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mayank-agarwal
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Why is it Hydrocele ?
• Can get above the swelling• Fluctuation present• Transillumination present• Testis not palpable• Non reducible swelling• Impulse on coughing absent
Definition ?
• Abnormal collection of serous fluid in some part of the processus vaginalis usually tunica.
CHARACTERSTICS OF HYDROCELE FLUID ?
• Amber colour• Specific gravity – 1.022 – 1.024• Water, salts , Albumin, Fibrinogen• Cholesterol and tyrosine crystals
Conditions in which hydrocele presents as inguinoscrotal swelling ?
• Congenital hydrocele• Infantile hydrocele
SWELLING WHICH REDUCE ON LYING DOWN ?
• Reducible Hernia• Varicocele• Lymph varix• Congenital hydrocele
Conditions in which there is loss of testicular sensations ?
• Syphilitic gumma• Lepromatous orchitis• Advanced testicular tumor
SWELLINGS SHOWING CROSS FLUCTUATION ?
• Plunging ranula• Compound palmar ganglion• Psoas abscess• Hydrocele en bisac (Bilocular hydrocele)
SWELLING WHICH ARE BRILLIANTLY TRANSILLUMINANT ?
• Vaginal Hydrocele• Epididymal cyst• Cysto hygroma• Ranula• Meningocele
Role of ultrasonography ?
• Testis not palpable ; Vaginal hydrocele.• Palpable but suspicious• Acute hydrocele
How will you differentiate between inguinal hernia and encysted hydrocele
of the cord ?
• Traction test• Reducibility• Impulse on coughing
COMPLICATIONS ?
• Pyocele• Hematocele• Testicular atrophy• Rupture• Herniation of hydrocele sac• Infertility
Treatment ?
• Congenital hydrocele – Herniotomy
• Acquired - VAGINAL HYDROCELE –1. Small size – Lord’s Operation2. Moderate size – Jaboulay’s Operation3. Large size – Excision of sac + Jaboulay’s operation4. Very Large size – Scrotoplasty + Excision of sac +
Jaboulay’s operation
LAYERS OF SCROTUM
1. Skin2. Dartos3. External spermatic fascia <- External oblique4. Cremastic fascia <- Internal oblique5. Internal spermatic fascia <- Fascia
transversalis6. Tunica Vaginalis
Differences between epididymal cyst and spermatocele ?
CYST OF EPIDIDYMIS• Bilateral• Behind the testis• Irregular surface• Multilocular• Transillumination present
SPERMATOCELE• Usually unilateral• Behind and above the testis• Smooth surface• Unilocular• Transillumination absent
How to differntiate between hematocele and testicular
malignancy ?HEMATOCELE
• History of trauma present• Long duration• Non progressive swelling• Weight loss absent• Surface smooth• Testicular sensation present• Lymph node absent
MALIGNANCY• History of trauma absent• Short duration• Progressive swelling• Weight loss present• Hard / Variable surface• Testicular sensation absent• Lymph node present
DISEASE and PARTS involved
• FILARIASIS – Epididymorchitis• TUBERCULOSIS – Epididymitis• SYPHILIS - Orchitis
Q 1. In reaching hydrocele sac which of the following layer is not incised ?
1. Dartos muscle and superficial fascia2. Tunica Albugenia3. Internal spermatic fascia4. Cremastic fascia
Q 2. Which one of them is not a recommended procedure for hydrocele ?
1. Lord’s procedure2. Jaboulay’s procedure3. Herniotomy4. Tapping / Aspiration