HYDROCELE
DR RAVI PARMAR
ASSITANT PROFESOR
Dept of General Surgery
Narendra Modi Medical college
DEFINITION:
• A hydrocele is an abnormal collection of
serous fluid in a part of the processus
vaginalis, usually the tunica vaginalis
around the testis and occasionally along
the spermatic cord.
• Hydrocele fluid contains Albumin and
Fibrinogen.
• More common in
• i) Premature
• ii) On Right side
AETIOLOGY:
• Defective in absorption of fluid by tunica vaginalis
• Excessive production of fluid as in secondary hydrocele
• Interference of fluid drainage by lymphatic vessels of cord
• Communication with the peritoneal cavity
PRIMARY VAGINAL HYDROCELE
• Occurs in middle-aged, common in tropical
countries.
• Testis is not palpable as it usually attains a large
size (unlike secondary hydroceles which are
small, except in filarial hydrocele).
• Fluctuant (elicited by, fixing the hydrocele with
hand and feeling for the fluid movement using
fingers placed in two Initially perpendicular
directions) .
• Initially transilluminant (elicited in front of the
swelling, side to side), but long-standing
hydrocele is nontransilluminant (due to thickened
dartos, thickened spermatic fascia, thickened
hydrocele sac, infected content, chylous fluid,
often filarial hydrocele, haematocele).
• Can get above the swelling (you can feel
only cord structures and nothing else at the
root of the scrotum, unlike in hernia).
• Testicular sensation can be elicited in
vaginal hydrocele by transmitting the
pressure sensation through the fluid.
Infantile Hydrocele
• Here tunica and processus
vaginalis (hydrocele) are
distended up to internal ring,
but sac has no connection
with the general peritoneal
cavity.
Congenital Hydrocele
• Processus vaginalis communicates
with the peritoneal cavity.
• As this communicating orifice is too
small, bowel does not descend and so
hernia usually will not develop.While
lying down, fluid disappears
gradually and while standing fluid
recollects.
• Hydrocele cannot be emptied by
digital pressure as it causes "inverted
ink bottle" effect.
• Ascites, tuberculous peritonitis are
the aetiologies for the same.
Encysted Hydrocele of
the Cord
• It is the fluid collection in a portion of
patent funicular process part of the tunica
vaginalis; but closed above and below;
located in inguinal/inguinoscrotal/scrotal
part which is fluctuant and transilluminant.
• On gentle traction to the testis, the swelling
becomes less mobile (traction test) .
• Differential diagnosis: Epididymal cyst,
inguinal hernia, lipoma of cord, varicocele.
• Treatment is excision under local
anaesthesia
Hydrocele-en-bisac
(Bilocular Hydrocele)
• Hydrocele has got two
intercommunicating sacs, one above
and one below the neck of the
scrotum. Upper one lies superficial or
in the inguinal canal or may insinuate
itself between the muscle layers-
cross-fluctuant.
Hydrocele of the
Canal of Nuck
It occurs in females, in relation
to the round ligament, always
in the inguinal canal.
Hydrocele of the
Hernial Sac
• It is due to adhesions of
the content of hernial sac.
Fluid secreted collects in
the hernial sac and forms
hydrocele of the hernial
sac.
Causes
• It is usually small, lax and testis is usually
palpable (unlike primary hydrocele).
SECONDARY Exception is,secondary hydrocele due to
filariasis. It can be very large.
VAGINAL • Infection: Filariasis
HYDROCELE • Tuberculosis of epididymis- 30% cases
have secondary hydrocele
• Syphilis
• Injury: Trauma, postherniorrhaphy
hydrocele
• Tumor: Malignancy I Secondary
hydrocele rarely attains large size
FILARIAL HYDROCEAL AND
CHYLOCELE
• Occurs commonly in coastal region , and in
and around the equator.
• Usually occurs after repeated attacks of
filarial epididymitis.
• Hydrocele is usually of large size and the
sac is thickened.
• Fluid contains fat, rich in cholesterol, and is
derived from ruptured lymph varix into the
tunica.
• It is often difficult to differentiate from
primary hydrocele.
• Hydrocele fluid is amber-coloured with
specific gravity of 1.022 to 1.024.
• It contains water, salts, albumin,
fibrinogen.
Hydrocele • Hydrocele fluid does not clot, but if it
fluid comes in contact with the blood,
fibrinogen gets activated and clots
firmly.
• Often fluid contains cholesterol and
tyrosine crystals.
• It is a cutaneous bag containing the right and
left testis, epididymis and lower part of
SURGICAL spermatic cord.
• It is divided into right and left half by a raphe
ANATOMY which is continued in front along the penis and
backwards along the perineum towards anus.
OF • Left hemiscrotum is lower than right.
SCROTUM • In cold environment scrotum is contracted,
short and corrugated due to contraction of
dartos muscle.
• In warm environment, it is flaccid and
elongated due to dartos relaxation
Layers of the Scrotum (From
without
Inwards)
• 1. Skin
• 2. Dartos muscle
• 3. External spermatic fascia
• 4. Cremasteric fascia
• 5. Internal spermatic fascia
• Infection
• Pyocele
COMPLICATION • Haematocele
OF HYDROCELE • Infertility
• Atrophy of testis
• Hernia of hydrocele sac (rare)
TREATMENT FOR HYDROCOELE
• Sub-total excision
• Partial excision and eversion
(Jabouley’s operation)
• Evacuation and eversion
• Lord’s plication
• Sharma and Jhawer’s technique
Trocar and cannula used to
evacuate the hydrocoele fluid.
Trocar and Canula used for
Hydrocele Surgery
CHYLOCELE
SUBTOTAL EXCISION
Scrotal support is used in all
scrotal surgeries
Encysted hydrocoele of the cord
Multiloculated hydrocoele.
Pyocoele with nonviable
testis is an indication for low
orchidectomy.
OPERATIVE PROCEDURE :
• If the sac is small, thin and contains clear fluid, either Lord’s plication, i.e. tunica
is bunched into a "ruff" by placing series of multiple interrupted chromic catgut
sutures so as to make the sac to form fibrous tissue (It is relatively avascular and
so hematoma will not occur).
• Or evacuation and eversion of the sac behind the testis (after eversion, everted
sac is sutured with chromic catgut by continuous sutures) is done.
• If the sac is thick, in large hydrocele and chylocele, subtotal excision of the sac is
done (as tunica vaginalis is reflected on to the cord structures and epididymis
posteriorly, total excision leads to orchidectomy with division of cord).
• Often the sac is excised partially and then eversion is done, which is called as
Jaboulay's operation.
• After evacuation, the sac with the testis is placed in a newly created pocket
between the fascial layers of the scrotum (Sharma and Jhawer's technique).
• Aspiration must be avoided as much as possible as it is only a temporary measure
(recurrence occurs very early) and chances of haematocele, infection are higher.
• A drain is placed near the root of the scrotum on the lateral aspect because it
becomes the most dependent portion, when scrotal support is given. Scrotal
support is given to reduce the scrotal oedema.
• Wound is closed in layers.
• Drain is removed in 48 hours.
COMPLICATIONS
• Reactionary haemorrhage
• Infection
• Pyocele
• SINUS formation
• RECURRENT
THANK YOU ……
DR RAVI PARMAR
ASSISTANT PROFESOR
