HYDROCELE

• A hydrocele is an abnormal collection of serous fluid in the tunica vaginalis of the testis or within some part of the processus vaginalis
• Painless swelling of one or both testicles with mild discomfort from the heaviness of swollen scrotum
• Middle aged men are mostly affected

Classification:

PRIMARY HYDROCELE

The cause of which is unknown; there is no associated disease in the testis or the epididymis

• Vaginal hydrocele- Commonest variety of hydrocele, There is abnormal accumulation of serous fluid within the tunica vaginalis
• Encysted hydrocele of the cord - When the central portion of the processus vaginalis remains patent, but its upper and lower parts are obliterated, such a condition is developed. Fluid accumulates in the patent portion of the processus vaginalis and presents a swelling in relation to the spermatic cord, hence called it as encysted hydrocele of the cord
• Infantile hydrocele - This condition is just opposite to the funicular hydrocele. The tunica vaginalis is continuous with the processus vaginalis which is shut off from the peritoneal cavity at the deep inguinal ring
• Congenital hydrocele -In this condition, the processus vaginalis remains patent so there is direct communication of the tunica vaginalis with the peritoneal cavity
• Funicular hydrocele- In this condition, the processus vaginalis remains patent up to the top of the testis where it is shut off from the tunica vaginalis

3 rare varieties

• Hydrocele of the canal of nuck - This condition is female counterpart of the previous condition. Seen in relation to round ligament
• Hydrocele of the hernial sac - Sometimes hydrocele may associate with the hernia sac, the reason is that some fluid gets stagnated within the hernia sac when a tag of omentum blocks the opening of the sac at the deep inguinal ring
• Bilocular hydrocele- In this condition, the hydrocele has two communicating sacs- one above and one below the necks of scrotum. The upper sac has no connection with the processus vaginalis and it is in fact the herniated tunica vaginalis

SECONDARY HYDROCELE

• Abnormal collection of fluid into the tunica vaginalis which accompanies disease of the testis and/ or the epididymis

Vaginal hydrocele:

• Defective absorption of hydrocele fluid by tunica vaginalis
• Excessive production of fluid within tunica vaginalis
• Interference with drainage of fluid by the lymphatic vessels of the cord
• There may be connection with the peritoneal cavity as in the congenital variety

Secondary hydrocele:

• Acute epididymoorchitis
• Chronic epididymoorchitis
• Syphilitic affection of the testis
• Malignant disease of the testis
• Trauma- rare
• Lymphatic obstruction -rare
• Post-herniorrhaphy hydrocele - rare

vaginal hydrocele:

• Age – primary hydrocele is common in middle aged people
• Swelling of the scrotum
• Slight amount of discomfort or pain
• Complications - Infection, Atrophy of the testis, Rupture, Haematocele, Hernia of the hydrocele sac, Calcification of the sac

Encysted hydrocele of the cord:

• Oval cystic swelling in relation to the spermatic cord
• Swelling is seen in the inguinal, inguino-scrotal or scrotal region depending on which part of the processus vaginalis is patent
• Testis can be felt separate from the swelling

Infantile hydrocele:

• Not necessarily it is seen in infants, it is often seen in adults
• It is an inguino scrotal swelling
• It is a cystic swelling

Congenital hydrocele:

• Present since birth
• When the patient lies horizontal, the hydrocele disappears as the fluid in the tunica vaginalis drains into the abdominal cavity. In the erect posture hydrocele appears again
• Not easily reducilble
• May be associated with tuberculous peritonitis in children

Funicular hydrocele:

• Swelling is inguinal rather than scrotal
• Testis can be felt separately
• Other features are similar to that of congenital hydrocele

Secondary:

• Hardly becomes big enough
• It is lax so the palpation of the testis and epididymis is not difficult
• If the testis and epididymis are not palpable due to excess fluid collection, diagnosis of secondary hydrocele is only possible after the fluid of the hydrocele has been aspirated out

O/E

Vaginal hydrocele:

• Position - often unilateral, sometimes bilateral
• Inspection - One or both sides of the scrotum are enlarged with a notch at the middle of the affected side of the scrotum
• Type of swelling- Purely scrotal swelling and one can get above the swelling
• Fluctuation test - Positive as it is a cystic swelling
• Transillumination test - Positive as the hydrocele fluid is clear
• Percussion - Dull
• Reducibility - Can’t be reduced
• Palpation of the testis - Occasionally may be palpable posterior to the vaginal hydrocele
• The testis cannot be felt separately as the fluid of hydrocele surrounds the body of the testis

Encysted hydrocele of the cord:

• Fluctuation and transillumination tests are positive
• Traction test – when gentle traction is exerted on the testis, the swelling moves downwards and becomes less mobile
• As the upper part of processus vaginalis is obliterated, swelling remain un reducible and cough impulse is absent

Infantile hydrocele:

• There is no impulse on coughing
• Fluctuation test is positive
• Transillumination test is positive
• It does not disappear when the patient lies down
• It is not reducible

Bilocular hydrocele: - Cross fluctuation

General investigation: -Scrotal ultrasound

Vaginal hydrocele: - Operative management:

• Jaboulay’s method of eversion of sac
• Lord’s procedure of excision of sac
• Subtotal excision
• Tapping

Encysted hydrocele of the cord:

• Excision of the cyst

Ayurvedic Treatment

Internal medicines

• Punarnavadi kashaya
• Ullivettedukadi kashaya
• Lashunaerandadi kashaya
• Lasuna ksheera
• Sukumara erandam
• Nonganadi erandam
• Vaiswanara choorna
• Poothikaranjasava
• Dashamoola hareetaki

Procedure

• Pichu – Eranda taila