HYDROCELE

Hydrocele is an abnormal collection of serous fluid in the tunica vaginalis covering the testicles

or within some part of processus vaginalis.

Hydrocele is the commonest cause of swelling in the scrotum in the elderly. About 5% of the

patients attending the geriatric outpatient department are hydrocele patients. Very large hydrocele in

the elderly can cause problems like embarrassment, heaviness and difficulty in walking normally.

Simple surgical correction like eversion or excision of sac can cure the problem and improve the

quality of life of the elders. It is important to examine the patients completely including the hernial

orifices, back and the perineal region and to refer them to the surgeons for surgical correction.

1. · Primary hydrocele cause not known (common)
2. · Secondary hydrocele secondary to a disease in testis or epididymis

Etiology

· Defective absorption of fluid by the tunica vaginalis
· Excessive production of fluid within the sac
· Lymphatic obstruction
· Communication with peritoneal cavity

Symptoms

In majority – swelling of the scrotum may be the only complaint. Occasionally patient may
complain of pain (due to heaviness or complications)

Examination

· Swelling confined to scrotum (can get above the swelling, cf. inguinal hernia)
· Fluctuation test positive( cystic swelling)
· Transillumination test positive (except in thickened, fibrosed and calcified sac)
· Irreducible
· Testis not felt separately (not in secondary hydrocele)

Complications

· Infection = Rupture
· Haematocele = Hernia of the hydrocele sac
· In long standing hydrocele (calcification of the sac, atrophy of the testis may be present)
· Skin excoriation due to in drawing of the penis and dribbling of urine.
· Decubitus ulcer in the scrotum.

Treatment 

Jaboulay’s method of eversion of sac;
In this procedure the hydrocele fluid is let out after opening the sac through scrotal
incision and then eversion of sac is done so that the secreting surface of the tunica
vaginalis turned outside

Lord’s procedure; 
In case of small hydrocele and thin sac, plication of the sac is done.

Excision of the sac done in case of massive hydrocele with thickened sac

In cases of secondary hydrocele due to testicular malignancy, the management protocol
for malignancy should be followed in tertiary care hospital

Postoperative complication

· Hematoma – drain aseptically
· Infection – treat conservatively/antibiotics after culture and sensitivity.if required