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HYDROCELE

HYDROCELE. Defined as a collection of fluid within the tunica vaginalis of the testis. CASSIFICATION. 1. Congenital 2. Primary 3. Secondary. 1. CONGENITAL. Communicating (“vogbreuk”) Infantile Interstitial Cord. 2. PRIMARY HYDROCELE. Idiopathic (aetiology not known)

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HYDROCELE

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  1. HYDROCELE • Defined as a collection of fluid within the tunica vaginalis of the testis

  2. CASSIFICATION • 1. Congenital • 2. Primary • 3. Secondary

  3. 1. CONGENITAL • Communicating (“vogbreuk”) • Infantile • Interstitial • Cord

  4. 2. PRIMARY HYDROCELE • Idiopathic (aetiology not known) • Imbalance between the fluid secretion and absorption of the tunica vaginalis

  5. 3. SECONDARY HYDROCELE • Infection • Trauma • Tumor • Abnormalities in inguinal lymph nodes

  6. DIFFERENTIAL DIAGNOSIS:SCROTAL CYSTIC MASSES • Indirect inguinal hernia • Epididymis cyst • Hydrocele • Varicocele • Spermatocele • Piocele • Hematocele

  7. TREATMENT • Communicating • Tying off the patent processus vaginalis • Primary • Hydrocelectomy • Aspiration + injection of sclerosing agent • Secondary • Treat underlying pathology

  8. DIFFERENTIATION

  9. DIFFERENTIATION

  10. FLUID ASPIRATED FROM CYSTIC MASSES

  11. VARICOCELE • Defined as an abnormal dilatation and distension of the veins of the pampiniform plexus

  12. INCIDENCE • 15% in the general population • (8% - 23%) • 16,3% in adolescents • (12,4% - 25,8%) • 33% in infertile men • (19% - 41%) • 58% - 93% left sided

  13. ETIOLOGY • Abnormality of the venous valves • Left spermatic vain joining the left renal vein directly at a 90° angle • Longer left spermatic vein with increased hydrostatic pressure • Pressure of superior mesenteric artery on the left renal vein (Nutcracker phenomenon)

  14. PRESENTATION • Complaints of a scrotal mass • (“Bag of worms”) • Complaints of scrotal discomfort • Fertility problems • Incidental diagnosis with clinical examination • Smaller left testis

  15. CLACCIFICATION • Primary • Abnormality of valves in the spermatic vein • Secondary • Tumor of the left kidney • Retro-peritoneal masses • Trauma

  16. GRADING

  17. INFERTILITY THEORIES • Stases of blood with testicular hypoxia • Reflux of renal and adrenal metabolites • Increased intra-testicular temperature

  18. INDICATIONS FOR FURTHER MANAGEMENT • Symptomatic * Pain * Mass (discomfort) • Infertility • Testicular atrophy

  19. TREATMENT • Spermatic venography plus embolisation with heated contrast/resin/coils • Surgery • Open • Ivanissevitch • Paloma • Laparoscopic

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