HydroceleA hydrocele is a collection of fluid around the testicle. In most cases, a hydrocele is congenital, i.e. a baby boy is born with it.non-communicating hydrocele. This condition usually corrects itself within the first 18 months of life. communicating hydrocele.In some cases, the sac itself remains open, and the fluid can travel up and down between scrotum and abdomen. It is smaller after a night’s rest and larger after a day of activity.
Hydrocele divided into :- 1) congenital 2) acquired → primary (idiopathic) → secondary, due to disease of testis.Hydrocele can produced in 4 ways (Etiology): 1 - by excessive production of fluid within the sac, e.g. secondary hydrocele. 2- By defective absorption of fluid by tunica vaginalis which may be caused by damage of Endothelial wall by a low — grade infection. 3 - by interference with the drainage of fluid by The lymphatic vessels of a spermatic cord.
4 - by connection with the peritoneal cavity, as in congenital hydrocele. Diagnostic rules for all hydroceles :-1) 99% of hydroceles are transluminated2) O/E it is possible “to get above the swelling” TreatmentHydrocelectomy → Jaboulay s procedure → Lord’s procedureTapping:- aspiration of the fluid by a syringe after doing transillumination
Torsion of the testis (Torsion of the spermatic cord) Predisposing causes :- Torsion does not occur in a normal fully descended testis. Therefore one of several anomalies must be present: a) Inversion of the testis, the commonest Predisposing cause. The testis is rotated, so that it lies transversely or upside down. b) high investment of the tunica vaginalis causes the testis to hang within the tunica like a clapper in a bell. c) Separation of the epididymis from the body of the testis permits torsion of the testis without involving the cord.
Clinical features :- The highest incidence is between 10 & 25 years of age. the 2nd most common age period is during infancy. most commonly patient experiences sudden & agonising pain in the groin & lower abdomen , & vomiting in the early stages of torsion, the affected testis is tender, slightly swollen & draw up into the neck of the scrotum where the cord may be palpably thickened. at a later stage, the overlying scrotal skin tends to become red & edematous , making accurate palpation difficult . At this point torsion may be difficult to distinguish clinically from acute epididymitis, but elevation of scrotum usually reduces the pain in epididymo-orchitis & makes it worse in torsion. Doppler US will confirm the absence of the blood supply to the affected testis
Treatment Immediate exploration of the scrotum within (6 hrs) , if there is doubt, then untwisting of the cord & testis, so the viability return to normal with orchiopexy (fixation of the testis to the scrotal wall to prevent recurrence Fixation of the other testis at the same time because the anatomical variation responsible for the torsion is likely to be bilateral. If the testis remained gangrenous black, then we do orchiectomy (orchidectomy) with fixation of the other testis.
Acute epididymo-orchitis :-if the inflammation remain confined to the epididymis this is called epididymitiswhen the infection spreads to the body of testis, the condition is known as epididymo-orchitis. Clinical featuresthe initial symptoms (dysuria, frequency,……….)few days later → pain in the groin and a fever.sever pain & swelling of testis occurs rapidly; the scrotal wall becomes red, edematous & shiny.the epididymis may become adherent to the scrotal skin & may be soften & later discharge.
Resolution is heralded by scaling of the scrotal skin & may take 6-8 weeks to completeThe primary infection is either a UTI with E.coli (50- 60 yr age group) or a STD infection with Chlamydia or N. gonorrhea (common in the 15- 30 yr. age group).When you raise the testis , the patient get relieved & the diagnosis is confirmedacute epididymo-orchitis of mumps develops in about 18% of males suffering from mumps. TreatmentBed rest ● Broad spectrum A.Banalgesic ● support to the scrotum
Undescended Testicles (Cryptorchidism) The testicles develop in the abdomen and usually descend into the scrotal sacs by the time of birth. Cryptorchidism (Undescended testes) is one of the most common malformations in young boys and occur in about 4 out of every 100 (4%) of newborn boys. An Undescended testicle must be distinguished from a retractile testis, one which is normal but has temporarily pulled up out of scrotal sac into the groin area. Upon examination the testicle can be pulled into the scrotal sac.
An Undescended testicle should be brought down into the scrotum as early as possible, preferably before the child is one year old. This is thought to preserve the function of the testicle with regard to fertility. A testicle that has not fully descended into the scrotum by age 6 months will not do so thereafter. Hormonal manipulation has been found to be ineffective in true Undescended testes. Retractile testes are more likely to respond to hormonal treatment. Occasionally, we will use hormonal therapy to differentiate retractile testes from Undescended testes.
What Problems Can Undescended Testis Cause? An Undescended testis that remains outside the scrotum throughout childhood may result in impaired or abnormal testicular development which could result in future infertility. Another concern is an increased risk of tumor development in the Undescended testis during early adulthood. Fortunately, the occurrence is uncommon. Careful periodic examination of the testicles by a physician and self-examination is therefore desirable throughout life. In addition, most Undescended testicles are associated with a congenital (present at birth) hernia and are more prone to injuries than a testicle located within the scrotal sac.
What is the treatment for an Undescended Testis? Operative treatment (surgery) is performed to bring the testicle down into the scrotal sac and to prevent or lesson the likelihood of problems associated with an Undescended testicle. In addition, the congenital hernia is corrected at the same time the Undescended testicle is placed within the scrotal sac. Non-operative treatment might include a series of hormone shots to stimulate testicular growth and descent into the scrotal sac. Unfortunately, results of hormone therapy have not been predictable and are generally unsuccessful. When Should The Surgery Be Done? Surgery at the age of 1 year is now recommended and should allow for maximum preservation of fertility. This may reduce the risk of developing testicular tumors later in life.