Mohammed Ibrahim Mahmoud Ali Obied

8/14/2019 Mohammed Ibrahim Mahmoud Ali Obied

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HYDROCELEHYDROCELE

Mohammed ibrahim mahmoud ali obiedMohammed ibrahim mahmoud ali obied


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Outline :Outline :

. Definition of Hydrocele:. Definition of Hydrocele:11

. Description of Hydrocele:. Description of Hydrocele:2 2

. Pathophysiology:. Pathophysiology:3 3

. Causes:. Causes:44

. Clinical sign and symptoms:. Clinical sign and symptoms:5 5

. Physical:. Physical:66

. complication:. complication:7 7

. Treatment of Hydrocele:. Treatment of Hydrocele:8 8

. Nursing care.. Nursing care.9 9 A. Before the operation: A. Before the operation:

in hospital:in hospital:--B. After B. After at home:at home:--c. After c. After


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Definition of Hydrocele:Definition of Hydrocele:

A hydrocele is an accumulation of fluid in any sac A hydrocele is an accumulation of fluid in any sac- -like cavity or duct specifically in like cavity or duct specifically in the tunica vaginalis testis or along the spermatic cord. The condition is caused by the tunica vaginalis testis or along the spermatic cord. The condition is caused by inflammation of the epididymis or testis or by lymphatic or venous obstruction of inflammation of the epididymis or testis or by lymphatic or venous obstruction of the cord.the cord.

The term hydrocele literally means a sac of water.The term hydrocele literally means a sac of water.


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Pathophysiology:Pathophysiology:

Embryologically, the processus vaginalis is a diverticulum of the peritonealEmbryologically, the processus vaginalis is a diverticulum of the peritonealcavity. It descends with the testes into the scrotum via the inguinal canalcavity. It descends with the testes into the scrotum via the inguinal canalaround thearound the 2828th gestational week with gradual closure through infancy andth gestational week with gradual closure through infancy andchildhood.childhood.

Adult hydroceles are usually late Adult hydroceles are usually late- -onset (secondary). Lateonset (secondary). Late- -onset hydroceles may onset hydroceles may present acutely from local injury, infections, and radiotherapy; they may present acutely from local injury, infections, and radiotherapy; they may present chronically from gradual fluid accumulation. Morbidity may result frompresent chronically from gradual fluid accumulation. Morbidity may result fromchronic infection after surgical repair. Hydrocele can adversely affect fertility.chronic infection after surgical repair. Hydrocele can adversely affect fertility.


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Causes:Causes:

11 . Most pediatric hydroceles are congenital; however, consider malignancy,. Most pediatric hydroceles are congenital; however, consider malignancy,infection, and circulatory compromise as possible causes of hydrocele presenting infection, and circulatory compromise as possible causes of hydrocele presenting after infancy.after infancy.

22. Hydrocele of the cord is associated with pathologic closure of the distal. Hydrocele of the cord is associated with pathologic closure of the distalprocessus vaginalis, which allows fluid pooling in the mid portion of the spermatic processus vaginalis, which allows fluid pooling in the mid portion of the spermatic cord.cord.

33. Communicating hydrocele is caused by failed closure of the processus vaginalis . Communicating hydrocele is caused by failed closure of the processus vaginalis at the internal ring.at the internal ring.

44. Noncommunicating hydrocele results from pathologic closure of the processus . Noncommunicating hydrocele results from pathologic closure of the processus vaginalis and trapping of peritoneal fluid.vaginalis and trapping of peritoneal fluid.


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55 .. Testicular torsion Testicular torsion may cause a reactive hydrocele in may cause a reactive hydrocele in 20 20% of cases. The% of cases. Theclinician may be misled by focusing on the hydrocele, which delays the diagnosis clinician may be misled by focusing on the hydrocele, which delays the diagnosis of torsion.of torsion.

66. Tumor, especially germ cell tumors or tumors of the testicular adnexa may . Tumor, especially germ cell tumors or tumors of the testicular adnexa may cause hydrocele.cause hydrocele.

77. Traumatic (ie, hemorrhagic) hydroceles are common.. Traumatic (ie, hemorrhagic) hydroceles are common.

88. Radiation therapy is associated with cases of hydrocele.. Radiation therapy is associated with cases of hydrocele.

99. Exstrophy of the bladder may lead to hydrocele.. Exstrophy of the bladder may lead to hydrocele.

1 01 0. Hydrocele may result from a change in the type or volume of peritoneal. Hydrocele may result from a change in the type or volume of peritonealfluid, like in patients undergoing peritoneal dialysis and those with afluid, like in patients undergoing peritoneal dialysis and those with aventriculoperitoneal shunt.ventriculoperitoneal shunt.


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Clinical sign and symptoms:Clinical sign and symptoms:

11 .. Most hydroceles are asymptomatic or sub clinical.Most hydroceles are asymptomatic or sub clinical.

22. Evaluate the onset, duration, and severity of signs and symptoms.. Evaluate the onset, duration, and severity of signs and symptoms.

33. Identify any relevant genitourinary (GU) history, sexual history, recent . Identify any relevant genitourinary (GU) history, sexual history, recent trauma, exercise, or systemic illnesses.trauma, exercise, or systemic illnesses.

44. The usual presentation is a painless enlarged scrotum.. The usual presentation is a painless enlarged scrotum.55 . The patient may report a sensation of heaviness, fullness, or dragging.. The patient may report a sensation of heaviness, fullness, or dragging.


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66. Patients occasionally report mild discomfort radiating along the inguinal area. Patients occasionally report mild discomfort radiating along the inguinal areato the mid portion of the back.to the mid portion of the back.

77. Hydrocele usually is not painful; pain may be an indication of an . Hydrocele usually is not painful; pain may be an indication of an accompanying acute epididymal infection.accompanying acute epididymal infection.

88. The size may decrease with recumbency or increase in the upright position . The size may decrease with recumbency or increase in the upright position Chronically formed hydroceles appear to be larger in size than acutely formedChronically formed hydroceles appear to be larger in size than acutely formedones.ones.

99. Systemic symptoms such as fever, chills, nausea, or vomiting are absent in . Systemic symptoms such as fever, chills, nausea, or vomiting are absent in uncomplicated hydrocele.uncomplicated hydrocele.

1 01 0. GU symptoms are absent in uncomplicated hydrocele.. GU symptoms are absent in uncomplicated hydrocele.


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Physical:Physical:

11 . Hydroceles are located superior and anterior to the testis, in contrast to. Hydroceles are located superior and anterior to the testis, in contrast tospermatoceles, which lie superior and posterior to the testis.spermatoceles, which lie superior and posterior to the testis.

22. Hydrocele is bilateral in . Hydrocele is bilateral in 7 7- - 10 10% of cases.% of cases.

33. Hydrocele often is associated with hernia, especially on the right side of the. Hydrocele often is associated with hernia, especially on the right side of thebody.body.

44.The size and the palpable consistency of hydroceles can vary with.The size and the palpable consistency of hydroceles can vary withposition.Hydrocele usually becomes smaller and softer after lying down it position.Hydrocele usually becomes smaller and softer after lying down it usually becomes larger and tenser after prolonged standing.usually becomes larger and tenser after prolonged standing.

55 .Systemic signs of toxicity are absent. The patient is usually afebrile with.Systemic signs of toxicity are absent. The patient is usually afebrile withnormal vital signs normal vital signs ..


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66. Abdominal or testicular tenderness are absent; no abdominal distension is . Abdominal or testicular tenderness are absent; no abdominal distension is present.present.

77. Bowel sounds cannot be auscultated in the scrotum unless an associated. Bowel sounds cannot be auscultated in the scrotum unless an associatedhernia is present.hernia is present.

88. Unless an infection causes an acute hydrocele, no erythema or scrotal. Unless an infection causes an acute hydrocele, no erythema or scrotaldiscoloration is observed.discoloration is observed.


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Complication :Complication :

Hemorrhage into the hydrocele can result from testicular trauma.Hemorrhage into the hydrocele can result from testicular trauma..11 22. Very large hydroceles may rupture due to an increase in the volume of . Very large hydroceles may rupture due to an increase in the volume of

the fluid.the fluid.

33. Infection of the fluid present in a hydrocele could lead to a Pyocele.. Infection of the fluid present in a hydrocele could lead to a Pyocele. 44. Calcification or hardening of the fluid could occur leading to atrophy of . Calcification or hardening of the fluid could occur leading to atrophy of

the testis.the testis.

55 . A large hydrocele may obstruct the testicular blood supply leading to. A large hydrocele may obstruct the testicular blood supply leading totesticular atrophy and subsequent impairment of fertility.testicular atrophy and subsequent impairment of fertility.


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Treatment of Hydrocele:Treatment of Hydrocele:

W hen they are small and asymptomatic, hydroceles, spermatoceles, andW hen they are small and asymptomatic, hydroceles, spermatoceles, andvaricoceles require no therapy other than reassurance. Indications forvaricoceles require no therapy other than reassurance. Indications forintervention include scrotal discomfort or disfigurement due to the sheer size of intervention include scrotal discomfort or disfigurement due to the sheer size of the mass. Treatment options include needle aspiration, aspiration with injection the mass. Treatment options include needle aspiration, aspiration with injection of a sclerosing agent, and surgical excision.of a sclerosing agent, and surgical excision.

Simple needle aspiration is seldom therapeutic because the cause of the problemSimple needle aspiration is seldom therapeutic because the cause of the problemis not addressed and the fluid typically reaccumulates is not addressed and the fluid typically reaccumulates Excellent results are possible with either surgical excision or needle aspiration Excellent results are possible with either surgical excision or needle aspiration combined with injection of a sclerosing agent. Success rates ranging fromcombined with injection of a sclerosing agent. Success rates ranging from 33 33 toto1 001 00 percent have been reported.percent have been reported.


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Nursing careNursing care

Before the operation:Before the operation:11.. Your child must have nothing to eat or drink for about six hours before the Your child must have nothing to eat or drink for about six hours before theoperation.operation.22. If your child has a cold in the week before admission to hospital, please. If your child has a cold in the week before admission to hospital, pleasetelephone the ward and let ward sister know.telephone the ward and let ward sister know.33. checked for past illnesses and may have special tests to make sure that he is . checked for past illnesses and may have special tests to make sure that he is

well prepared and can have the operation as safely as possible. Many hospitals well prepared and can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you and your child visit for an hour ornow run special preadmission clinics, where you and your child visit for an hour ortwo, a week or so before the operation for your child to have these checks two, a week or so before the operation for your child to have these checks ..


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at home:at home:-- After After

11.. Your child may need frequent sleeps for a day or two. Your child may need frequent sleeps for a day or two.22. try to help your child avoid any excess physical activity for four to six weeks . try to help your child avoid any excess physical activity for four to six weeks after the operation especially if he is over five years old.after the operation especially if he is over five years old.33.The groin wound is usually held together underneath the skin with stitches that .The groin wound is usually held together underneath the skin with stitches that

eventually dissolve and which don eventually dissolve and which don t need t o be removed. . There may be s t itc hes t need t o be removed. . There may be s t itc hes in t he wound, whi c h should mel t away in abou t in t he wound, whi c h should mel t away in abou t 77 t ot o 1 01 0 days.days.44.There may be some bruising of t he surrounding skin whi c h will improve in t wo.There may be some bruising of t he surrounding skin whi c h will improve in t wot o t hree days.t o t hree days.55 .Your c hild c an wash bu t should t ry t o keep t he wound area dry un t il t he s t itc hes .Your c hild c an wash bu t should t ry t o keep t he wound area dry un t il t he s t itc hes

mel t away or for abou t a week if t here are only s t itc hes under t he skin.mel t away or for abou t a week if t here are only s t itc hes under t he skin.66. If your c hild goes t o s c hool, he c an re t urn t o lessons in . If your c hild goes t o s c hool, he c an re t urn t o lessons in 1 01 0 days or so. Yourdays or so. Yourc hild c an res t ar t any spor t af t er abou t four t o six weeks.c hild c an res t ar t any spor t af t er abou t four t o six weeks.


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Mohammed Ibrahim Mahmoud Ali Obied

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