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Hydrocele
Hydrocele
HYDROCELES
Definition :
An abnormal collection of serous fluid in some part of
the processus vaginalis, ussualy in the tunica
Types
Congenital Aquired
Vaginal Hydroceles a. Primary (idiopathic)
- Infantile hydrocele b. Secondary
- Congenital hydrocele
- Hydrocele of the cord
AETIOLOGY
Hydocele can be produce in four ways :
Excessive production of fluid within the sac (secondary
hydrocele)
Defective absorbtion of fluid
Interference with lymphatic drainage of scrotal structure
Connection with hernia of the peritoneal cavity in
congenital variety
TREATMENT
Congenital hydroceles :
Special form of indirect inguinal hernia
May resolve spontaneously
Treated by herniotomy if unresolved
Hydrocelectomy
Inguinal Approach.
High-resolution scrotal ultrasonography should be
performed in all men with hydrocele
An inguinal approach to hydrocelectomy is indicated when
sonography or palpation suggests an intratesticular mass
If no malignant disease is found, needless orchiectomy is
avoided. Hydrocelectomy is then performed by one of the
techniques described later in this section.
Hydrocelectomy
Scrotal approach
May be safely performed when ultrasonographic examination
of the testis is normal
Simple excision of the thick-
walled hydrocele sac and
oversewn edges
Jaboulay’s procedure
Large, thin, floppy sacs
Bottleneck operation, in which
the sac edges are sewn together
behind the cord
Lord’s Procedure
Thin sacs
Plication is quick and
relatively bloodless
COMPLICATIONS
Hematoma most common complication
The use of a drain does not appear to change the
incidence of complications
Fertile man, primary danger: injury to the
epididymis or the vas deferens
If generalized oozing is present and the
possibility of postop hematoma is significant, a
Penrose drain may be placed for 24^ 8 h.