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Hydrocele

  • Posted on- Apr 16, 2018
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A hydrocele is a condition where there is excessive fluid collection in the tunica vaginalis sac of male testis.

Types
They are usually of two types:

  • Congenital - where the condition is acquired genetically.
  • Acquired - this is again divided into primary and secondary hydrocele

Primary Hydrocele - are the most common hydrocele seen in adults. They are soft, moderate to big sized, watery filled cavities and are painless. It may be due to the defective absorption of the fluid or defective lymphatic drainage.

Secondary Hydrocele - these are acquired after the secondary infections recurrent epididymo-orchitis in filariasis, tuberculosis, testicular cancer, infections and trauma. They are small sized, where the testis can be easily examined, lax and cystic in consistency and are usually negative for transillumination tests.

Complications
The hydrocele, when left untreated can lead to the complications such as haematocele, pyocele, calcification of the hydrocele sac, rupture, hernia and testicular atrophy.

Treatment
Hydrocele correction involves 3 surgical methods
  • Lord’s Plication - This is done in small hydrocele. In this, the sac is opened, and the cut edge of the sac is plicated (folded lengthwise). Due to this, the sac gets crumpled up near the testis. Now the secretions get absorbed by subcutaneous lymphatics and venous system.
  • Jaboulay’s Operation – this is performed in large-sized hydrocele. The thick, large, sac is partially opened and sutured behind the testis.
  • Aspiration - a temporary method where the fluid content is aspirated.

Circumcision
Circumcision refers to the removal of prepuceal skin. It is a male surgical procedure followed under conditions
  • Phimosis - a condition where the foreskin of the penis cannot be pulled back past the glans.
  • In some religions, circumcision is done as the ritual at the very young age between 5-7 years.

Causes of phimosis may be congenital by birth, inflammation of glans penis and skin diseases affecting the male genitals.

Phimosis is a common condition in young children, and about 90% cases get usually resolved by it between 7-16 years.

If this does not get corrected then circumcision is done. This is done under general anesthesia in children and under local anesthesia in adult males.

In adults, it is done by separating the foreskin from the glans and splitting up to the middle and thereby trimming and uniting the prepuceal layers.

In children, the prepuce is held, pulled gently and ligated after all the bleeding points are sutured.

Contraindications
This cannot be done if the opening of urethra is on the underside of the penis, as the prepuceal skin is required for the procedure.

Complications of circumcision
There may be an injury to the glans penis leading to the increased bleeding and blood clot formation within the glans penis.

There may also be tension at the suture line if too much skin is removed which can lead to painful erection in the later years. It is always advisable to consult a skilled surgeon to understand the possibilities of the procedure.

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