HYDROCELE AND SPERMATOCELE

HYDROCELE

A hydrocele is an abnormal accumulation of serous fluid between the layers of the vaginal coat. Embryologically, the vaginal coat is an extension of the peritoneal sac which has a serous surface that secretes and absorbs the fluid. It is believed that the collection of fluid that occurs is the source of an imbalance between production and absorption within the layers of the vaginal coat. Hydrocele can be congenital or acquired. Congenital hydrocele derives from the persistence of the vaginal process (peritoneal sac or peritoneal vaginal canal) and is treated by ligation of the peritoneal sac to the internal inguinal ring by an inguinal incision if this persists after 1 year of life. Hydroceles acquired are mostly idiopathic, although some are linked to trauma, infections, testicular tumors.

Africandoctor’s natural remedy for hydrocele

Hydrocele, dropsy of the testicle - many names of a disease, which consists of the formation and accumulation of serous fluid in the testes (their membranes). This disease occurs in both male children and adult men or adolescents. If you have a hydrocele, don't panic anymore. We have a special herbal remedy that will get rid of hydrocele. Indeed, our tisane will stimulate the movement of fluids in your body to resolve the blockage and allow the liquid to be drawn into the body. It will also relax your muscles to resolve sensitivity. Before thinking about having an operation give our natural remedy a chance.

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Spermatocele

The spermatocele is a cystic structure which generally derives from the head of the epididymis and from the testicular network. It is usually filled with a milky liquid containing semen. Sperm are usually found on the upper surface of the testicle, but they can occur anywhere on the epididymis. Although the exact etiology is unknown, obstruction and trauma have been implicated. Sperm are more common in middle-aged men and their incidence increases with age.

DIAGNOSTIC

The patient with a hydrocele usually has scrotal tension swelling, which can be painful or interfere with their appearance. After an examination, the swelling is limited to the scrotum, distinguishing it from an inguinal hernia. A hydrocele will be transilluminated to varying degrees, depending on the thickness of the wall. The testicle is generally not palpable within the hydrocele. In this case, or in case of suspected presence of an underlying testicular tumor, a scrotal ultrasound should be performed. The patient with a spermatocele usually has a scrotal mass. Physical examination reveals a separate upper mass of the testicle. This gives the impression that the patient has three testicles, the so-called pawnshop sign.

INSTRUCTIONS FOR SURGERY

No surgery is indicated unless the hydrocele or spermatocele is causing pain, social discomfort or a tumor is suspected based on the ultrasound results.

ALTERNATIVE THERAPY

A transcutaneous aspirated needle, with or without the instillation of sclerosing agents such as tetracycline, may be indicated in elderly patients with severe and symptomatic hydroceles who may present low surgical risks. This form of therapy is contraindicated in younger, healthier patients due to the high recurrence rate and the risk of persistent discomfort after sclerosis. Sometimes the spermatocele can be aspirated and injected with a sclerosing agent, such as tetracycline, although this is rarely necessary.

SURGICAL TECHNIQUE: hydrocele

Surgery can be performed under local, vertebral or general anesthesia. The entire scrotum is shaved immediately before the procedure, but the pubic hair is left intact. The scrotum and penis are cleaned with betadine and the area is draped with sterile curtains, one of which is under the scrotum to elevate it. The incision in the scrotum can be made along the median raphe or transversely in an avascular area between the blood vessels crossing transversely in the scrotal wall, while an assistant grasps the scrotum and compresses the hydrocele against the skin. The incision in the skin is made with a cutting edge, while the rest of the incision through the layers and the darts and subcutaneous and muscular is made by electrocoagulation to obtain a satisfactory hemostasis.

The Jaboulay procedure

 It is preferred in the case of a thick-walled bag, while the Lord procedure is more suitable for thin-walled hydroceles. With both procedures, the testicle and appendages should be carefully examined for pathology. Hydrocele fluid is generally not sent for examination only if the fluid appears purulent or bloody.

Lord procedure

The Lord's procedure is performed by directly opening the parietal layer of the hydrocele bag without analyzing it or releasing it from the dartos layer. The testicle is then extruded into the surgical area and examined. The parietal layer of the vaginal coat is then sutured with a 3-0 chromic catgut suture in small steps at 1 cm intervals. Eight 10 of these sutures are placed about 1 cm from each other and are therefore all attached accordionly to the bag in a necklace that surrounds the testicles and the epididymis. (A) Operation of the Lord: the testicle is extruded through a small incision in the middle of the bag. (B) The bag is closed with several points.

In the Jaboulay procedure, the hydrocele is released from the dartos layer using a detachment with dry gauze before the bag is opened and the testicle exposed. The excess bag is removed leaving a residue of 2 to 3 cm around the testicle, and the edges are recent with a 3-0 continuous suture. The rest of the bag is then wrapped back around the spermatic cord and sutured with a 3-0 chromic intestinal suture, taking care not to twist or tighten the cord too much. In the Jaboulay technique, most of the bag is excised and a continuous suture freely closes the free edges on the cord. It is a quick method to control annoying bleeding.

SURGICAL TECHNIQUE: spermatocele

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The preparation and incision of the skin are identical to those described above for hydrocele repair. The vaginal coat is open and the testicle is exposed with the spermatocele. The spermatocele is dissected from the epididymis using electrocoagulation, and if the attachment of the spermatocele to the epididymis is visible, it is tied with a 4-0 chromic suture gut. Using this technique, the spermatocele can usually be removed intact. The edge of the vaginal coat is sutured with a 4-0 catgut chromic suture running for hemostatic purposes, and the vaginal coat is left open to prevent the formation of a hydrocele. The scrotal incision is then sutured in two layers, as indicated for the closure of the hydrocele.

Spermatocelectomy: The spermatocele is separated from the epididymal head by electrocoagulation. Once both types of repairs have been made, drains are generally not required. However, if hemostasis is difficult to achieve, Penrose drainage should be placed and brought through a separate incision in the underside of the scrotum. The incision is closed in two layers using 3-0 chromic catgut sutures, the first layer approaching the dartos muscle in execution mode and the second layer closing the skin with interrupted sutures, a horizontal mattress attached freely without tension. A fluffy dressing is applied and fixed with a scrotal support. An ice pack is kept on the scrotum for the first 24 hours to reduce pain and swelling, and adequate oral pain relievers are prescribed. Antibiotics are not used routinely.

Results and complications

The most common complication is usually a hematoma. Wound infection, scrotal abscess, and recurrent hydrocele or spermatocele are less common. These complications are less common when the Lord procedure is performed. The success rate for hydrocelectomy or spermatocelectomy should be 100%.

Read also: How to cure hydrocele with folk remedies

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