Epidemiological and Therapeutic Aspects of the Vaginal Hydroceles

Purpose: Our purpose was to describe the epidemiological and therapeutic aspects of the vaginal hydroceles. Methodology: It was a forward-looking and descriptive study of Mars 2014 in July, 2017, which realized in the service of general surgery of the Reference Health Center of Kati (Mali). All the patients operated in the service for hydrocele were included. Other causes of big stock exchange and hydroceles operated outside our service were not including. Results: We operated 92 hydroceles or 5.9% of the surgical activities of the service. The average age was of 34.5 years with extremes of 2 years and 82 years. The most frequent signs of hydrocele were the big painless stock exchange (100%); a transillumination positive (90%) and the effusion of the vaginal in the ultrasound (100%). The cure of hydrocele was realized according to the techniques of Bergmann (94.6%) and of Lord (5.4%). The mortality was nil and the morbidity was 3.3% (2 operating infections of the site and 1 bruise). Conclusion: The hydrocele is a frequent pathology in Africa. The therapeutic strategies are multiple and varied. However, we prefer the Bergmann technique, which is easy, fast and has few complications.


Introduction
The hydrocele is a liquid collection between the leaves of the vaginal of the testicle.Mild affection, it is the 3 rd talks of big stock grant at the adult, behind orc- hi-epididymitis and Hernia inguinoscrotal [1].
The etiology arouses numerous discussions, but both main clauses are the congenital hydroceles by obstinacy of the peritonea-vaginal canal and the acquired hydroceles [2].
The diagnosis of the hydrocele is clinical [3].In case of doubt only the testicular ultrasound may be asked because of its sensibility and because of its specificity [4].
The surgical treatment of the hydrocele is at present codified well and rests mainly on the techniques of Bergmann and of Lord [3].
We introduced this study as objective to describe the epidemiological and therapeutic aspects of the vaginal hydroceles.

Patients
It was about a forward-looking and descriptive study of Mars 2014 in July, 2017, realized in the service of general surgery of the Reference health center of Kati (Mali).
All the patients operated in the service for hydrocele in the service during the period of study were included.Other causes of big stock exchange and hydroceles operated except our service were not including.

Methods
The operated sick were listed by the Technical directors of the Centers being of the Reference health center, the community relays and by the surgeons.
A complete clinical examination, an ultrasound if necessary, a preoperative biological balance sheet and a consultation of anesthesia were realized at all the sick.
The studied variables were: the sociodemographic characteristics, the clinical signs and paracliniques, the operating techniques, the post-operative suites.
These data were seized and analyzed on the software Ear Information (version 6).The test of Khi 2 and Student were used to compare our results to those of the other authors.The threshold of meaning was fixed to 0.05.

Results
We operated 92 hydroceles or 5.9% of the surgical operations (1547 interventions) during the period of study.

Sociodemographic Data
The average age was of 34.

Clinical Signs and Paracliniques
All the patients had a big painless stock exchange (100%) and the transillumination (Figure 1) was positive in 90%.The hydrocele was to the right in 54.3% (50 sick), to the left in 32.1% (30 sick) and bilateral in 13.4% (12 sick) (Figure 2).
The ultrasound asked at 10 patients found a unilateral effusion in 6 cases and bilateral in 4 cases (Figure 3).
In 4.3% a surgical pathology was associated with the hydrocele (an adenoma of the prostate, a hernia homolateral, a hernia inguinoscrotal homolateral and an umbilical hernia) (Figure 4).

Techniques and Operating Consequences
The local anesthetic in the xylocaine 2% was used in 80.2%, the general anesthesia in 13.7% and the spinal anesthesia 6.1%.
The inguinal manner was realized in 16.3% at the patients under age 15 whereas a scrotal manner either on the median raphe or the transverse side scrototomy was practiced at 83.7%.
The plicature simple of the vaginal according to Lord was realized at 5 patients (5.4%) and the resection of the vaginal according to Bergmann at 87 patients (94.6%).
In three cases the cure of hydrocele was associated with a hernia cure and in a case in an adenectomy transvesical of the prostate.
The operating mortality was nil and the morbidity was 3.3% made by 2 infections of the operating site and by a bruise of stock exchange the evolution of which was favorable in every case under treatments surgical (evacuations-drainages and local care) and medical (analgesic, anti-inflammatory, antiseptic and antibiotic).

Discussion
The vaginal hydrocele is a mild, frequent pathology still on the African conti-

nent [ 1 ]
[3] [5].The diagnosis is clinical often confirmed in the testicular ultrasound; the reference treatment is surgical[6] because it is the effective only one with its two major principles of radical cure.So the interventions for hydrocele represented 5.9% of the surgical activities of the Reference health center of Kati.Our rate is close to 4.4% reported by Boukinda F. and Nervetti G.The ascendancy of hydroceles to the old subject described in the literature[7] was M. A. Keita et al.DOI: 10.4236/ss.2018.912054477 Surgical Science

Figure 1 .
Figure 1.Transillumination is positive at a child's of 2ans.

Figure 2 .
Figure 2. Localization of the hydrocele at the patients.

Table 1 .
5 years with extremes of 2 years and 82 years.The age bracket of 18 years and more represented 81.5%.The patients came outside Kati Age bracket of the patients.