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    Scrotal Swelling (Hydrocele) and Masses

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    GAURAV
    This document discusses different types of scrotal swelling and masses. It describes hydrocele as an abnormal collection of fluid between the layers of the tunica vaginalis. The main types of hydrocele are discussed as primary/congenital or secondary. Testicular masses are usually malignant and evaluating any masses found in the testicle is important. Different investigations, management options, and complications of hydrocele are also summarized.

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    Scrotal Swelling (Hydrocele) and Masses

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    GAURAV
    4K views59 pages
    This document discusses different types of scrotal swelling and masses. It describes hydrocele as an abnormal collection of fluid between the layers of the tunica vaginalis. The main types of hydrocele are discussed as primary/congenital or secondary. Testicular masses are usually malignant and evaluating any masses found in the testicle is important. Different investigations, management options, and complications of hydrocele are also summarized.

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    This document discusses different types of scrotal swelling and masses. It describes hydrocele as an abnormal collection of fluid between the layers of the tunica vaginalis. The main types of hydrocele are discussed as primary/congenital or secondary. Testicular masses are usually malignant and evaluating any masses found in the testicle is important. Different investigations, management options, and complications of hydrocele are also summarized.

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    Download as ppt, pdf, or txt
    4K views59 pages

    Scrotal Swelling (Hydrocele) and Masses

    Uploaded by

    GAURAV
    This document discusses different types of scrotal swelling and masses. It describes hydrocele as an abnormal collection of fluid between the layers of the tunica vaginalis. The main types of hydrocele are discussed as primary/congenital or secondary. Testicular masses are usually malignant and evaluating any masses found in the testicle is important. Different investigations, management options, and complications of hydrocele are also summarized.

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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
    4.Testicular Masses

    5.Spermatocele
    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
    INVESTIGATION
    • 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.
    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 Sac
    4.Subtotal excision - Big size Hydrocele
    -circular incision,middle of Scrotum
    5.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
    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…
    Etc…
    Etc…
    Questions?
    THANK YOU
    TYPES
    • Congenital • Acquired

    1. PrimaryHydrocele
    1. Vaginal Hydrocele
    2. Infentile Hydrocele 2. seconderyHydrocele
    3. Congenital Hydrocele
    4. Hydrocele of cord

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