hydrocele varicocele

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HYDROCELE Defined as a collection of Defined as a collection of fluid within the tunica fluid within the tunica vaginalis of the testis vaginalis of the testis

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  • HYDROCELEDefined as a collection of fluid within the tunica vaginalis of the testis

  • CASSIFICATION1. Congenital2. Primary3. Secondary

  • 1. CONGENITALCommunicating (vogbreuk)InfantileInterstitialCord

  • 2. PRIMARY HYDROCELEIdiopathic (aetiology not known)Imbalance between the fluid secretion and absorption of the tunica vaginalis

  • 3. SECONDARY HYDROCELEInfectionTraumaTumorAbnormalities in inguinal lymph nodes

  • DIFFERENTIAL DIAGNOSIS:SCROTAL CYSTIC MASSESIndirect inguinal herniaEpididymis cystHydroceleVaricoceleSpermatocelePioceleHematocele

  • TREATMENTCommunicatingTying off the patent processus vaginalisPrimaryHydrocelectomyAspiration + injection of sclerosing agentSecondaryTreat underlying pathology

  • DIFFERENTIATION

    HYDROCELEINGUINALHERNIAPalpate cord above massYESNOTranslucentYESNOFluctuateYESNOFluid thrill YESNO

  • DIFFERENTIATION

    HYDROCELEINGUINALHERNIATestis palpableNOYESCough impulseNOYESReducibleNOYESBowl soundsNOYES

  • FLUID ASPIRATED FROM CYSTIC MASSES

    SUPRA TESTICULARCYSTIC MASSCOLOR OF FLUIDCord hydroceleStraw color SpermatoceleMilky orGrey opaque (barley-water)Epididymis cystClear

  • VARICOCELEDefined as an abnormal dilatation and distension of the veins of the pampiniform plexus

  • 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

  • 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)

  • PRESENTATIONComplaints of a scrotal mass(Bag of worms)Complaints of scrotal discomfortFertility problemsIncidental diagnosis with clinical examinationSmaller left testis

  • CLACCIFICATIONPrimaryAbnormality of valves in the spermatic veinSecondary Tumor of the left kidneyRetro-peritoneal massesTrauma

  • 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

  • INFERTILITY THEORIESStases of blood with testicular hypoxiaReflux of renal and adrenal metabolitesIncreased intra-testicular temperature

  • INDICATIONS FOR FURTHER MANAGEMENTSymptomatic*Pain*Mass (discomfort)InfertilityTesticular atrophy

  • TREATMENTSpermatic venography plus embolisation with heated contrast/resin/coilsSurgeryOpenIvanissevitchPalomaLaparoscopic