Hydrocele, varicocele, etc. Flashcards
Define hydrocele
Collection of fluid between the visceral and parietal layers of tunica vaginalis of testicle or along the spermatic cord
What is the most common cause of scrotal swelling?
Hydrocele
What % of newborn males have a patent processus vaginalis?
80% , most close within 18 months of age
Congential cause of hydrocele?
Process vaginalis does not close or closes after fluid becomes trapped in scrotal cavity
What are adult causes of hydrocele?
- Imbalance of secretion and reabsorption of fluid from tunica vaginalis
A. May be secondary to:
-Infection
-Trauma
-Tumor
-Obstruction of lymphatic or venous drainage in spermatic cord
How do you tell if the scrotum is fluid-filled?
Trans-illumination test is positive. Distinguishes fluid filled from solid mass (mass does not illuminate)
Sxs of hydrocele
- Usually painless enlarged scrotum
2, Patient may report a sensation of heaviness or fullness
Where are hydroceles often located?
Hydroceles are located superior and anterior to the testis
Where are spermatoceles often located?
superior and posterior to the testis
What other conditions are asst. with congenital hydroceles?
- Often associated with hernia
- Gets smaller and softer when supine
- Gets larger and tenser after prolonged standing
What test is always performed when the testis/scrotum are enlarged?
- Ultrasonography
Visualizes testis and presence of fluid
Important if hydrocele is result of testicular neoplasm
What is the surgical tx of hydrocele?
- Excision of hydrocele sac
- Treatment of choice for congenital hydrocele
- Herniorrhaphy: open inguinal hernia repair
What tx is reccomended with recurrent hydrocele?
Percutaneous aspiration of hydrocele fluid with installation of sclerosing agent into sac
If a hydrocele persists past the first ? months of life, it should be surgically repaired
12
Inguinal hernia in infants is usually repaired within the first ? months of life
3
What two conditions are difficult to dinstinguish from each other?
hydrocele and inguinal hernia on exam
What are some complications from hydrocele?
adversely affect fertility
Define varicocele
Mass of dilated and tortuous veins in spermatic cord
What is the prevalence of varicocele?
Occurs in 15 of 100 men
Occurs in 40 out of 100 men with infertility
What are the demographics for varicocele?
- More common in ages 15-25 years
- Found in approximately 15 – 20% of post pubertal males
- 30% of all men diagnosed with infertility have a varicocele
What are varicoceles caused by?
Caused by dilation of pampiniform plexus of spermatic veins
Which side is more affected by varicoceles and why?
Left > Right
(L) gonadal vein drains into renal vein (8-10 cm > R)
(R) drains into IVC
“Nutcracker syndrome”