Pathology

1. Hydrocoele
   • Excess accumulation of fluid in processus vaginaluis (embryological tunica vaginalis)
2. Anatomical classification
   • Vaginal hydrocoele: fluid accumulation in vaginalis which surrounds testis but does not extend up into cord
   • Hydrocoele of cord: accumulates around spermatic cord and mass appears around ductus deferens
   • Congenital hydrocoele: proximal part of processus vaginalis has not oliterated, sac communicates directly with peritoneum and hydrocoele is filled with peritoneal fluid
   • Infantile hydrocoele: situation in between hydrocoele and hydrocolele of the cord - processus vaginalis obliterated at deepring and so thehydrocoele does not communicated with the abdomen but it remains patent in both the cord and scrotum

Approach

• Examination of the scrotum

1. Inspect
   • Swollen scrotum
2. Palpate
   • Usually inseparable from testsis
   • Firm - may be tense or lax
   • May be transilluminable (less as it becomes more chronic)
   • Distinct from superifical inguinal ring (can get above mass)
3. Percuss
4. Ascultate 

Completion

1. Examine contralateral testis

Treatment options

1. Non-surgical
   • Watch / wait
   • Aspiration - to relieve symptoms but tends to re-accumulate
2. Surgical
   • Lords plication: small incision into scrotum to lift out testis; sac plicated with interrupted sutures to junction of testis and epipidydimis
   • Jaboulay procedure: sac everted through longitudinal incision, excess sac excised and raimed replaced behind the cord