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

2. CASSIFICATION
1. Congenital
2. Primary
3. Secondary

3. 1. CONGENITAL
Communicating (“vogbreuk”)
Infantile
Interstitial
Cord

4. 2. PRIMARY HYDROCELE Idiopathic (aetiology not known)
Imbalance between the fluid secretion and absorption of the tunica vaginalis

5. 3. SECONDARY HYDROCELE Infection Trauma Tumor
Abnormalities in inguinal lymph nodes

6. DIFFERENTIAL DIAGNOSIS: SCROTAL CYSTIC MASSES
Indirect inguinal hernia
Epididymis cyst
Hydrocele
Varicocele
Spermatocele
Piocele
Hematocele

7. TREATMENT Communicating Tying off the patent processus vaginalis
Primary
Hydrocelectomy
Aspiration + injection of sclerosing agent
Secondary
Treat underlying pathology

8. DIFFERENTIATION HYDROCELE INGUINAL HERNIA Palpate cord above mass YESNO
Translucent
Fluctuate
Fluid thrill

9. DIFFERENTIATION HYDROCELE INGUINAL HERNIA Testis palpable NO YES
Cough impulse
Reducible
Bowl sounds

10. FLUID ASPIRATED FROM CYSTIC MASSES
SUPRA TESTICULAR
CYSTIC MASS
COLOR OF FLUID
Cord hydrocele
Straw color
Spermatocele
Milky or
Grey opaque (barley-water)
Epididymis cyst
Clear

11. VARICOCELE
Defined as an abnormal dilatation and distension of the veins of the pampiniform plexus

12. INCIDENCE 15% in the general population (8% - 23%)
16,3% in adolescents
(12,4% - 25,8%)
33% in infertile men
(19% - 41%)
58% - 93% left sided

13. ETIOLOGY Abnormality of the venous valves
Left spermatic vain joining the left renal vein directly at a 90° angle
Longer left spermatic vein with increased hydrostatic pressure
Pressure of superior mesenteric artery on the left renal vein (Nutcracker phenomenon)

14. PRESENTATION Complaints of a scrotal mass (“Bag of worms”)
Complaints of scrotal discomfort
Fertility problems
Incidental diagnosis with clinical examination
Smaller left testis

15. CLACCIFICATION Primary Abnormality of valves in the spermatic vein
Secondary
Tumor of the left kidney
Retro-peritoneal masses
Trauma

16. GRADING GRADE 0 Venous noise on doppler with Valsalva maneuver GRADE 1
Distended veins can be palpated with Valsalva
GRADE 2
Distended veins can be palpated without Valsalva
GRADE 3
Distended veins can be observed

17. INFERTILITY THEORIES Stases of blood with testicular hypoxia
Reflux of renal and adrenal metabolites
Increased intra-testicular temperature

18. INDICATIONS FOR FURTHER MANAGEMENT
Symptomatic
* Pain
* Mass (discomfort)
Infertility
Testicular atrophy

19. TREATMENT
Spermatic venography plus embolisation with heated contrast/resin/coils
Surgery
Open
Ivanissevitch
Paloma
Laparoscopic