66) Cysts of the Epidydimis & Hydrocele скачать в хорошем качестве

66) Cysts of the Epidydimis & Hydrocele

1. CYSTS OF THE EPIDIDYMIS - filled with crystal clear fluid. Aetiology. These cysts are due to cystic degeneration of- (a) Remnants of the paramesonephric or Mullerian duct - the appendix of the testis (sessile hydatid of Morgagni). (b) Remnants of the mesonephric duct or Wolffian duct system. (i) The paradidymis or organ of Giraldes - this is the most common cause. (ii) Appendix of the epididymis or pedunculated hydatid of Morgagni. (C) The vasdeferens of Haller. 2. SPERMATOCELE - which is an acquired condition and a unilocular retention cyst derived from some portion of sperm-conducting system of the epididymis. SPERMATOCELE - This is an acquired condition. It is a unilocular retention cyst formed in the epididymis, derived from retention of a portion of sperm-conducting duct of the epididymis. EPIDIDYMO-ORCHITIS - be divided into acute epididymitis and chronie and epididymo-orchitis. ACUTE EPIDIDYMO-ORCHITIS - In fact epididymis is first inflamed which is know epididymitis and later on infection spreads to the testis and then the condition is called epididymo orchits. Aetiology - At first infection reaches the globus minus of the epididymis to vas-deferens and he infection usually comes from either urethra, prostate of seminal vesicles. Such infection may be of two types- (1)Sexually transmitted group from urethritis. (2)The other type is associated with hydrostatic pressure associated with voiding or physical strain which force infected urine from urinary tract infection prostatitis or following prostatectomy Pathology.- At first there is cellulitis of the lower pole of the epididymis. HYDROCELE - Hydrocele is an abnormal collection of serous fluid in the tunica vaginalis of the testis or within some part of the processus vaginalis according to aetiology hydrocele can be divided into two categories. 1. primary or idiopathic hydrocele - the cause of which is unknown i.e there is no associated disease in the testis or the epididymis. 2. Secondary hydrocele - when hydrocele is secondary to a disease in the testis ardor in the epididymis A secondary hydrocele is usually small and lax PRIMARY OR IDIOPATHIC HYDROCELE - Five varieties of such hydrocele can be seen - (i) Vaginal hydrocele - the commonest (ii) Encysted hydrocele of the cord. (iii) Infantile hydrocele. (iv) Congenital hydrocele. Unusual. (v) Funicular hydrocele. Three very rare varieties are (vi) Hydrocele of the canal of Nuck. (vii) Hydrocele of the hemial sac (viii) Hydrocele en bisac VAGINAL HYDROCELE - This is by far the commonest variety of hydrocele. In this condition there is abnormal accumulation of crous fluid within the tunica vaginalis. Aetiology - (a) Defective absorption of hydrocele fluid by the tunica vaginalis -. Damage to the endothelial wall by low grade infection is the med probable explanation (b) Excessive production of fluid within tunica vaginalis (c) Interference with drainage of fluid by the lymphatic vessels of the cord. (d) There may be some connection with the peritoneal cavity as in the congenital variety. LOCAL EXAMINATIONS- (i) Position --Though hydrocele is often unilateral, it may (ii) On inspection one side or both the sides of the scrotum are enlarged with a notch at the middle of the affected side of the scrotum. This is quite characteristic (iv)Fluctuation test (v) Trans-illumination test (vi)On percussion it is always dull. (vii) Reducibility:- Vaginal hydrocele cannot be reduced. (viii) Palpation of the testis Differential Diagnosis - 1.Inguinal hernia 2.Haematocele. 3. Pyocele 4. Chylocele 5. Filariasis of the scrotum 6. Cysts in relation to the epididymis. 7. Encysted hydrocele of the cord. 8.Tumours of the testis. Complications of a Hydrocele - (i) Infection (ii) Atrophy of the testis (iii)Rupture - may be traumatic or occasionally spontaneous (iv)Homalocele-may result from trauma, but occasionally may occur spontaneously. (V) Hernia of the hydrocele sac (vi) Calcification of the sac - sometimes occurs in longstanding cases Treatment - Operation is definitely the treatment of choice Types of operations - 1.Jaboulay's method of eversion of sac. 2.Lord's procedure of excision of sac. 3.Excision of the sac- 4.Subtotal excision CONGENITAL HYDROCELE - In this condition the processus vaginalis remains patent so there is direct communication of the tunica vaginalis with the peritoneal cavity. The communicating orifice at the deep inguinal ring is too small for the Development of a hernia ENCYSTED HYDROCELE OF THE CORD - When the central portion of the processus vaginalis remains patent, but its upper and lower parts are obliterated such condition is deseloped Fluidaccumulates in the pateril portion of the processus vaginalis ant presents a swelling in relation to the spermatic cord hope it is called encysted hydrocele of the.couch swelling is a localised oval cystic swelling situated in the scrotal region, inguinoscrotal region or in the inguinal region.