hydrocele varicocele
DESCRIPTION
tTRANSCRIPT
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HYDROCELEDefined as a collection of fluid within the tunica vaginalis of the testis
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CASSIFICATION1. Congenital2. Primary3. Secondary
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1. CONGENITALCommunicating (vogbreuk)InfantileInterstitialCord
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2. PRIMARY HYDROCELEIdiopathic (aetiology not known)Imbalance between the fluid secretion and absorption of the tunica vaginalis
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3. SECONDARY HYDROCELEInfectionTraumaTumorAbnormalities in inguinal lymph nodes
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DIFFERENTIAL DIAGNOSIS:SCROTAL CYSTIC MASSESIndirect inguinal herniaEpididymis cystHydroceleVaricoceleSpermatocelePioceleHematocele
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TREATMENTCommunicatingTying off the patent processus vaginalisPrimaryHydrocelectomyAspiration + injection of sclerosing agentSecondaryTreat underlying pathology
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DIFFERENTIATION
HYDROCELEINGUINALHERNIAPalpate cord above massYESNOTranslucentYESNOFluctuateYESNOFluid thrill YESNO
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DIFFERENTIATION
HYDROCELEINGUINALHERNIATestis palpableNOYESCough impulseNOYESReducibleNOYESBowl soundsNOYES
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FLUID ASPIRATED FROM CYSTIC MASSES
SUPRA TESTICULARCYSTIC MASSCOLOR OF FLUIDCord hydroceleStraw color SpermatoceleMilky orGrey opaque (barley-water)Epididymis cystClear
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VARICOCELEDefined as an abnormal dilatation and distension of the veins of the pampiniform plexus
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INCIDENCE15% in the general population(8% - 23%)16,3% in adolescents(12,4% - 25,8%)33% in infertile men(19% - 41%)58% - 93% left sided
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ETIOLOGYAbnormality of the venous valvesLeft spermatic vain joining the left renal vein directly at a 90 angleLonger left spermatic vein with increased hydrostatic pressurePressure of superior mesenteric artery on the left renal vein (Nutcracker phenomenon)
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PRESENTATIONComplaints of a scrotal mass(Bag of worms)Complaints of scrotal discomfortFertility problemsIncidental diagnosis with clinical examinationSmaller left testis
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CLACCIFICATIONPrimaryAbnormality of valves in the spermatic veinSecondary Tumor of the left kidneyRetro-peritoneal massesTrauma
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GRADING
GRADE 0Venous noise on doppler with Valsalva maneuverGRADE 1Distended veins can be palpated with ValsalvaGRADE 2Distended veins can be palpated without ValsalvaGRADE 3Distended veins can be observed
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INFERTILITY THEORIESStases of blood with testicular hypoxiaReflux of renal and adrenal metabolitesIncreased intra-testicular temperature
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INDICATIONS FOR FURTHER MANAGEMENTSymptomatic*Pain*Mass (discomfort)InfertilityTesticular atrophy
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TREATMENTSpermatic venography plus embolisation with heated contrast/resin/coilsSurgeryOpenIvanissevitchPalomaLaparoscopic