HYDROCELE.
This may be safely left alone till it assumes dimensions which cause inconvenience. Temporary relief may be obtained by tapping, though except in the child the fluid is bound to accumulate again.
The patient should be seated in a chair with the buttocks brought forward to the edge; the surgeon grasps the scrotum from behind near the neck of the sac, and by squeezing the tumour the skin and tunica are made very tense. The testicle and any large scrotal veins being located, a fine sharp trochar with its canula is plunged into the sac, the canula being pushed home as the trochar is withdrawn, when the con tents of the sac will be thoroughly evacuated. The trochar should be made to enter the tunica above the centre of the tumour by pushing it directly backwards, elevating the point slightly so as to avoid injury to the testicle, and care taken to insure that no hernia is present. The scrotal wound is afterwards sealed by the application of Collodion or by a small pad of lint soaked in Friar's Balsam, and the patient is made to rest for a few hours.
For the radical cure of ordinary hydrocele the older operation of injecting the emptied sac with 2 drs. weak Tincture of Iodine or 3o mins. Carbolic Acid and kneading the scrotum gently so as to insure thorough contact may be resorted to where for any reasons a cutting operation is inadmissible.
For all ordinary cases the modern plan of retroversion of the sac by making an incision in the scrotum is the safest and most reliable pro cedure. The incision should he sufficiently large to permit of the testicle being delivered through the wound with the parietal layer of the sac retroverted, after which the lips of the wound in the latter are sutured with catgut behind the epididymis and the sac well washed out before returning the testicle to the scrotum and closing the skin wound. The patient should be confined to bed for a week.
In old hydroceles with very thick walls the parietal portion of the sac should be dissected out and excised, all obvious bleeding-points caught and tied, and the cavity temporarily packed with gauze till all hacmor rhagc is stopped, after which the skin wound may be closed by suturing, the stitches being placed very close together to prevent inversion of the wound.
Congenital hydrocele sometimes disappears and does not return; the closure of the inguinal canal by a well-fitting truss the descent of a knuckle of bowel and causes obliteration of the open funicular process, which connects the abdominal cavity with the sac of the tunica vaginalis.
When a truss fails, tapping or acupuncture may be tried, and if the fluid continues to accumulate, the upper part of the sac should be exposed and the neck treated as in the radical cure for hernia, and the hydrocele dealt with by the retroversion of the lower portion of the sac. .
Infantile hydrocele usually yields to tapping with an aspirator needle or to acupuncture by a Clover's needle, but when these fail the sac may be excised or retroverted as in the treatment of ordinary hydrocele.
Encysted hydroceles of the cord, of the testicle and of the epididymis (spermatocele) may be tapped or acupunctured, and when this fails excision of the sac should be effected. Injection after tapping usually suffices, but an encysted hydrocele of the cord may communicate with the peritoneal cavity, and should not be injected with any irritating fluid; sometimes it may be cured by the application of Iodine externally.
Tydrocele of a hernial sac may exist after the cure of a hernia has been accomplished by the use of a truss which has obliterated the neck of the old sac; the best method of procedure in such a case is to excise the sac after ligaturing its neck.