Name
HYDROCELE
DESCRIPTION
DETAIL
CAUSES β’ Closure of processus vaginalis trapping peritoneal fluid (non-communicating) β’ Closure of distal processus, trapping fluid in mid portion of processus vaginalis (hydrocele of cord) β’ Failure of closure of processus vaginalis (communicating hydrocele) β’ Infection β’ Tumors β’ Trauma β’ Ipsilateral renal transplantation -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Indirect inguinal hernia β’ Orchitis β’ Epididymitis β’ Traumatic injury to testicle β’ Torsion of testicle or torsion of appendix testesOTHER TESTS : * DIRECT MICROSCOPIC EXAMINATION OF THE MICROFILARIA IN BLOOD, HYDROCELE FLUID OR IN OTHER BODY FLUIDS FOR W. BANCROFTI INFECTION. SENSTIVITY & SPEFICITY - 96 - 100 % . * RAPID FORMAT IMMUNOCHROMATOGRAPHIC CARD TEST FOR W. BANCROFTI INFECTION. SENSTIVITY & SPECIFICITY 96 - 100 % . * SERUM IGE & ANTIFILARIA ANTIBODIES - RAISED * EXAMINATION OF SCROTUM USING HIGH FREQUENCY ULTRA SOUND IN CONJUNCTION WITH DOPPLER TECHNIQUES MAY DETECT MOTILE ADULT WORM WITHIN DILATED LYMPHATICS ( IN 80 % CASES) IMAGING β’ Abdominal x-ray - may be useful to distinguish incarcerated hernias from hydrocele (rarely needed) β’ Inguinoscrotal ultrasound - should be able to demonstrate presence of bowel, e.g., distinguish incarcerated hernia in child from a hydrocele of the cord β’ Testicular nuclear scan or doppler ultrasound - to distinguish testicular torsion
TYPENOTES
RISK FACTORS: Ventriculoperitoneal shunt, Exstrophy of the bladder, Ehlers-Danlos syndrome, Peritoneal dialysisSURGICAL MEASURES β’ Inguinal approach with ligation of processus vaginalis and drainage of hydrocele sac in children. (In hydrocele of cord, sac can be completely removed.) β’ Scrotal approach with drainage of hydrocele and resection of tunica vaginalis in adults β’ In adults no therapy is needed unless hydrocele causes discomfort or unless there is a significant underlying cause such as tumor β’ Jaboulay-Winkelmann procedure (for thick hydrocele sac) - hydrocele sac wrapped posteriorly around cord structures β’ Lord procedure (for thin hydrocele sac) - radial sutures used to gather hydrocele sac posterior to testis and epididymis β’ Aspiration of hydrocele should not be done (with possibleexception of postoperative hydrocele) PATIENT MONITORING β’ Follow at 3 month intervals until decision for/against surgery made β’ Postoperative, follow up at 2-4 weeks and then at 2-3 month intervals until resolution of any postoperative (traumatic) hydrocele POSSIBLE COMPLICATIONS β’ Postoperative traumatic hydrocele common. Usually resolves spontaneously. β’ Injury to vas deferens or spermatic vessels β’ Suture granuloma β’ Hematoma β’ Wound infection EXPECTED COURSE/PROGNOSIS Recovery should be rapid and complete
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
ABSOLUTE EOSINOPHIL COUNT, X-RAY ABDOMEN A.P. VIEW FOR KUB, COMPLETE BLOOD COUNT, PCR, ELISA TEST, ULTRA SOUND EXAM