Congenital vaginal hydrocele/Dr.Anthony

A vast review about hydrocele and its importance in congenital anamoly cases

1. ANTHONY GABRIAL.S Indira Gandhi Medical College & Research Institute Pondicherry CONGENITAL VAGINAL HYDROCELE A case report

2. INTRODUCTION Definition: I s a collection of fluid within the tunica vaginalis of the testis. Common in newborns. Most hydroceles disappear without treatment within the 18 months of life.

3. Usually unilateral, but can also occur bilatarally Hydrocele normally is seen in infant boys - as enlarged scrotum . in infant girls - as enlarged labia . Hydrocele boys > girls. There is a greater chance of infertility if the hydrocele does not show itself until the child has reached adulthood.

4. MATERIALS & METHODS A 4 years old boy was referred to the pediatric OPD with swelling of right scrotum since birth. The mother complained of swelling of right scrotum, which increased in size gradually. No h/o pain. There was no h/o decresing in size of swelling on lying position. No h/o increase in size with swelling on coughing.

5. HYDROCELE

6. ON EXAMINATION Skin and subcutaneous tissue: Tense, normal rugosity of the skin lost. Impulse on coughing: Negative Fluctuation: Positive Transillumination test: Positive Reducibility: Positive. Testis- can be palpated posteriorly Lymph nodes- Not palpable Left scrotum was normal. USG : Done for right scrotum

7. ULTRASONOGRAPHY USG reveals the right testicle with hydrocele

8. On examination, It was identified as COMMUNICATING HYDROCELE . It was diagnosed as CONGENITAL RIGHT SIDED VAGINAL HYDROCELE & surgical correction of the hydrocele was done.

9. DISCUSSION CONGENITAL VAGINAL HYDROCELE Fluid-filled sac surrounding a testicle swelling of the scrotum Presented as loose bag of skin underneath the penis.

10. As the testes descends it carries along with it a double layered Peritoneal sac – PROCESSUS VAGINALIS . Later on the distal portion of processus vaginalis alone persists as TUNICA VAGINALIS . Proximal portion obliterates. DEVELOPMENT

11. Descend of Testis

12. TYPES VAGINAL HYDROCELE COMMUNICATING HYROCELE INFANTILE HYDROCELE HYDROCELE OF CORD

13. Congenital vaginal hydrocele results when the processus vaginalis remains patent, allowing fluid from the peritoneum to accumulate in the scrotum.

14. INCIDENCE 30% in the infant boys (8% - 33%) 10% in the infant girls (6% - 15%) 40% in aldults (19% - 41%) 58% - 93% right sided <10% left sided Few are bilateral

15. SURGICAL TREATMENT Mostly resolve with medical treatment. If discomfort or very large, two methods of treatment are available a) aspiration and b) hydrocelectomy (surgery).

16. ASPIRATION Needle is used to drain the fluid. Not common treatment for hydroceles , but performed when surgery is too risky. Complication: FIBROSIS

17. Hydrocelectomy   Minor surgical procedure where fluid is drained. Under anesthesia, through a small incision, fluid is drained and while stitching, the tunica vaginalis is everted and stitched. Here the proximal part is also cut and stitched. Complications: blood clot, infection & injury to scrotum

18. COMPLICATIONS Infertility Testicular atrophy. Haematoma. Excessive scar formation . Recurrence of the hydrocele after inguinal approaches .

19. CONCLUSION Hydrocele is a differential diagnosis in males commonly presenting with an enlarged scrotum. Hydroceletomy is done & tunica vaginalis is everted &stitched. Proximal part extending into inguinal region is also stitched in its proximal portion. Most commonly seen in boys than girls. Congenital communicating hydrocele is accompanied with hernia and so a search on hernia with hydrocele should be ruled out.

20. BIBLIOGRAPHY Scrotal swelling : NICE, CKS, Feb 2010. Aspiration versus hydrocelectomy for the treatment of hydroceles. Rudkin SE et al, Hydrocele in emergency medicine Clinical hydrocele : A Manual Method Of Surgeey, S.DAS Hydrocele swelling : net source Wikipedia Hydrocele overview : Mayo Clinic Kogan BA. Communicating hydrocele /hernia repair in children. BJU Int 2007;100:703-13