Hydrocele

Hydrocele

1. Ratheesh.R SLMGNC HYDROCELE

2. INTRODUCTION Hydrocele is an abnormal fluid collection in the scrotum between the visceral and parietal areas of the tunica vaginalis . In infants is usually the result of incomplete closure of the process us tunica vaginalis . It may or may not be associated with inguinal hernia. In older boys and men it may be idiopathic but more likely to be secondary to another pathologic process in the scrotum or adjacent structures

3. Structure

4. CAUSES Infectious disease of Epididymis . Local trauma Systematic infectious disease like Mumps. Imbalance in production and reabsorption of fluid with in the tunica vaginalis . An opening between the peritoneum and tunica vaginalis .

5. Structure

6. Risk factors Most hydroceles are present at birth (congenital), and babies who are born prematurely have a higher risk of having a hydrocele . Risk factors for developing a hydrocele later in life include: Scrotal injury Infection, including sexually transmitted infections

7. SIGNS & SYMPTOMS A bulge in the groin Scrotal enlargement is the classic presentation of hernia or communicating hydrocele . Pain is generally not a prominent feature but may occur if a hydrocele expands quickly; tension in the wall may cause milder pain. Hydrocele may become infected and cause pain. Frequently, parents report an intermittent bulge. The bulge may reduce at night in the supine position. A history of vomiting, colicky abdominal pain, or constipation suggests bowel obstruction, which may occur with an incarcerated or strangulated hernia.

8. Cont…. Constant discomfort Embarrassment Impaired circulation Scrotal mass become large Tense

9. Diagnostic Evaluation PHYSICAL ASSESSMENT: The exam may reveal an enlarged scrotum that isn't tender to the touch. Pressure to the abdomen or scrotum may enlarge or shrink the fluid-filled sac, which may indicate an associated inguinal hernia. Because the fluid in a hydrocele usually is clear, doctor may shine a light through the scrotum ( transillumination ). With a hydrocele , the light will outline the testicle, indicating that clear fluid surrounds it.

10. Cont…. Blood and Urine tests may help determine whether there is an infection, such as epididymitis . The fluid surrounding the testicle may keep the testicle from being felt. In that case, Ultrasound imaging test is done. Trans-illumination - This test can rule out a hernia, testicular tumor or other cause of scrotal swelling.

11. TREATMENT Hydroceles usually improve without any treatment within the first year of life. An operation is usually only advised if the hydrocele persists after 12-18 months of age. Surgery Aspiration/Surgical Drainage: - It is treated by aspirating the fluid and injecting a sclerosing drug such as urea hydrochloride into the scrotal sac.

12. Cont…. Incision of Tunica Vaginalis : > An incision made through the wall of the scrotum down to the distanced Tunica Vaginalis . > The sac is resected or after being opened, is sutured together to collapse the wall. Hydrocelectomy : > Excision of the tunica vaginalis to withdraw the fluid collection from it .

13.  Cont…. The operation for a hydrocele involves making a very small cut in the lower tummy (abdomen) or the scrotum. The fluid is then drained from around the testicle (testis). The passage between the abdomen and the scrotum will also be sealed off so the fluid cannot reform in the future. This is a minor operation and is performed as a day case, so does not usually involve an overnight stay in the hospital. There are no long-term effects of having a hydrocele . Having a hydrocele does not affect the testicles (testes) or a boy's fertility in the future.

14. Potential Complications from Surgery Complications from surgery are very rare, but are more likely if the child has previous groin surgery. Possible risks include infection, bleeding recurrence, pulling up of the testicle, and injury to the testicle or its ducts.

15. Complication Haematoma in the loose scrotal tissue Testicular Tumor Inguinal Hernia.

16. Nursing Diagnosis Excess Fluid Volume related to the collection of fluid in the sac of scrotum as evidenced by enlargement of scrotum. Risk for impaired skin integrity r/t problems in managing the urine collection appliance. Acute pain r/t surgical incision Potential for sexual dysfunction r/t structural and physiologic alterations. Deficient Knowledge r/t management of urinary function.

17. Nursing Management A pressure dressing is applied on the scrotum which is elevated. The patient should be observed carefully for any symptoms of Hemorrhage and Bleeding may not be external. The patient needs a scrotal support when he is up. Scrotum is elevated on a pillow or bride dressing. Ambulation is encouraged with scrotal support.