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Scrotal Swelling(Hydrocele)
and Masses
DR.AMAR RATHOD M.S.(Mumbai)
Scrotal Swelling and Masses
1. Hydrocele
2. Hernia
3.Varicocele
5.Spermatocele
4.Testicular Masses
Evaluation of the Scrotum
• Layers of scrotum-skin, Subcut tissue,dartos muscle,Ext,Cremasteric Fascia ,Int spermatic fascia, & tunica vaginalis.
• Normal testes measure 4.5 x 2.5 cm and are rubbery in consistency
• Epididymis lies posteriolateral to the testis and varies in its degree of testicular attachment
• Masses arising from within the testes are usually malignant; those from epididymis and spermatic cord structures usually benign
Anatomy Review
Anatomy Review
Hydrocele
“Hydro" - meaning water and “Cele" - meaning out pouching
• Abnormal collection of serous fluid in between the two layers of tunica vaginalis or within some part of processus vaginalis.
Aetiology
• Primary- unknown cause
• Secondary-due to disease in the testis
Aetiology
Primary- unknown cause• Vaginal hydrocele• Encysted hydrocele• Infentile hydrocele• Funicular hydrocele• Hydrocele of canal of Nuck• Hydrocele of hernial sac• Hydrocele of bisac
Secondary-due to disease in the testis• Acute epididymo-orchitis
• Syphilitic infection• Chronic epididymo-orchitis• Malignant disease• Trauma• Lymphatic Disease
• Post herniorrhapy
Causes Normally there is balance between produced fluid and its reverse
absorption.
• Defective absorption of fluid• Excessive production of fluid• Interference with Drainage of fluid by
lymphatic vessels of cord• Connection to peritoneal cavity
(congenital)
Composition of fluid
• Amber Coloured
• Sp. Gravity 1.022-1.024
• Water
• Inorganic salt
• 6% albumin
• Fibrinogen
• Cholesterol
Clinical Feature
• Common in middle Age
• Common in tropical courtiers
• SYMPTOMES:
swelling of the scrotal region
Clinical Test
1.Fluctuation
2.Transillumination
3.Palpation of the testis(Reaching above the swelling)
4.Reducibility
• BLOOD EXAMINATION
- Eosinofilia And Microfaileriasis Seen In Faileriasis - Lymphocytosis And ESR seen In Acute Epididymo-orchities
• URINE EXAMINATION
-Tuberculose Epididymo-orchities
• SCROTAL ULTRASOUND. -To confirm diagnosis -Identification position of testis -To know testis are normal or not
• MRI.
INVESTIGATION
D.D.
• Inguinal Hernia• Haematocele• Pyocele• Chylocele• Faileriasis of scrotum• Cyst• Tumours of the testis• Lipoma of cord
Complication
• Infection and Pyocele formation
• Atrophy of the Testis
• Rupture due to Trauma/ Spontaneous
• Haematocele
• Hernia of the hydrocele of the Sac through the Dortous muscle in long standing case
• Calcification of sac.
Management• Conservative Watchful waiting
• Surgery (L.A./Spinal/G.A.)
• Indication• Inconvenience while walking• Infection / trauma• Excoriation of skin by urine• Infertility (Testicular Atrophy)• Cosmetic• Difficulties in intercourse• Herniation of Hydricele sac• Medical fitness for jobs
Contra indications
• Local infection of skin• Poor general condition
1.Jaboulays method of eversion of Sac- mostly practiced now a days for small & medium size.
2.Lords procedure- Big size Hydrocele
3.Excision of sac - Haematocele -infected Sac4.Subtotal excision - Big size Hydrocele -circular incision,middle of Scrotum5.Tapping- Not a radical surgical treatment To be Avoided as for as possible
6.Andrew”s method- Eversion of sac with Excision
7.Sharma Jhawars subdartos pouch
IN INFENT HYDROCELE SHOULD BE LEFT ALONE AS THEY MAY DISAPPEAR SPONTANEOUSLY
If persist – Surgery incision-inguino-Scrotal upper end of Sac ligated
Complication of surgery
• Haemorrhage• Damage to cord,Testis,Epididymis,Pampiniform plexus• Torsion of testis• Haematoma• Haemoscrotum• Pyoscrotum• Infection• Stitch abscess• Urinary retention• Necrosis• Recurrence• Epididymo-orchitis
Congenital Hydrocele
• Processus vaginalis remain patent
• Communicating orifice at the deep inguinal ring is too small for the development of hernia.
• Diagnosis-present since birth
Pt lies-disappears
in erect posture appear again
• This condition may be associated with Tuberculous peritonitis
Funicular hydrocele
• Processus vaginalis patent up to top of testis, where it is shut off from the tunica vaginalis
• Diagnosis-
swelling in inguinal region rather than scrotal
• Testis can be felt
• Swelling reduced when lies down.
Infantile Hydrocele • This condition is just opposite to funicular hydrocele-
vaginalis is shut off from the peritoneal cavity at the deep inguinal ring.
• Diagnosis- seen in infants & adult
Inguino scrotal swelling similar to inguinal hernia
• Not reducible /cough impels –ve
• Cystic swelling
Encysted Hydrocele• Central portion of processus vaginalis remain
patent- upper and lower end oblitrated.• Oval cystic • swelling(scrotal/inguinal/inguino-scrotal)
• Diagnosis- cystic swelling in relation to spermatic cord• Testis felt separate.• Traction test-
• Hydrocele of Bisac-
hydrocele having two intercommunicating sac.
One above & one below, upper sac connected with
processus vaginalis
• Hydrocele of Hernial Sac
• Hydrocele of canal of Nuck
Ayurvedic Aspect• Introduction-
Vriddhi is being discussed in Sushrut-Samhita Nidan sthan chapter 12 & Chikitsa sthan chapter 19
*Vaataj = Tortion of testes / Strangulated Hernia* Pittaj = Abscess / Pyocele* Kaphaj = ? Tumor of testes e.g.Seminoma * Raktaj = Haematocele* Medaj = Filarial swelling / Lypoma* Mutraj = Hydrocele* Aantraj = Inguinal hernia
• Defination-
• maU~sya maU~sadRSatrlasya vaRiw: maU~vaRiw È
• Samprapti:
• AMQa: p`kuiptao Anyatmaao ih daoYa: flakaosavaaihnaIriBap`pVQamanaI; flakaoYayaao: vaRiwMjanayait , taM vaRiwima%yaacaxato Èsau.ina.12
Poorvha Roop
•baistkiTmauYkmaoZoYau vaodnaa maa$tinaga`h: , flakaoSaSaaofcEaoit È
sau.ina.12
Rupa: PRODROMAL FEATURES
• maU~saMQaarNaSaIlasya maU~vaRiwBa-vait saagacCtao|mbaupUNaa-M dRitirva xauByait , maU~kRcC/vaodnaaM vaRYaNayaao: EvayaqauM kaoSayaaoEcaapadyait Èsau.ina.12
• Scrotum develop movement like Bag of water,dysuria,pain in testicels and swelling of scrotum.
Chikitsa
• Fomentation
• Lepa with Latakaranj patra
• Wrap with cloth and then puncture made by the side of raphae below the most prominent part of the swelling with help of BRIHIMUKHA SHASTRA
• Drainage tube
• Sthagika bandha
THANK YOU
Testicular Masses
• Testicular masses are usually malignant and must be fully evaluated
• If any doubt whether a mass is within or outside the testicle, scrotal US and urologic consultation should be obtained
• Tumors of testis are usually painless, firm, solid lesions within the substance of the testis. These lesions do not transilluminate
Testicular Masses
• Any mass, any pt, any time felt to be in the testicle MUST be addressed with direct contact with a urologist. Do not simply place a consult and hope for the best…to do so would be malpractice
Testicular Pt Ed
• Benefit of monthly TSE is now questioned…however…
Etc…
Etc…
Etc…
Etc…
Questions?
THANK YOU
TYPES
• Congenital
1. Vaginal Hydrocele
2. Infentile Hydrocele
3. Congenital Hydrocele
4. Hydrocele of cord
• Acquired
1. PrimaryHydrocele
2. seconderyHydrocele