|Year : 2009 | Volume
| Issue : 1 | Page : 25-26
Tunica vaginalis hydrocele of reposited testis
Manish K Tiwari, Anand A Sinha, Divyang N Dave
Department of General Surgery, Government Medical College and New Civil Hospital, Surat, India
|Date of Submission||28-Aug-2008|
|Date of Acceptance||31-Jan-2009|
Manish K Tiwari
170, R.D. Hostel, S.M.S. Hospital Campus, Jaipur, Rajasthan - 302 003
| Abstract|| |
Tunica vaginalis hydrocele (TVH) is a relatively common entity. The procedure of testicular reposition in a subcutaneous pouch following severe scrotal avulsion injury is also a standard line of care. Though, the occurrence of TVH in such a reposited testis is extremely rare clinical presentation. We herein report a case of 55-year male patient who presented with swelling over medial aspect of left upper thigh which was diagnosed as TVH of reposited testis on detailed assessment. The patient was managed on the usual lines of management protocols of TVH with successful outcome.
Keywords: Reposited testis, testicular swelling, tunica vaginalis hydrocele
|How to cite this article:|
Tiwari MK, Sinha AA, Dave DN. Tunica vaginalis hydrocele of reposited testis. Urol Ann 2009;1:25-6
| Introduction|| |
The occurrence of tunica vaginalis hydrocele (TVH) is relatively common and is endemic in various parts of India. The procedure of testicular reposition in a subcutaneous pouch following severe scrotal avulsion injury is also a standard line of care.  The occurrence of TVH in such a reposited testis is extremely rare clinical presentation and a thorough review of literature failed to show any such reported case till date.
| Case Report|| |
A 55-year-old male patient presented in our unit with swelling over upper medial aspect of left thigh for last 10 years. It was gradually increasing in size and was associated with mild dragging pain. On examination, there was 15 × 10 × 6 cm size cystic swelling situated on medial aspect of left upper thigh [Figure 1] with fluctuation and transillumination present. There was scant scrotal skin and testes were absent. Hypertrophied scars were present at base of the testis and suprapubic region [Figure 2]. On repeated questioning, the patient revealed the history of trauma over genital region at the age of eight years for which he had undergone a surgical procedure, wherein right testis was removed and left testis was reposited at left upper thigh. This bit of history together with clinical examination established the diagnosis which was later confirmed by ultrasonographic examination [Figure 3]. On exploration, 500 ml of clear amber-colored fluid was evacuated [Figure 4], the parietal layer of tunica vaginalis sac was plicated, and redundant skin was excised. The patient made an uneventful postoperative recovery.
| Discussion|| |
Tunica vaginalis hydrocele is a relatively common entity and is endemic in various parts of India. It occurs due to collection of fluid in the tunica vaginalis sac due to impairment of dynamics of fluid production and absorption.
During severe avulsion injuries of scrotum, testis and spermatic cord are exposed to the exterior and thus the standard line of management in such a case is immediate testicular reposition in a subcutaneous pouch, usually on medial aspect of thigh. This is normally followed by delayed scrotal reconstruction using skin tissue grafts or thigh flaps. ,,
The initial as well as the operative trauma of testicular reposition leads to destruction of normal lymphatic pathways. This leads to an increased predisposition of reposited testis to develop TVH - a risk factor, in addition to the usual lifetime risk of development of TVH. Such a condition, if develops, can be clinically misleading. Hence, the possibility of such a condition should be kept in mind during clinical diagnosis.
| Acknowledgment|| |
We would like to thank our teachers and parents for their support.
| References|| |
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|2.||Aboseif S, Gomez R, McAninch JW. Genital self-mutilation. J Irol 1993;150:1143-6. |
|3.||McAninch JW. Management of genital skin loss. Urol Clin North Am 1989;16:387-97. [PUBMED] |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]