Laporan Kasus

Hydrocele Testis

Oleh:

Vina Novin Phenomie, S.Ked

04084811416103

Pembimbing:

dr. H. Marta Hendry, SpU

BAGIAN ILMU BEDAH

RUMAH SAKIT Dr. MOH. HOESIN PALEMBANG

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA

2015

HALAMAN PENGESAHAN

Presentasi Kasus yang Berjudul:

Hidrokel TestisOleh

Vina Novin Phenomie, S.Ked

04084811416103

Telah diterima sebagai salah satu syarat dalam mengikuti Kepaniteraan Klinik Senior

(KKS) di bagian Ilmu Bedah Rumah Sakit Dr. Moh. Hoesin Palembang Fakultas

Kedokteran Universitas Sriwijaya periode 22 Juli-25 September 2015.

Palembang, Agustus 2015

Pembimbing,

dr. H. Marta Hendry, SpU

CASE REPORT

Hydrocele

Vina Novin Phenomie1, Marta Hendry2

1Clinical Senior Clerkship, School of Medicine, Medical Faculty of SriwijayaUniversity, Dr. Mohammad Hoesin General Hospital, Palembang2Department of Urology, School of Medicine, Medical Faculty of SriwijayaUniversity, Dr. Mohammad Hoesin General Hospital, Palembang

Background: Hydrocele is a accumulation of fluid between the parietal and visceral layers of the tunica vaginalis. In United States, hydrocele is estimated to affect 1% of adult men. More than 80% of newborn boys have a patent processus vaginalis, but most close spontaneously within 18 months of age. Hydrocele is a disease observed only in males. Most hydroceles are congenital and are noted in children aged 1-2 years. Chronic or secondary hydroceles usually occur in men older than 40 years.Clinical Presentation: A male, 67 years old, came to emergency room General Hospital DR. Mohammad Hoesin Palembang with the chief complain of swollen on left scrotum. From physical examination, general examination was normal. On local examination, Scrotum region from inspection looks mass size 10x6 cm, same color with the surrounding. On palpation, cystic consistency, firm boundaries, mobile, impalpable testis, fluctuation (+). Transillumination test (+). Laboratorory test within normal limits. Ultrasonography of this patient show hydrocele in testis.Discussion: Swollen on scrotum is one of chief complain that caused by some diseases. There is no complaints like pain in scrotum and urination and the size of the swollen never shrink, so the differential diagnosis of testis tumor and inguinal hernia can be removed .In this case, swollen on scrotum is caused by accumulation of fluid between the parietal and visceral layers of the tunica vaginalis that can be seen in ultrasonography.Conclusion: Hydrocele testis is an accumulation of excess fluid between the parietal and visceral layers of the tunica vaginalis. Diagnosis of hydrocele testis enforced through anamnesis, physical examination, investigations such as ultrasound.

Keywords: Hydrocele, testis.

Background

Hydrocele is a accumulation of fluid between the parietal and visceral layers of the

tunica vaginalis. Under normal circumstances, the fluid inside the cavity as it exists

and is in the balance between production and reabsorption by lymphatic system in

the vicinity.

Hydrocele that occurs in newborns can be caused by: (1) incomplete closure of the

processus vaginalis resulting in peritoneal fluid flow to the processus vaginalis or (2)

incomplete lymphatic system in the scrotum in conducting fluid reabsorption

hydrocele.

In adults, hydrocele can occur in idiopathic (primary) and secondary. Secondary

causes occur due to abnormalities found in the testis or epididymis that causes

disruption of the system or the secretion of fluid reabsorption in the bag hydrocele.

Abnormalities in the testis may be a tumor, infection, or trauma to the testis /

epididymis.

In United States, hydrocele is estimated to affect 1% of adult men.

More than 80% of newborn boys have a patent processus vaginalis, but most close

spontaneously within 18 months of age. The incidence of hydrocele is rising with the

increasing survival rate of premature infants and with increasing use of the peritoneal

cavity for ventriculoperitoneal (VP) shunts, dialysis, and renal transplants.

Hydrocele is a disease observed only in males. Most hydroceles are congenital and

are noted in children aged 1-2 years. Chronic or secondary hydroceles usually occur

in men older than 40 years.

Patients complain of a lump in the scrotum bag that is not painful. On physical

examination found a lump in the scrotum bag with consistency kistus and

penerawangan examination showed transluminasi. At the infected hydrocele or

scrotal skin is very thick sometimes difficult to perform these checks, so it should be

assisted by ultrasound. According to the layout of the pockets hydrocele testis,

clinically distinguished several kinds of hydrocele, namely (1) hydrocele testis, (2)

hydrocele funikulus, and (3) hydrocele communicant. This division is important

because it relates to a method operation performed at the time of correction

hydrocele.

At hydrocele testis, hydrocele bag as if surround the testicles so that the testes can

not be touched. In the anamnesis, the magnitude of hydrocele bag does not change

throughout the day.

At funikulus hydrocele, hydrocele bag is in funikulus is located next to the cranial

from the testes, so on palpation, testicular palpation and are outside the bag

hydrocele. In the anamnesis hydrocele bag fixed amount throughout the day.

At hydrocele communicant there is a relationship between the processus vaginalis

the peritoneal cavity can be filled so that the processus vaginalis peritoneal fluid. In

the anamnesis, hydrocele bag can usually change that is getting bigger by the time

the child was crying. On palpation, hydrocele bag separate from the testis and can be

inserted into the abdominal cavity.

Hydrocele in infants usually wait until the child reaches the age of 1 year in the hope

after the processus vaginalis closes, hydrocele will heal itself; but if the hydrocele is

still present or grow large need a lot of rethinking to do corrections.

Measures to address the hydrocele is fluid by aspiration or surgery. Aspiration of

hydrocele is not recommended because in addition to high kekamuhannya figures,

sometimes in the form of infection is likely to cause complications.

Some indications to perform operations on the hydrocele is: (1) a large hydrocele so

as to suppress the blood vessels, (2) an indication of cosmetics, and (3) hydrocele

permagna felt too heavy and disturbing the patient in performing daily activities.

In the congenital hydrocele inguinal approach is due to hydrocele is often

accompanied by an inguinal hernia operation so that when the hydrocele, and

conduct herniorafi. In the adult testis hydrocele done scrotal approach with excision

and marsupialization bag in the manner Winkleman hydrocele or hydrocele bag

complication in the way Lord. At the extirpation hydrocele hydrocele funikulus done

by in toto.

If left unchecked, hydrocele large enough easily traumatized and hydrocele

permagna can suppress the blood vessels leading to the testicles causing testicular

atrophy.

Clinical Presentation

A male, 67 years old, came to emergency room General Hospital DR. Mohammad

Hoesin Palembang with the chief complain of swollen on left scrotum.

Approximately 4 years ago, patients admitted there is swelling in the left scrotum

that was originally about the size of marbles are getting bigger. Size swollen

recognized patients never shrink. Pain in swelling (-), there are no complaints about

urination. A history of trauma to the genitals denied. Fever (-)

From the history of past illness, this patient have been diagnosed Hernia Inguinalis

dextra and took surgery 8 years ago. He has no history of diabetes melitus and CVD,

and no history of same diseases in his family.

From physical examination, general examination was normal. On local examination,

Scrotum region from inspection looks mass size 10x6 cm, same color with the

surrounding. On palpation, cystic consistency, firm boundaries, mobile, impalpable

testis, fluctuation (+). Transillumination test (+).

Laboratory examination show hemoglobin (10,8 g/dL), normal leukocyte

(7200/mm3), and normal BSS (110 mg/dL). From the clinical chemical such as

ureum (14 mg/dl) and creatinin (0,77 mg/dl) is normal. USG of this patient show

hydrocele (figure 1).

Figure 1.

This patient was diagnosed with hydrocele testis sinistra. The treatment for this

disease is hydrocelectomy. Prognosis for this patient, quo ad vitam is dubia ad

bonam and quo ad functionam is dubia ad bonam

Disscussion

In this case, A male, 67 years old, came to emergency room General Hospital DR.

Mohammad Hoesin Palembang with the chief complain of of swollen on left

scrotum. Swollen on scrotum can be caused by some diseases like testis tumor,

inguinal hernia and infection.

Based on autoanamnesis, the symptoms of this patient is swollen in scrotum. There

is no complaints like pain in scrotum and urination and the size of the swollen never

shrink, so the differential diagnosis of testis tumor and inguinal hernia can be

removed. From the history of past illness, there is a history of hernia inguinalis that

can lead to hydrocele testis.

Based on physical examination, in this patient show normal general examination.

Scrotum region from inspection looks mass size 10x6 cm, same color with the

surrounding. On palpation, cystic consistency, firm boundaries, mobile, fluctuation

(+). Transillumination test (+). so the differential diagnosis of hernia inguinalis and

tumor can be removed.

From the laboratory test, the levels of hemoglobin, hematocrit, leukocytes and

diff.count within normal limits as well as clinical chemistry urea and creatinine

within normal limits. Therefore, it can be concluded that there are no signs of

infection, anemia, and normal kidney function. But, based on the ultrasonography,

we found hydrocele.

So, from the anamnesis of present complaints, history of the past illness, physical

examination and several additional examination of these patients, we can diagnosed

with hydrocele testis sinistra. Management that can be given to patients with

hydrocel testis are with hydrocelectomy. The disease is said to be cured, so this

patient's prognosis quo ad vitam is dubia ad bonam and quo ad functionam is dubia

ad bonam.

Conclussion

Hydrocele testis is an accumulation of excess fluid between the parietal and visceral

layers of the tunica vaginalis that the majority of cases are found in children aged 0-

12 months and rarely in adults. The mechanism of hydrocele testis in children is

incomplete closure of the processus vaginalis and incomplete in the reabsorption of

the lymphatic system, whereas in adults is caused by idiopathic factors and

abnormalities in the testis or epididymis.

Diagnosis of hydrocele testis enforced through anamnesis, physical examination,

investigations such as ultrasound. Management of hydrocele testis is divided into

observation unti children aged 0-12 months, aspirations and operative actions in

terms of the age and the risk of recurrence. Hydrocele testis can lead to

complications such as circulatory compression testicles, testicular atrophy, bleeding,

and secondary infection.

Refferences

1. Scott E. Rudkin, M.D., Department of Emergency Medicine, Irvine Medical

Center, California. Hydrocele in Emergency Medicine. http://www.medlineplus.com/

medicalencyclopedia.html

2. Sadler T. Langman’s medical embryology. New York: Lippincott Williams and

Wilkins; 2006.

3. Tanagho EA and McAninch JW. Smith’s General Urology 17th Edition. New

York: McGraw Hill.

4. Purnomo BB. 2007. Dasar-Dasar Urologi. Edisi Kedua. Jakarta: CV. Sagung Seto.