title: Surgical management of morbidity due to lymphatic filariasis: the usefulness of a standardized international clinical classification of hydroceles.
abstract: The objective of this work is to evaluate the usefulness of a standardized clinical   classification of hydroceles in lymphatic filariasis endemic countries to guide their surgical   management. 64 patients with hydroceles were operated in 2009-2010, in Level II hospitals   (WHO classification), during two visits to Fiji, by the same mobile surgical team. The number   of hydroceles treated was 83. We developed and evaluated a much needed clinical   classification of hydroceles based on four criteria: Type (uni/bilateral); Side (left/right); Stage   of enlargement of the scrotum rated from I to VI; Grade of burial of the penis rated from 0 to   4. It lead to the conclusion that 1) A Stage I or II hydrocele, associated with Grade 0 or 1 penis   burial could be considered a "Simple Hydrocele". The surgical treatment is simple with no   anticipated early complication. WHO Level II of health care structure seems adapted. 2) A   Stage III or IV hydrocele associated with Grade 2, 3 or 4 penis burial could be considered a   "Complicated Hydrocele". The operation is longer, more complicated and the possibility of   occurrence of complications seems greater. A level III health care facility would be more   adapted under the normal functioning of the health system. We conclude that a standardized   clinical classification of hydroceles based on the Stage of enlargement of the scrotum and   the Grade of burial of the penis appears to be a useful tool to guide the decision about the   level of care and the surgical technique required. We use the same classification for penoscrotal   lymphoedema. A decision tree is presented for the management of hydroceles in   lymphatic filariasis endemic countries which could usefully complement the "Algorithm for   management of scrotal swelling" proposed by WHO in 2002. An international classification   system of hydroceles would also allow standardization and facilitate study design and   comparisons of their results.
authors.affiliation: Ministry of Health, 88 Amy street, PO Box 2223, Government Buildings, Suva, Fiji. capuanop@gmail.com
authors.forename: G P
authors.initials: GP
authors.lastname: Capuano
authors.forename: C
authors.initials: C
authors.lastname: Capuano
mesh_terms: D000293:Adolescent; D000328:Adult; D004605:Elephantiasis, Filarial / Q000473:pathology* / Q000601:surgery*; D005367:Fiji; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D006848:Testicular Hydrocele / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult