
S/E: can possibly lead to infection, hematoma, and pain
How do you preform a hydrocelectomy
In OR with anesthesia, trans-scrotal incision is made, hydrocele sac opened, and fluid drained
Then evert and marsupialize the tunica vaginalis to minimize recurrence
Suture penrose drain to scrotum overnight
S/E: can possibly lead to pain, hematoma, infection, rarely loss of testis
What is a varicocele
dilated veins of pampiniform plexus (= low flow= blood build up in testis)
What are the effects of a varicocele
pain
fibrosis of testis
decreased spermatogenesis, testis atrophy
infertility (stress pattern on semen)
What will you note on PE of a varicocele
Bag of worms!!!
must examine patient supine, standing, and valsalva while standing
What are the grades of a varicocele
I: small, palpable on valsalva
II: medium, palpable while standing
III: large, grossly visible
Which side is a varicocele MC on
left!
the left gonadal vein drains into the left renal vein, and then into the IVC. so it is a slower system than the right, and more likely to have a varicocele
When would you simply surveil a varicocele
If palpable in a young man, with normal semen analysis (do semen analysis q1-2 years)
If normal testis size in children (measure testis annually for atrophy)
When would surgery be an option for varicocele treatment
If symptomatic
If palpable with abnormal semen analysis (couple is infertile and female is nl)
If testis is small/atrophied (you can reverse atrophy)
What surgeries are available to treat varicocele if necessary
Ligation of gonadal vein to redirect venous outflow (open or laparoscopic)
Percutaneous embolization
Are varicocele repairs effective
Yes, 70% of men see improvement in semen quality s/p 3-6 mo after repair
