Three days ago, a man came to Mbah Dukun Bagong, He wanted to consult about his problem. He said, "Mbah, i have a problem, please don't laugh, because my problem about my genital". "Okey, tell your problem!" mbah dukun asked. " Its been 3 months, my scrotum growing big, give me advice, what i have to do", patient reported. "Let me see, mmm, i think you have hydrocele", mbah dukun answered.
What is Hydrocele?Hydrocele is an excessive accumulation of fluid between the parietal and visceral layers of tunica vaginalis. Normally, fluid inside the cavity that do exist and are in the balance between production and reabsorption by the lymphatic system in the vicinity.
|Anatomy of Hydrocele|
Hydrocele that occurs in newborns the caused by: (1) the incomplete closure of processus vaginalis resulting in the flow of peritoneal fluid into the processus vaginalis or (2) incomplete lymphatic system in the scrotum in doing hydrocele fluid reabsorption. In adults, hydrocele can occur in idiopathic (primary) and secondary. Secondary cause due to abnormalities found in the testes or epididymis that causes disruption of secretion or reabsorption of fluid systems in the pocket hydrocele. Abnormalities of the testes may be a tumor, infection, or trauma to the testis and epididymis.
Patient complained of a lump in scrotum bag that is not painful. on physical examination found a lump on scrotum sack with cystic consistency and on-ray examination showed translumination. on an infected hydrocele or scrotum skin is very thick, sometimes difficult to perform this examination. so it must be assisted by ultrasound examination.
According to the location of the pockets of testicular hydrocele, the clinical hydroceles are classified into 3 types, namely:
1. Testis Hydrocele
2. Funiculus Hydrocele
3. Communicant Hydrocele
This classification is important because it deals with methods of operation to be performed at the time of making corrections hydrocele.
a. Hydrocele testis (noncomunicating Hydrocele) :
Hydrocele bag as if it surrounds the testes so that testicular testis can not be touched. on anamnesis, the magnitude of the bag hydrocele does not change throughout the day.
b. Hydrocele Funiculus (of the Cord):
hydrocele bag was in funiculus, which is located in the cranial of the testis, so that on palpation of the testes can be touched and are beyond the pockets hydrocele. on anamnesis, the magnitude remains throughout the day.
c. Hydrocele communicant:
there is a relationship between the processus vaginalis with peritoneal cavity so that the processus vaginalis can be filled peritoneal fluid. In namnesis, hydrocele bag size can change, growing larger while crying. on palpation, hydrocele bag separate from the testis and can be inserted into the abdominal cavity.
|Type of Hydrocele|
How to treat hydrocele?
Hydrocele in infants usually wait until the child reaches the age of 1 year in the hope of the processus vaginalis closes, hydrocele will heal itself, but if the hydrocele is still there or increase in size should be considered for correction.
Measures to cope with hydrocele fluid is with the aspirations and operations. Hydrocele fluid aspiration is not recommended because in addition to the high relapse rate, some time can cause complications in the form of the infection.
Indications for surgery are:
a. blood vessels depressed by a large hydrocele
b. cosmetic indications
c. hydrocele permagna the which felt too heavy and disturbing patients in their activities.
In the congenital hydrocele, inguinal approach was due to hydrocele is often accompanied with inguinal hernia so, at the time of surgery can be done herniografi hydrocele.
In the adult testis hydrocele, conducted Scrotal approach by performing excision and marsupialisation bag in the manner of Winkelman hydrocele or hydrocele applications bag in the way Lord.
In Funiculus hydrocele, hydrocele extirpation performed by in toto
What complications of hydrocele? If left unchecked, big hydrocele easily traumatized and hydrocele can permagna pressing blood vessels leading testicle, causing testicular atrophy.