A 25 year old man presents with hydrocele on the left side. Associated condition could be a: September 2008: (A) Nephroma, (B) Hepatic malignancy, (C) Testicular tumour, (D) Penile malignancy
Answer is C. Ans. C: Testicular tumour Hydrocele is an abnormal collection of serous fluid in the tunica vaginalis covering the testicles or within some pa of processus vaginalis. Primary/idiopathic hydrocele cause not known (common) 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) Acute hydrocele in a young man may be associated with testicular malignancy. 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. Postoperative Complication Hematoma - drain aseptically Infection - treat conservatively/antibiotics after culture and sensitivity, if required.