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“A CLINICO-PATHOLOGICAL STUDY AND MANAGEMENT OF
CYSTIC SWELLINGS OF SCROTUM”
Synopsis of the Dissertation
Submitted to
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
In partial fulfillment of the regulations for the Award of Degree of
Master of Surgery-General Surgery
Submitted by
Dr. YASHAS .H. R.
M.B.B.S.
Post Graduate in General Surgery
Under the guidance of
Dr.B.J.SREEKANTAIAH
M.B.B.S.; M.S.
Professor & Head Of Department
Department of Surgery
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Sl.
No.
01.
02.
03.
Title
Name Of The Candidate
Designation
Address
04.
Name Of The Institution
05.
Course Of The Study &
Subject
06.
07.
Date Of Admission To Course
Title Of The Topic
08.
Brief Resume Of The Intended
Work
1- Need for the Study
2- Review of the Literature
3- Objectives of the Study
Details
Dr. Yashas. H. R.
Post Graduate-General Surgery
Room No.-54,
Kalpataru Bhavana,
A.I.M.S.,
B.G.Nagara, Nagamangala
Taluk,
Mandya District.
Karnataka. -571448.
Ph-9986790526
Adichunchanagiri Institute Of
Medical Sciences,
B.G.Nagara, Nagamangala
Taluk,
Mandya District.
Karnataka. -571448.
Post Graduation In
Master Of Surgery In
General Surgery
30 May 2009
“A clinico-pathological study
& management of cystic
swellings of scrotum”
APPENDIX-I
Appendix-IA
Appendix-IB
Appendix-IC
09.
10.
11.
Materials And Methods
1- Source of Data
2- Method of Collection of
Data-Including Sampling
Procedure if any
3- Does the Study Require any
Investigations or
Interventions to be
Conducted on Patients or
Other Animals; if so
Describe briefly
4- Has Ethical Clearance been
Obtained from your
Institution for the Above
List of References
Signature Of The Candidate
12.
Remarks Of The Guide
13.
Name Of Guide
Designation Of Guide
Signature Of Guide
14.
Co-Guide (If Any)
Designation
Signature
APPENDIX-II
Appendix-IIA
Appendix-IIB
Appendix-IIC
Appendix-IID
Appendix-III
Cystic swellings of the scrotum
are a common surgical
problem which causes concern
to a patient more with his
fertility. This study aims at the
study of various presentations,
their clinical management &
the outcome of the surgery.
Prof. Dr.B.J.Sreekantiah
M.B.B.S.; M.S.
Professor & H.O.D.
Department Of General
Surgery;
A.I.M.S.; B.G.Nagara.
Dr. Tulasi Vasudevaiah
Assistant Professor
15.
Head Of The Department
Signature
16.
Remarks Of The Chairman &
Principal
Signature
Prof. Dr.B.J.Sreekantiah
M.B.B.S.,M.S.,
Professor & H.O.D.,
Department Of General
Surgery,
A.I.M.S.; B.G.Nagara.
APPENDIX-I
08. BRIEF RESUME OF INTENDED WORK
APPENDIX-IA
08.1- Need For The Study:
Cystic swelling of the scrotum are a common surgical problem which affects
the physical wellbeing of the patient, it is rather a mental agony for him.
These swellings are easily accessible for clinical examination. The spectrum
consists of hydrocele, epididymal cysts, spermatocele, hematocele, pyocele,
chylocele, parasitic cyst and sebaceous cysts.
Primary hydrocele is an abnormal collection of serous fluid in some part of
the processus vaginalis usually the tunica[1]. It is divided into simple (scrotal)
and communicating[2]. This is known by the common terminology ‘cheer’ in
northern parts of Karnataka. Epididymal cysts represent cystic degeneration
of the epididymis and are filled with crystal clear fluid[2].
Spermatocele is a retention cyst arising from either the vasa efferentia of the
testis or from the epididymis[3]. The scrotum has abundant quantity of
sebaceous glands, which may become infected and obstructed forming
sebaceous cysts.
Secondary hydrocele occurs secondary to disease of the testis and
epididymis and its management consists of treatment of the underlying
cause.
Filarial hydrocele and chylocele account for upto 80% of hydrocele in
endemic areas. Cystic swellings of the scrotum are invariably painless and
can attain very large size without causing much discomfort to the patient.
Indication for treatment include pain, discomfort and the cosmetic
appearance of the scrotum or the patients wish[4].
Conventional treatments for primary hydrocele, epididymal cysts and
spermatocele include repeated aspiration, aspiration and injection of
sclerosant or surgery. Aspiration and injection of sclerosant can cause severe
pain, and simple aspiration has to be repeated and carries risk of infection
and hematoma formation[5]. The gold standard continues to be surgical
extirpation of the cystic lesion[6].
There is no specific treatment for secondary hydrocele. Management of this
condition consists of treatment of the underlying cause.
Surgical treatment of idiopathic hydrocele includes four basic techniques –
Lord’s placation[8], Jaboulay eversion of sac[9], Winkelmann’s partial
excision and eversion of the sac[7] and radical excision of the sac[7]. Recent
quicker operation in adults consists of the window operations or vaginal
fenestrations[10][11]. Congenital hydrocele are treated by herniotomy.
Treatment of epididymal cysts and spermatocele consist of excision of the
cysts[2][3].
With this background a clinical study of cystic swelling of the scrotum is
undertaken to study its classification, etiology, clinical presentation and
management.
APPENDIX-IB
08.2- Review of Literature:
Cystic swelling occur more commonly in the scrotum and have known
to occur since ancient times and have been reported as far back as 5th century
B.C. Sushrutha,the father of Indian surgery described hydrocele in his book
“Sushrutha Samhitha”. According to sushrutha any swelling in the body is
due to Thridosha- vata, pitta, kafa.
Sushrutha described surgical treatment of hydrocele to be punctured
and tapped.
Celsus(53 BC-7 AD) distinguished hydrocele from hernia by its
translucency.
Ambrosis pare coined the term hydrocele in 5th century, Percival pott
wrote a masterpiece on hydrocele in 1762.Dupuytrens described hydrocoeleen-bissac in1834 and the name abdominoscrotal hydrocoele was proposed
by bickle in 1919[13].
Mathew jabauley(1860-1913)described the operation of eversion of
the sac for hydrocoele. Marcheffi(1902)was first to analyse hydrocoele fluid
biochemically. in 1907,Andrews described the bottle operation for treatment
of hydrocoele[14].Odilek described the window operation in 1957[15].
Mackay & Baznett in 1958 treated congenital hydrocele by ligating &
dividing the processus vaginalis through inguinal route & aspiration of
hydrocoele fluid. Mallace A.F suggested that hydrocoele was the result of
lymphatic obstruction either due to low- grade inflammation of the
epididymis or due to trauma to the scrotum.
In 1962,Montella and Fontana tried injection of hydrocortisone in to
hydrocoele sac after completely aspirating the fluid.
In 1964,Peter H Lord described the technique of plication ,a
bloodless operation for the radical cure of idiopathic hydrocoele[8]. In
1970,Lord PH described bloodless for spermatocoele and epididymal
cyst[16].
Wilkinson JL advocated an operation for large scrotal hydrocoele in
1973 . Sharma LS and Jhawar PK described a simplified minimal
dissection technique for hydrocoele[18].
[17]
Dandapat et al.,in 1990 showed partial arrest of spermatogenesis in
10% and total arrest of spermatogenesis in 8 %of cases,the remaining
82%showed normal spermatogenesis.
Recently Lavelle MA described surgical treatment of cystic swellings of
scrotum under local anaesthesia.
APPENDIX-IC
08.3- Objectives of Study:
 To evaluate the relative incidence of various cystic scrotal swellings .
 To study the etiology of cystic swellings of scrotum.
 To study the mode of presentation of various cystic swellings &
diagnostic modalities in the management of the same.
 To study the various surgical procedures in the treatment of cystic
swellings of the scrotum & analyzing the results of the various
procedures.
 To study the post-operative complications & measures to prevent
them.
APPENDIX-II
09. MATERIALS AND METHODS
APPENDIX-IIA
09.1- Source of Data:
The material for the present study is proposed to be collected from the
patients who present to the Department of Surgery, Sri Adichunchanagiri
Institute Of Medical science with swelling in the scrotal region fulfilling the
inclusion criteria.
Sample size of a minimum of 50 patients fulfilling the inclusion
criteria will be a part of this study.
APPENDIX-IIB
09.2- Method of Collection of Data:









Detailed history taking
Complete clinical examination
Investigations-Appendix-IIC
Performing surgery for the cases, noting the findings and follow up of
the histopathology reports
Ultrasound in all cases
Operative findings were recorded
Histopathological study was asked for relevant cases
Postoperative course and management of pasostoperative
complications
Finally follow up was done
 Inclusion Criteria
 Patients aged between 0 to 60yrs.
 Cystic swellings from the testes & its coverings, epididymis,
spermatic cord & from scrotal skin.
 Exclusion criteria
 Cystic inguino-scrotal swellings.
 Patients aged above 60.
APPENDIX-IIC
09.3- Does the study require any investigations or interventions to be
conducted on patients or other animals; if so describe briefly:
Yes
INVESTIGATIONS
 Routine investigations:
 Hemoglobin percentage
 Total count
 Differential count
 Erythrocyte sedimentation rate
 Bleeding time
 Clotting time
 Urine for protein, sugar and microscopy
 Random blood sugar
 Blood urea
 Serum creatinine
 Specific investigations:
 Hydrocele fluid analysis
 Ultrasound scrotum with scrotal doppler
 Chest radiograph
 Electrocardiograph
INTERVENTION
 Surgical procedures in all the selected cases.
APPENDIX-IID
09.4- Proforma Application For Ethics Committee Approval
SECTION A
01. Title Of The Study
02. Principle Investigator
(Name & Designation)
03. Co-Investigator
(Name & Designation)
04. Name Of The Collaborating
Department/Institution
05. Whether Permission Has Been
Obtained From The Head Of
The Collaborating Departments
& Institution.
SECTION B
Summary Of The Project
SECTION C
Objectives Of The Study
SECTION D
Methodology
01. Where The Proposed Study Will
Be Undertaken
02. Duration Of The Project
03. Nature Of The Subjects:
 Does The Study Involve
Adult Patients?
 Does The Study Involve
Children?
 Does The Study Involve
Normal Volunteers?
 Does The Study Involve
Psychiatric Patients?
“A clinico-pathological study &
management of cystic swellings of
scrotum”
Dr. Yashas. H.R.
P.G. In General Surgery
Prof. Dr. B.J.Sreekantiah
M.B.B.S.,M.S.,
Professor and H.O.D.
Department Of General Surgery,
A.I.M.S., B.G.Nagara.
Department Of General Surgery,
A.I.M.S., B.G.Nagara.
Yes
APPENDIX – I
APPENDIX – IC
APPENDIX – IIB
A.H. & R.C.,
B.G.Nagara.
18 months
Yes
Yes
No
No
 Does The Study Involve
Pregnant Women?
04. If The Study Involves Health
Volunteers
 Will They Be Institute
Students?
 Will They Be Institute
Employees?
 Will They Be Paid?
 If They Are To Be Paid,
How Much Per Session
05. Is The Study Part Of Multi
Central Trial?
If Yes, Who Is The Coordinator?
(Name & Designation)
Has The Trial Been Approved
By The Ethics Committee Of
Other Centers?
06. If The Study Involves The Use
Of Drugs:
Please Indicate Whether,
1. The Drug Is Marketed In
India For The Indication
In Which It Will Be Used
In The Study.
2. The Drug Is Marketed In
India But Not For The
Indication In Which It
Will Be Used In The
Study.
3. The Drug Is Only Used
For Experimental Use In
Humans.
4. Clearance Of The Drug
Controller Of India Has
Been Obtained For:
 Use Of The Drug In
Patients For A New
Indication.
No
No
No
No
No
-NANo
-NA-NA-
No
-NA-
-NA-
-NA-NA-
-NA-
07.
08.
09.
10.
11.
12.
 Phase One & Two
Clinical Trials.
 Experimental Use In
Patients & Health
Volunteers.
How Do You Propose To Obtain
The Drug To Be Used In The
Study?
 Gift From A Drug
Company
 Hospital Supplies
 Patients Will Be Asked
To Purchase
 Other Sources (Explain)
Funding (If Any) For The
Project Please State
 None
 Amount
 Source
 To Whom Payable
Does Any Agency Have A
Vested Interest In The Outcome
Of The Project?
Will Data Relating To
Subjects/Controls Be Stored In
Computer?
Will The Data Analysis Be Done
By
 The Researcher?
 The Funding Agent?
Will Technical/Nursing Help Be
Required From The Staff Of The
Hospital?
If Yes, Will It Interfere With
Their Duties?
-NA-
-NA-
No
No
Yes
No
No
-NANo
Will You Recruit Other Staff
For The Duration Of The Study?
If Yes, Give Details Of
 Designation
-NA-
 Qualification
 Number
 Duration Of Employment
13. Will Informed Consent Be
No
Taken?
If Yes,
-NAWill It Be Written Informed
-NAConsent?
-NAWill It Be Oral Consent?
Will It Be Taken From The
-NASubject Themselves?
Will It Be From The Legal
Guardian?
14. Describe Design, Methodology
APPENDIX – II
& Techniques
Please note: NA = not applicable.
Ethical Clearance Has Been Accorded
Date:
Chairman
P.G. Training-Cum Research Committee
A.I.M.S., B.G.Nagara.
APPENDIX-III
10. LIST OF REFERENCES
1. Christopher Fowler. The testis and scrotum. chapter 79.in;bailey and
love’s short practice of surgery, Russel R.C.G.et.al.(eds).24th
edition,London; Arnold publishers2004;1403-1416.
2. Marc goldstin .surgical management of male infertility and other scrotal
disorder.vol.1.in;Campbell’s urology,Patrick c.walsh, Alan B Retik,
Vaughan(eds).8th edition. Edinburgh:WB saunders company 2002;313316.
3. Margaret. Surgery of the groin and External genitalia. In: Farquharsons’s
Text book of operative general surgery, Farquarsons M, Morgan B
Hodder (eds). 9th edition.
Edinburgh: Arnold Publishers 2004; 474
4. Ku JH. The Excision, Plication and Internal drainage techniques-a
Comparison of the results for idiopathic Hydrocoele. British Journal of
Urology International 2001; 87:82-84.
5. Lavelle MA. Surgical treatment of cystic swelling of scrotum under local
Anaesthesia. England: Annals of Royal College of Surgeons
1996;78:541-543
6. Courtney SP, Wightman J. Sclerotherapy for Scortal cysts using
Tetracycline Instillation. Edinburgh: Journal of Royal college of
Surgeons 1991; 36:103-104.
7. Rodrigues WC, Rodigues DD. The operative treatment for hydrocoele A comparison of 4 basic techniques. Journal of Urology 1981;
125:804-805.
8. Lord PH. A bloodless operation for the radical cure of idiopathic
Hydrocoele. British Journal of Surgery 1964;51:914-916.
9. Aria. F Olumi, Jerome P Richie. Urologic Surgery. Vol. II. In:
Sabiston Textbook of Surgery – The Biological Basis of Modern
Surgical Practice, Beauchamp D, Evers BM, Mattox KL (eds).
17th edition. Edingurgh: W.B. Saunders company 2004 2304-2305.
10. Nigam UK. Window operation – New technique for hydrocoele.
British Journal of Urology International 1984;24:481-482.
11. Falandry L. A simple alternative technique in the treatment of idiopathic
hydrocoele in adult- vaginal fenestration. Prog UROL 1995;5:568-574.
12. Oesterling JE. Scrotal surgery – A reliable method ofr the prevention of
postoperative Heamatoma and edema. Journal of Urology 1990;143(6):
1201-1202.
13. Tanga. Abdminoscrotal hydrocoele- short notes of rare obscure cases.
British Journal of Surgery 1973;60:834-836.
14. Andrews EW. The Bottle operation method for the radical cure of
hydrocoele. Annals of Surgery 1907; 46:915.
15. Ozdilek S. The pathogenesis of Idiopathic hydrocoele and simple
operative technique. Journal of Urology 1957;77: 282.
16. Lord PH. A bloodless operation for spermatocoele or cyst of epididymis.
British Journal of Surgery 1970; 57(9): 641-644.
17. Wilkinson JL. An operation for large scrotal hydrocoele. British Journal
of Surgery, 1973; 60:450.
18. Jhawer PK. Surgery of hydrocoele, a rare simplified minimal dissection
technique. Indian Journal of Surgery 1979; 700-704.