Varicocele

Definition:

It is abnormal dilatation of testicular veins.

The veinus plexuses in testis drain into testicular vein. On left side the testicular vein drain into left renal vein. On right side the right testicular vein drains into inferior vena cava. The Varicocele is common on left side because the pressure in renal vein is more as compared to inferior vena cava.

Causes of Varicocele:

o   Renal tumor in left side can obstruct the renal vein.

o   Testicular artery overlying the vein can increase pressure in vein.

o   Incompetency of valves

Clinical features:

Ø  Dragging vague sensation

Ø  Mild ache

Ø  The affected testis hangs lower than normal.

Ø  The testis appears as bag of worms on palpation

Ø  When the side is elevated the veins will get empty.

Diagnoses:

It is clinically one should identify the cause.

Management:

Ligation of testicular vein is an option the vein can be ligated high in its course or low ligation in inguinal canal.

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Hydrocele

Definition:

The accumulation of serous fluid in the processus vaginalis (tunica vaginalis) is called Hydrocele.

Types of Hydrocele:

A.    Congenital:

When the fluid accumulate between the tunica vaginalis and processus vaginalis and it communicates with the peritoneal cavity.

B.    Acquired:

1.     Primary Hydrocele:

a.      Vaginal:

When the fluid accumulates in tunica vaginalis is called vaginal Hydrocele.

b.     Infantile:

When the fluid accumulates in tunica vaginalis and processus vaginalis but it does not communicate with peritoneal cavity is called infantile Hydrocele.

c.      Encysted:

When the fluid accumulates in some part of processus vaginalis is called encysted Hydrocele.

d.     Funicular:

When the fluid is only in processus vaginalis is called funicular Hydrocele.

2.     Secondary Hydrocele:

It can occur due to:

·         Trauma

·         Tumor

·         Infection (epidydimo-orchitis)

Clinical features of Hydrocele:

         i.            Swelling of scrotum

       ii.            The swelling is translucent

      iii.            In vaginal type the swelling is limited to scrotum. In congenital type one can’t go above the swelling. In infantile type the swelling ends in inguinal canal and one can go above the swelling.

     iv.            The rugosity on skin is lost.

Management:

         i.            Aspiration of fluid is done through a cannula.

       ii.            Sclerosing agent (tetracyclins) can be introduced into tunica to prevent reaccumulation.

Surgery:

a)     Lord’s plication/ Jabuly’s procedure:

The tunica vaginalis is everted and sutures are applied.

b)     Subtotal excision:

Subtotal excision of tunica vaginalis is an option.

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