HYDROCELE Defined as a collection of fluid within the tunica vaginalis of the testis Defined as a...
Transcript of HYDROCELE Defined as a collection of fluid within the tunica vaginalis of the testis Defined as a...
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HYDROCELE
Defined as a collection of fluid within the Defined as a collection of fluid within the tunica vaginalis of the testistunica vaginalis of the testis
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CASSIFICATION
1. Congenital1. Congenital 2. Primary2. Primary 3. Secondary3. Secondary
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1. CONGENITAL
Communicating (“vogbreuk”)Communicating (“vogbreuk”) InfantileInfantile InterstitialInterstitial CordCord
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2. PRIMARY HYDROCELE
Idiopathic (aetiology not known)Idiopathic (aetiology not known) Imbalance between the fluid secretion and Imbalance between the fluid secretion and
absorption of the tunica vaginalisabsorption of the tunica vaginalis
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3. SECONDARY HYDROCELE
InfectionInfection TraumaTrauma TumorTumor Abnormalities in inguinal lymph nodesAbnormalities in inguinal lymph nodes
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DIFFERENTIAL DIAGNOSIS:SCROTAL CYSTIC MASSES Indirect inguinal herniaIndirect inguinal hernia Epididymis cystEpididymis cyst HydroceleHydrocele VaricoceleVaricocele SpermatoceleSpermatocele PiocelePiocele HematoceleHematocele
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TREATMENT
CommunicatingCommunicating Tying off the patent processus vaginalisTying off the patent processus vaginalis
PrimaryPrimary HydrocelectomyHydrocelectomy Aspiration + injection of sclerosing agentAspiration + injection of sclerosing agent
SecondarySecondary Treat underlying pathologyTreat underlying pathology
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DIFFERENTIATION
HYDROCELEHYDROCELE INGUINALINGUINAL
HERNIAHERNIA
Palpate cord Palpate cord above massabove mass
YESYES NONO
TranslucentTranslucent YESYES NONO
FluctuateFluctuate YESYES NONO
Fluid thrill Fluid thrill YESYES NONO
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DIFFERENTIATION
HYDROCELEHYDROCELE INGUINALINGUINAL
HERNIAHERNIA
Testis palpableTestis palpable NONO YESYES
Cough impulseCough impulse NONO YESYES
ReducibleReducible NONO YESYES
Bowl soundsBowl sounds NONO YESYES
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FLUID ASPIRATED FROM CYSTIC MASSES SUPRA TESTICULARSUPRA TESTICULAR
CYSTIC MASSCYSTIC MASS
COLOR OF FLUIDCOLOR OF FLUID
Cord hydroceleCord hydrocele Straw color Straw color
SpermatoceleSpermatocele Milky orMilky or
Grey opaque (barley-Grey opaque (barley-water)water)
Epididymis cystEpididymis cyst ClearClear
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VARICOCELE
Defined as an abnormal dilatation and Defined as an abnormal dilatation and distension of the veins of the pampiniform distension of the veins of the pampiniform plexusplexus
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INCIDENCE
15% in the general population15% in the general population (8% - 23%)(8% - 23%)
16,3% in adolescents16,3% in adolescents (12,4% - 25,8%)(12,4% - 25,8%)
33% in infertile men33% in infertile men (19% - 41%)(19% - 41%)
58% - 93% left sided58% - 93% left sided
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ETIOLOGY
Abnormality of the venous valvesAbnormality of the venous valves Left spermatic vain joining the left renal vein Left spermatic vain joining the left renal vein
directly at a 90directly at a 90° angle° angle Longer left spermatic vein with increased Longer left spermatic vein with increased
hydrostatic pressurehydrostatic pressure Pressure of superior mesenteric artery on the Pressure of superior mesenteric artery on the
left renal vein (Nutcracker phenomenon)left renal vein (Nutcracker phenomenon)
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PRESENTATION
Complaints of a scrotal massComplaints of a scrotal mass (“Bag of worms”)(“Bag of worms”)
Complaints of scrotal discomfortComplaints of scrotal discomfort Fertility problemsFertility problems Incidental diagnosis with clinical Incidental diagnosis with clinical
examinationexamination Smaller left testisSmaller left testis
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CLACCIFICATION
PrimaryPrimary Abnormality of valves in the spermatic Abnormality of valves in the spermatic
veinvein Secondary Secondary
Tumor of the left kidneyTumor of the left kidney Retro-peritoneal massesRetro-peritoneal masses TraumaTrauma
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GRADING
GRADE 0GRADE 0 Venous noise on doppler Venous noise on doppler with Valsalva maneuverwith Valsalva maneuver
GRADE 1GRADE 1 Distended veins can be Distended veins can be palpated with Valsalvapalpated with Valsalva
GRADE 2GRADE 2 Distended veins can be Distended veins can be palpated without palpated without ValsalvaValsalva
GRADE 3GRADE 3 Distended veins can be Distended veins can be observedobserved
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INFERTILITY THEORIES
Stases of blood with testicular hypoxiaStases of blood with testicular hypoxia Reflux of renal and adrenal metabolitesReflux of renal and adrenal metabolites Increased intra-testicular temperature Increased intra-testicular temperature
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INDICATIONS FOR FURTHER MANAGEMENT SymptomaticSymptomatic
** PainPain
** Mass (discomfort)Mass (discomfort) InfertilityInfertility Testicular atrophyTesticular atrophy
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TREATMENT
Spermatic venography plus embolisation Spermatic venography plus embolisation with heated contrast/resin/coilswith heated contrast/resin/coils
SurgerySurgery OpenOpen
IvanissevitchIvanissevitchPalomaPaloma
LaparoscopicLaparoscopic