© 2023 JETIR August 2023, Volume 10, Issue 8 www.jetir.

org (ISSN-2349-5162)

A SYSTEMIC STUDY ON HYDROCELE: AN

SURGICAL REVIEW
Dr. Shivam Kumar Shakya1, Dr. V.S. Yadav2, Dr. Deepika Singh3

1. Final Year PG Scholar, Department of Shalya Tantra, Major S.D. Singh P.G. Ayurvedic Medical College &
Hospital, Bewar Road, Farrukhabad, Uttar Pradesh.
2. Guide, Department of Shalya Tantra, Major S.D. Singh P.G. Ayurvedic Medical College & Hospital,
Bewar Road, Farrukhabad, Uttar Pradesh.
3. Co -Guide, Department of Shalya Tantra, Major S.D. Singh P.G. Ayurvedic Medical College & Hospital,
Bewar Road, Farrukhabad, Uttar Pradesh.

Corresponding Author - Dr. Shivam Kumar Shakya, Final Year PG Scholar, Department of Shalya Tantra,
Major S.D. Singh P.G. Ayurvedic Medical College & Hospital, Bewar Road, Farrukhabad, Uttar Pradesh

ABSTRACT
The abnormal accumulation of serous fluid in the pelvis and groin caused by numerous etiologies, such as
illnesses or trauma, is known as a hydrocele. It has different clinical symptoms, especially pain and mental
distress. Understanding the anatomy, embryology, and physiology of hydrocele creation is essential to
comprehending the initiation and development of the condition. Due to the variety of hydrocele classifications
and etiologies, a deliberate differential diagnosis is crucial to preventing impending life-threatening
consequences and delivering the right care. Identification of the underlying cause depends on properly defining
the hydrocele as primary, secondary communicating, secondary non-communicating, microbe-induced,
inflammatory, iatrogenic, trauma-induced, tumor-induced, canal of Nuck, congenital, and enormous.
Key Words- Hydrocele, Scrotal pain, Scrotal swelling,
Introduction:

A fluid-filled sac that is generally present in the scrotum and less frequently in the external genitalia and pelvic
areas is the hallmark of a hydrocele. It could be a symptom of certain serious underlying disorders. A patent
processus vaginalis or an imbalance of secretion and absorption inside the tunica vaginalis may be the cause of
the fluid accumulation. A hydrocele can be divided into a number of categories and can affect both sexes at
any age. Although hydrocele often causes little pain, it can have negative effects on the body and mind. If the
right diagnostic and treatment approaches are taken, more issues may be avoided. We thoroughly discuss the
classifications, etiology, pathophysiology, subsequent complications, assessment, and therapy of hydrocele in
light of its morphological, embryological, and physiological background.

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Anatomy

At the base of the front abdominal wall lies the inguinal area, or groin. It represents the inguinal canal, a
tubular conduit that runs from the pelvis to the groin. The deep inguinal ring and superficial inguinal ring are
the two apertures of the inguinal canal. Although the canal's anatomy is identical in males and females, it
serves different purposes depending on the gender. The spermatic cord may travel between the testicles and
abdomen in males thanks to the canal. The canal in females acts as a conduit for the uterine round ligament as
it travels from the uterus to the labium majus.The processus vaginalis, a structure that forms from the
peritoneum during gestational week 12, is also embodied by the inguinal canal throughout embryonic
development.
It allows the testes to fall into the scrotal sac in men by extending through the inguinal canal and into the
scrotum. The processus vaginalis undergoes programmed cell death to destroy the pathway between the
peritoneum and scrotum when testicular descent is complete. The bottom part of the process following
closure.The tunica vaginalis testis develops from the vaginalis. Failure to do so leaves the processus vaginalis
patent, which can cause issues such communicating hydrocele and inguinal hernia. The canal of Nuck is a
patent pouch of peritoneum that forms in females when the processus vaginalis is not closed. Additionally,
communicative hydrocele and inguinal hernia problems are linked to the canal of Nuck [1].

The fluid that accumulates in the bilayered tunica vaginalis causes a hydrocele. Due to the patent processus
vaginalis, which permits peritoneal fluid to pass through the processus vaginalis into the scrotum and surround
the testicle, this fluid generally builds up in babies [2]. If the extra fluid can't drain, it builds up. We list the
possible causes of fluid in the scrotum.

Etiology

The disturbance of the lymphatic system is usually the most frequent. The postoperative complication of
hydrocele is brought on by surgeries, such as laparoscopic varicocelectomy, which can either fully or partially
compromise testicular lymphatic drainage [50]. Another reason for hydrocele is an imbalance of outflow and
input into the lymphatic tissue around the scrotum [9, 51]. Aquaporin channels may be the cause of hydrocele
that is not communicative. [52] Hattori et al. examined how aquaporin channel expression relates to
noncommunicating hydrocele. Tunica vaginalis from hydrocele patients was examined, and the results were
compared to a control group of males without hydrocele. In the tunica vaginalis of individuals with hydrocele,
aquaporin channel one was found to be overexpressed, according to the study's conclusion. The hydrocele
fluid may appear as a result of lymphatic drainage that is less than the output due to increased fluid output
from capillaries with overexpressed aquaporin channel 1.
After a kidney transplant, a hydrocele might also happen. This most likely results from a disrupted lymphatic
system. [53] Penn et al. explains a study that involved several kidney transplants and difficulties with the
testicles. The most frequent consequence, hydrocele, was brought on by a disturbance of the lymphatic
pathways along the iliac stream. Despite consistent fluid flow, the lymphatic disruption adversely hampered
lymphatic absorption, which resulted in the hydrocele.

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Management:
There are two categories of surgical treatment, invasive and noninvasive.

Non-invasive Options-

examination and duplex ultrasound Prior to aspiration and the use of sclerosing drugs to treat hydrocele,
Doppler must be conducted in both an upright and supine posture. Aspiration and sclerotherapy are two of the
noninvasive therapeutic techniques that are employed increasingly regularly. The optimum way to apply these
approaches is in conjunction with one another. When hydrocele is treated solely with aspiration, it frequently
returns [110]. One research found an 80% success rate for aspiration and sclerotherapy with doxycycline. Other
sclerosing medications besides doxycycline may be used in conjunction with sclerotherapy; these other
medicines may be just as effective as hydrocelectomy.

Surgical Procedures

One of the major surgical therapies for hydrocele is hydrocelectomy. When the hydrocele is significant and
chronic, this operation is strongly advised [124]. Compared to its nonsurgical equivalent, hydroceletomy is
more intrusive but occasionally has a better success rate. The hydrocelectomy's primary disadvantage is its
postoperative consequences. Scrotal edema, hematomas, chronic discomfort, diminished fertility, ongoing
swelling, Fournier's gangrene, and infection are examples of postoperative consequences [125–127]. A
recommended substitute is a minimal access hydrolecetomy since it is less invasive and requires a smaller
incision. Saber describes a novel minimum access hydrocelectomy that reduces traumatic insult to the patient
without compromising safety and effectiveness. In compared to a conventional hydrocelectomy, the operation
lasts just 12 to 18 minutes, and the recuperation period is also decreased [126].

Conclusion

There are several etiologies for hydroceles, including canal of Nuck, congenital, gigantic, microbe-induced,
inflammatory, secondary communicating, secondary noncommunicating, iatrogenic, trauma-induced, tumor-
induced, and inflammatory. Hydrocele has to be treated properly and closely watched.regardless of whether it
affects young children or elderly patients, especially when uncommon secondary consequences endanger the
patient's life or quality of life.Transillumination should no longer be used in the diagnosis of hydrocele and
should be replaced with radiological imaging in both supine and upright postures. Prior to removing any
techniques, all therapeutic choices should be taken into account.

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