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Hydrocele Varicocele

Hydrocele is defined as a collection of fluid within the tunica vaginalis of the testis. It can be congenital, primary, or secondary. Congenital hydroceles include communicating and infantile types. Primary hydroceles have an unknown etiology and may be due to an imbalance in fluid secretion and absorption. Secondary hydroceles are caused by infection, trauma, or tumors. Treatment involves tying off communicating processes, hydrocelectomy, or treating the underlying pathology. Varicocele is an abnormal dilatation of the veins of the pampiniform plexus and is a common cause of male infertility. It can be primary due to valve abnormalities or secondary to tumors. Treatment options include sper

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158 views19 pages

Hydrocele Varicocele

Hydrocele is defined as a collection of fluid within the tunica vaginalis of the testis. It can be congenital, primary, or secondary. Congenital hydroceles include communicating and infantile types. Primary hydroceles have an unknown etiology and may be due to an imbalance in fluid secretion and absorption. Secondary hydroceles are caused by infection, trauma, or tumors. Treatment involves tying off communicating processes, hydrocelectomy, or treating the underlying pathology. Varicocele is an abnormal dilatation of the veins of the pampiniform plexus and is a common cause of male infertility. It can be primary due to valve abnormalities or secondary to tumors. Treatment options include sper

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ﻣﻮﺩﻫﻴﺘﺎ ﻛﻮﺭﻧﻴﺎ ﺳﻴﺎﺭﻳﻔﺎ
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HYDROCELE

Defined as a collection of fluid within the


tunica vaginalis of the testis

CASSIFICATION
1. Congenital
2. Primary
3. Secondary

1. CONGENITAL
Communicating (vogbreuk)
Infantile
Interstitial
Cord

2. PRIMARY HYDROCELE
Idiopathic (aetiology not known)
Imbalance between the fluid secretion and
absorption of the tunica vaginalis

3. SECONDARY HYDROCELE
Infection
Trauma
Tumor
Abnormalities in inguinal lymph nodes

DIFFERENTIAL DIAGNOSIS:
SCROTAL CYSTIC MASSES
Indirect inguinal hernia
Epididymis cyst
Hydrocele
Varicocele
Spermatocele
Piocele
Hematocele

TREATMENT
Communicating
Tying off the patent processus vaginalis
Primary
Hydrocelectomy
Aspiration + injection of sclerosing agent
Secondary
Treat underlying pathology

DIFFERENTIATION
HYDROCELE

Palpate cord
above mass
Translucent

YES

INGUINAL
HERNIA
NO

YES

NO

Fluctuate

YES

NO

Fluid thrill

YES

NO

DIFFERENTIATION
HYDROCELE
Testis palpable

NO

INGUINAL
HERNIA
YES

Cough impulse

NO

YES

Reducible

NO

YES

Bowl sounds

NO

YES

FLUID ASPIRATED FROM


CYSTIC MASSES
SUPRA TESTICULAR
CYSTIC MASS
Cord hydrocele

COLOR OF FLUID

Spermatocele

Milky or
Grey opaque (barleywater)
Clear

Epididymis cyst

Straw color

VARICOCELE

Defined as an abnormal dilatation and


distension of the veins of the pampiniform
plexus

INCIDENCE
15% in the general population
(8% - 23%)
16,3% in adolescents
(12,4% - 25,8%)
33% in infertile men
(19% - 41%)
58% - 93% left sided

ETIOLOGY
Abnormality of the venous valves
Left spermatic vain joining the left renal
vein directly at a 90 angle
Longer left spermatic vein with increased
hydrostatic pressure
Pressure of superior mesenteric artery on
the left renal vein (Nutcracker phenomenon)

PRESENTATION
Complaints of a scrotal mass
(Bag of worms)
Complaints of scrotal discomfort
Fertility problems
Incidental diagnosis with clinical
examination
Smaller left testis

CLACCIFICATION
Primary
Abnormality of valves in the spermatic
vein
Secondary
Tumor of the left kidney
Retro-peritoneal masses
Trauma

GRADING
GRADE 0

Venous noise on doppler


with Valsalva maneuver

GRADE 1

Distended veins can be


palpated with Valsalva

GRADE 2

Distended veins can be


palpated without Valsalva

GRADE 3

Distended veins can be


observed

INFERTILITY THEORIES
Stases of blood with testicular hypoxia
Reflux of renal and adrenal metabolites
Increased intra-testicular temperature

INDICATIONS FOR FURTHER


MANAGEMENT
Symptomatic
* Pain
* Mass (discomfort)
Infertility
Testicular atrophy

TREATMENT
Spermatic venography plus embolisation
with heated contrast/resin/coils
Surgery
Open
Ivanissevitch
Paloma
Laparoscopic

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