HYDROCELE

Definition

Hydrocele is the accumulation of fluid in the tunica vaginalis the sac that contains fluid on which the testes float

Causes of Hydrocele: This is a complication of Bancroftian filariasis  and Onchocersiasis

Risk Factors: Presence of Wuchereria bancrofti ; nematode worms and  Culex(urban) and Anopheles mosquitoes(rural areas

Any condition that exposes an individual to the bite of these mosquitoes

Step3:  Pathophysiology of Hydrocele (15 minutes)

·         The disease process is indirectly initiated by a bite of the mosquito which diposts microfilaria worms  into the  subcutaneous tissues of the host

·         The larvae lodge in the lymph vessels where  they mature for about one year

·         Following maturity the female worm gives birth to live microfilariae

·         The body   reacts  against the worms (foreign body reaction)

·         Many years after the attack the lymph glands and lymph vessels  become obstructed  leading to lymph-oedema ,(elephantiasis in the legs) Hydrocele in the legs ,other parts of the body affected are the breast and arms

Signs and Symptoms of Hydrocele

·         Accumulation of fluid in the tunica vaginalis

·         Too big (elephantoid)hydrocele may interfere with sexual activity

Step 4 Diagnostic Measures (15 minutes)

·         Physical assessment of the scrotum to differentiate hydrocele from inguinal hernia

·         History of having been infected  by Bancroftian filariasis

·         Laboratory tests of blood to detect the microfilarial worms (useful as a preventive measure )

Step 5 Treatment and Nursing Management of a Patient with  a Hydrocele (55 minutes)

The treatment of choice is surgical removal of the fluid in the tunica vaginalis(hydrocelectomy) where the fluid is removed and the tunica vaginalis inverted to prevent further accumulation

Pre-operative care includes:

·         Thorough explanation of the patient about the operation

·         Ensuring the patient is clean

·         Signing an informed consent about the operation

·         Fasting the night before the operation

·         Labelling the patient correctly(name ward from,operation site)

·         Laboratory testsof blood to exclude such conditions as anaemia

Post –operatively

·         Inspect the operation site for wound gapping, bleeding

·         Assess the patient the patient’s level of consciousness

·         Check and record vital signs

·         Administer any treatment in the form of drugs as indicated in the prescription and as necessitated by the condition of the patient

·         Perform exercises as early as possible to prevent post operative complications

Step 6: Complications of Hydrocele (10 minutes)

·        Cancer of the testis

·        Sterility leading to infertility

·        Psychological stress as it may interfere with sexual activity

·        Impotence