Scrotal

Swelling(Hydrocele)
and Masses
DR.AMAR RATHOD
M.S.(Mumbai)
 Scrotal Swelling and Masses

1. Hydrocele

2. Hernia

3.Varicocele
4.Testicular Masses

5.Spermatocele
 Evaluation of the Scrotum
• Layers of scrotum-skin, Subcut tissue,dartos
muscle,Ext,Cremasteric Fascia ,Int spermatic
fascia, & tunica vaginalis.
• Normal testes measure 4.5 x 2.5 cm and are
rubbery in consistency
• Epididymis lies posteriolateral to the testis and
varies in its degree of testicular attachment
• Masses arising from within the testes are usually
malignant; those from epididymis and spermatic
cord structures usually benign
Anatomy Review
Anatomy Review
 Hydrocele
“Hydro" - meaning water and “Cele" - meaning out pouching

• Abnormal collection of serous fluid in between

the two layers of tunica vaginalis or within some
part of processus vaginalis.
 Aetiology
• Primary- unknown cause

• Secondary-due to disease in the testis

 Aetiology
Primary- unknown cause
• Vaginal hydrocele
• Encysted hydrocele
• Infentile hydrocele
• Funicular hydrocele
• Hydrocele of canal of Nuck
• Hydrocele of hernial sac
• Hydrocele of bisac
Secondary-due to disease in the testis
• Acute epididymo-orchitis
• Syphilitic infection
• Chronic epididymo-orchitis
• Malignant disease
• Trauma
• Lymphatic Disease
• Post herniorrhapy
 Causes
Normally there is balance between produced fluid and its reverse
absorption.

• Defective absorption of fluid

• Excessive production of fluid
• Interference with Drainage of fluid by
lymphatic vessels of cord
• Connection to peritoneal cavity
(congenital)
 Composition of fluid
• Amber Coloured
• Sp. Gravity 1.022-1.024
• Water
• Inorganic salt
• 6% albumin
• Fibrinogen
• Cholesterol
 Clinical Feature
• Common in middle Age
• Common in tropical courtiers

• SYMPTOMES:
swelling of the scrotal region
Clinical Test
1.Fluctuation
2.Transillumination
3.Palpation of the testis
(Reaching above the
swelling)
4.Reducibility
 INVESTIGATION
• BLOOD EXAMINATION

- Eosinofilia
And Microfaileriasis Seen In Faileriasis
- Lymphocytosis And ESR seen In Acute Epididymo-orchities

• URINE EXAMINATION

-Tuberculose Epididymo-orchities

• SCROTAL ULTRASOUND.
-To confirm diagnosis
-Identification position of testis
-To know testis are normal or not

• MRI.
 D.D.
• Inguinal Hernia
• Haematocele
• Pyocele
• Chylocele
• Faileriasis of scrotum
• Cyst
• Tumours of the testis
• Lipoma of cord
 Complication
• Infection and Pyocele formation
• Atrophy of the Testis
• Rupture due to Trauma/ Spontaneous
• Haematocele
• Hernia of the hydrocele of the Sac through the Dortous
muscle in long standing case
• Calcification of sac.
 Management
• Conservative Watchful waiting

• Surgery (L.A./Spinal/G.A.)

• Indication
• Inconvenience while walking
• Infection / trauma
• Excoriation of skin by urine
• Infertility (Testicular Atrophy)
• Cosmetic
• Difficulties in intercourse
• Herniation of Hydricele sac
• Medical fitness for jobs

Contra indications

• Local infection of skin

• Poor general condition
1.Jaboulays method of eversion of Sac-
mostly practiced now a days for small & medium size.
2.Lords procedure- Big size Hydrocele

3.Excision of sac - Haematocele

-infected Sac
4.Subtotal excision - Big size Hydrocele
-circular incision,middle of Scrotum
5.Tapping- Not a radical surgical treatment
To be Avoided as for as possible

6.Andrew”s method- Eversion of sac with Excision

7.Sharma Jhawars subdartos pouch

IN INFENT HYDROCELE SHOULD BE LEFT ALONE AS

THEY MAY DISAPPEAR SPONTANEOUSLY

If persist – Surgery
incision-inguino-Scrotal
upper end of Sac ligated
 Complication of surgery
• Haemorrhage
• Damage to cord,Testis,Epididymis,Pampiniform plexus
• Torsion of testis
• Haematoma
• Haemoscrotum
• Pyoscrotum
• Infection
• Stitch abscess
• Urinary retention
• Necrosis
• Recurrence
• Epididymo-orchitis
 Congenital Hydrocele
• Processus vaginalis remain patent

• Communicating orifice at the deep

inguinal ring is too small for the
development of hernia.

• Diagnosis-present since birth

Pt lies-disappears

in erect posture appear again

• This condition may be associated with

Tuberculous peritonitis
 Funicular hydrocele
• Processus vaginalis patent up to top of testis,
where it is shut off from the tunica vaginalis

• Diagnosis-

swelling in inguinal region rather than scrotal

• Testis can be felt

• Swelling reduced when lies down.

 Infantile Hydrocele
• This condition is just opposite to funicular hydrocele-vaginalis is
shut off from the peritoneal cavity at the deep inguinal ring.

• Diagnosis- seen in infants & adult

Inguino scrotal swelling similar to inguinal hernia

• Not reducible /cough impels –ve

• Cystic swelling
 Encysted Hydrocele
• Central portion of processus vaginalis remain
patent- upper and lower end oblitrated.
• Oval cystic
• swelling(scrotal/inguinal/inguino-scrotal)

• Diagnosis- cystic swelling in relation to spermatic cord

• Testis felt separate.
• Traction test-
• Hydrocele of Bisac-
hydrocele having two intercommunicating sac.
One above & one below, upper sac connected with

processus vaginalis

• Hydrocele of Hernial Sac

• Hydrocele of canal of Nuck

 Ayurvedic Aspect
• Introduction-

Vriddhi is being discussed in Sushrut-Samhita Nidan sthan chapter 12 & Chikitsa sthan chapter 19

*Vaataj = Tortion of testes / Strangulated Hernia

* Pittaj = Abscess / Pyocele
* Kaphaj = ? Tumor of testes e.g.Seminoma
* Raktaj = Haematocele
* Medaj = Filarial swelling / Lypoma
* Mutraj = Hydrocele
* Aantraj = Inguinal hernia

• Defination-

• maU~sya maU~sadRSatrlasya vaRiw: maU~vaRiw È

• Samprapti:
• AMQa: p`kuiptao Anyatmaao ih daoYa:
flakaosavaaihnaIriBap`pVQamanaI;
flakaoYayaao: vaRiwMjanayait , taM
vaRiwima%yaacaxato Èsau.ina.12
Poorvha Roop

•baistkiTmauYkmaoZoYau vaodnaa
maa$tinaga`h: ,
flakaoSaSaaofcEaoit È
 Rupa: PRODROMAL FEATURES
• maU~saMQaarNaSaIlasya maU~vaRiwBa-vait
saagacCtao|mbaupUNaa-M dRitirva xauByait ,
maU~kRcC/vaodnaaM vaRYaNayaao:
EvayaqauM kaoSayaaoEcaapadyait
Èsau.ina.12

• Scrotum develop movement like Bag of water,dysuria,pain

in testicels and swelling of scrotum.
 Chikitsa
• Fomentation
• Lepa with Latakaranj patra
• Wrap with cloth and then puncture made by the
side of raphae below the most prominent part of
the swelling with help of BRIHIMUKHA SHASTRA
• Drainage tube
• Sthagika bandha
THANK YOU
 Testicular Masses
• Testicular masses are
usually malignant and
must be fully evaluated
• If any doubt whether a
mass is within or
outside the testicle, scrotal US and urologic
consultation should be obtained
• Tumors of testis are usually painless, firm, solid
lesions within the substance of the testis. These
lesions do not transilluminate
 Testicular Masses
• Any mass, any pt, any time felt to be in the
testicle MUST be addressed with direct
contact with a urologist. Do not simply place a
consult and hope for the best…to do so would
be malpractice
 Testicular Pt Ed
• Benefit of monthly TSE is now
questioned…however…
Etc…
Etc…
Etc…
Etc…
Etc…
Etc…
Questions?
THANK YOU
 TYPES
• Congenital • Acquired

1. PrimaryHydrocele
1. Vaginal Hydrocele
2. Infentile Hydrocele 2. seconderyHydrocele
3. Congenital Hydrocele
4. Hydrocele of cord