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 Testis
Oleh
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
1

Clinical Senior Clerkship, School of Medicine, Medical Faculty of

SriwijayaUniversity, Dr. Mohammad Hoesin General Hospital, Palembang
2
Department 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 012 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. Langmans medical embryology. New York: Lippincott Williams and
Wilkins; 2006.
3. Tanagho EA and McAninch JW. Smiths General Urology 17th Edition. New York:
McGraw Hill.
4. Purnomo BB. 2007. Dasar-Dasar Urologi. Edisi Kedua. Jakarta: CV. Sagung Seto.