HYDROCELE

DEFINITION:
The excessive fluid in the tunica
vaginalis testis.
Anatomy of the Scrotal
Anatomy of the Scrotal
PATHOPHISIOLOGY:
A. Congenital hydrocele (primary)
The tunica vaginalis cavity is connected to the peritoneal
cavity so that the peritoneal fluid can flow in and out.

B. Acquired Hydrocele (secondary/ idiopathic)

Disturbance in the fluid production-reabsorption process
in the tunica vaginalis cavity.
Could be : a. Excessive production.
b. Defective reabsorption
c. Combination a + b.
The fluid circulating in the tunica vaginalis cavity function
as a heat transmitter, so the temperature of the testis
surroundings, remains optimal for spermatogenesis.
Clinical:
1. Congenital (primary) hydrocele
2. Acquired (secondary) hydrocele – causa +
- causa ?
3. Idiophatic hydrocele
Primary hydrocele :
1. Vaginal type.
2. Congenital (communicans) type.
3. Infantil type.
4. Funicular (funicocele) type.
Type of Hydrocele
H
y
d
r
o
c
e
l
e
Diagnosis:
History :
* Mass in the scrotum (enlarge).
* Painless (except extremely large or
infected)
 Diagnosis:
Physical examination :
* Cystic consistency / fluctuative.
* If large hard / tense.
* pain (-).
* transillumination (+).
* testis located behind / beneath the mass.
* If extremely large / tense the testis
difficult to palpate to palpate (sometimes
necessary to aspirate first)
* Aspiration fluid clear light yellowish
(to be done in sterile condition).
THERAPY:
A. OPERATIVE
a. Bergman : - opening the sac & taking out the fluid/aspirate.
- simple but often reccurent (residif).
b. Winkelman : - excision of the sac (tunica vaginalis testis)
c. Bergman-Winkelman : - combination of both methods.
- relatively simple and widely used
d.Jaboulay-Winkelman : - BW + herniotomy (children).
e. Lord : - plication of the sac without excision.
- often reccurent due to loosening of plication.
f. Andrew : - known as ‘bottle neck operation’.
- the sac not excissed, but inverted sutured
- often done on old people or in cases of
thickening of the sac.
 Bergman-
Winkelman’s
Operation
Andrew’s
Operation
 Lord’s
Operation
THERAPY:
Particularly in babies and children :
Operative therapy of congenital hydrocele
(primary) in the form of processus vaginalis
peritonei ligation similar to herniotomy in children.
 THERAPY:
In the past ‘sclerosing therapy’
by instilling Na-morhuate/
(sclerosing agent) into the
tunica vaginalis
This method indevelopable due to necrotic
complications.
THERAPY:
B. THOSE REFUSING OPERATION
- Observation only when small.
- When extremely large and painfull
repeated aspirations
(intermittently)
Aspiration
of
Hydrocele
T H E R A P Y:
C. SECONDARY HYDROCELE
Special therapy for the primary disease.
PROGNOSIS : Good
Thank
You