Hydrocele / Varicocele

Hydrocele
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Def:
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Hydrocele is a collection of serous fluid between the layers of the membrane (tunica vaginalis) that surrounds the testis or along the spermatic cord.

Two Types:
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1. communicating - processus vaginalis communicates with the peritoneal cavity
2. non-communicating - processus vaginalis does not communicate with the peritoneal cavity, but more fluid is produced by the tunica vaginalis than it is absorbed.

Dx:
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Clinical diagnosis: transluilluminable, soft(may be tense if small) scrotal mass

If other/additional Dx is suspected ( e.g. with fever, vomitting, diarrhoea, testis not palpable etc ) -> Sonar scrotum


Rx:
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4 options:

- 1. Observation

- 2. Surgical excision of the hydrocele sac

- 3. Simple aspiration - generally unsuccessful due to rapid reaccumulation of fluid.

- 4. Sclerotherapy
(When fertility is not an issue, aspiration of the hydrocele followed by instillation of sclerosing agent into the scrotum.
Complication:
reactive orchitis/epididymitis and a higher rate of recurrence/makes open surgery more difficult due to adhesion.)

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in children:

<= 2 yr : observation
>= 2 yr : surgery

In adults :
- wihtout discomfort or infection - observation
- with discomfort or infection - surgery or sclerotherapy
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Varicocele
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Def:
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abnormal dilatation of venous pelux

Grade:
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1. small, palpable only with valsalva
2. moderate, PALPABLE on standing, non-visible
3. large, VISIBLE on gross inspection.


Dx:
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Ninety percent of varicoceles are on the left side, while approximately 10% are bilateral. A right-sided varicocele alone is rare and should raise suspicion of the presence of a retroperitoneal or pelvic compressive mass.

Scrotal Sonar

'bag of worms' appearance

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Reason why it occurs on the left commonly:
Left testicular vein drains into left renal vein.
Left renal vein's pressure is higher than testicular vein because it's compressed between aorta and superior mesenteric vein.
This leads to failure of venous valves, causing varicocele.
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Rx:
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Warn patient about possible decreased fertility.
If fertility is a concern to the pt -> semen analysis every 2 years.

Young pt (<= 20 yr) with clinically obvious hydrocele -> Surgery

Otherwise observation.