RESUMO
Mesothelioma of the tunica vaginalis testis (MTVT) is a rare tumour and a cause of hydrocele. This case report concerns a 26-year-old male with hydrocele treated with left hydrocelectomy. Histopathology revealed MTVT, and left radical orchiectomy was performed followed by chemotherapy. Fluorescence in situ hybridization, DNA and RNA next-generation sequencing showed no mesothelioma-associated tumour suppressor gene mutations, but deletion of CDKN2A and a rare TFG-ADGRG7 fusion both reported in pleural mesotheliomas, were detected. Clinicians should consider malignancy in case of discrepancy between symptoms and objective findings in scrotal conditions.
Assuntos
Mesotelioma Maligno , Mesotelioma , Hidrocele Testicular , Neoplasias Testiculares , Masculino , Humanos , Adulto , Testículo/patologia , Hibridização in Situ Fluorescente , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/genética , Neoplasias Testiculares/cirurgia , Mesotelioma/diagnóstico , Mesotelioma/genética , Mesotelioma/cirurgia , Mesotelioma Maligno/complicações , Mesotelioma Maligno/patologia , Hidrocele Testicular/complicações , Hidrocele Testicular/patologiaRESUMO
The testis develops in the abdominal cavity and descends into the scrotum. Although numerous theories have been proposed, the mechanism of descent and the reason for its inhibition remain unknown. Furthermore, none of the explanations account for the other occurrences related to the descent, such as failed obliteration of the processus vaginalis, or the reasons for the decrease in fertility and increase in the risk of malignancy associated with an undescended testis. The gubernaculum is a primitive mesenchymal tissue that was first described in 1786. However, the role of the gubernaculum in the descent process remains obscure. The testis descends through the processus vaginalis. Although the processus vaginalis (PV) is usually defined as a simple peritoneal protrusion, it actively develops into the gubernaculum. The gubernaculum gives rise to the smooth muscles that surround the processus vaginalis. The striated cremaster muscle (CM) is also derived from the gubernaculum. Because the testis descends through the processus vaginalis, the muscles develop to propel the testis. After propelling the testis, the smooth muscle (SM) undergoes programmed cell death. The initiation of programmed cell death through the intrinsic pathway requires activation of phospholipase C. A transient shift in the autonomic balance via a decrease in the sympathetic tonus and an increase in the parasympathetic tonus is essential for initiating this programmed cell death. Programmed cell death in the SM is the physiological pathway for the obliteration of the processus vaginalis. Differences in the timing, intensity, or duration of this physiological pathway result in pathological conditions. A shift before testicular descent diminishes the SM content that is required to propel the testis, and thus inhibits descent. The early shift persists throughout childhood and results in the decrease in fertility and increase in the risk of malignancy because of the differences in signal transduction. Despite a successful descent, persistence of the shift alters the contractility of the CM by increasing the cytosolic calcium levels. Contracted CMs retracts or even ascends the testis. Inadequate intensity or duration of the shift of autonomic tonus causes failure of the programmed cell death. Persistence of the SM hinders the obliteration of PV and gives rise to hydroceles or inguinal hernias depending on the amount of residual smooth muscles. Similar findings from different countries support these explanations. Thus, our proposed mechanism satisfactorily explains the process of descent while considering all the factors related to the process of testicular descent.
Assuntos
Criptorquidismo , Neoplasias , Hidrocele Testicular , Masculino , Humanos , Criança , Criptorquidismo/etiologia , Canal Inguinal , Hidrocele Testicular/complicaçõesRESUMO
INTRODUCTION: Hydrocele, an abnormal fluid collection between parietal and visceral layers of the tunica vaginalis, is the commonest cause of scrotal swelling, and it affects all age groups. Calcification of hydrocele sac/wall is a rare clinical entity. The etiology of calcification of hydrocele sac is not clear, but most literature proposes that calcification is secondary to chronic irritation. Trauma and infectious diseases including Schistosoma haematobium, filariasis, and tuberculosis can also cause calcification of the hydrocele sac. CASE PRESENTATION: A 74-year-old Ethiopian male patient presented with left side scrotal swelling of 3 years duration, which was initially small but progressively increased. He had no history of trauma, and he had no history of swelling on the contralateral side. Scrotal ultrasound (US) showed a large echodebrinous left-side scrotal collection with calcifications, bilateral testis appear normal in size, echogenicity, and color Doppler flow with the index of likely chronic hematocele. Therefore, with a diagnosis of left-sided calcified hydrocele, the patient was operated on and the calcified sac was excised and sent for histopathology. Finally, the patient was discharged improved after 2 days of hospital stay. CONCLUSION: Calcification of the tunica vaginalis is very rare and is probably due to chronic irritation of the wall from the coexisting hydrocele. Surgical excision of calcified hydrocele sac is the treatment of choice.
Assuntos
Calcinose , Doenças dos Genitais Masculinos , Hidrocele Testicular , Humanos , Masculino , Animais , Idoso , Casca de Ovo/patologia , Hidrocele Testicular/complicações , Hidrocele Testicular/diagnóstico por imagem , Hidrocele Testicular/cirurgia , Doenças dos Genitais Masculinos/complicações , Escroto/diagnóstico por imagem , Escroto/patologia , Testículo/patologia , Calcinose/complicações , Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Inflamação/complicaçõesRESUMO
INTRODUCTION: Open hydrocelectomy via scrotal incision is the standard approach for secondary hydroceles. Traditionally, the Swiss urologic community offer hydrocelectomy with additional resection of the epididymis in elderly men with completed family planning. It is believed that the additional resection of the epididymis reduces the postoperative recurrence rate of hydroceles. However, there is no evidence supporting this theory. Therefore, the aim of this study was to compare the recurrence and complication rates for patients with secondary hydroceles undergoing either pure hydrocelectomy (puH) or hydrocelectomy with additional resection of the epididymis (HRE). MATERIALS AND METHODS: We reviewed all male patients who underwent surgical therapy for secondary hydroceles between May 2003 and February 2019 at our institution. Patient's baseline and perioperative characteristics as well as postoperative characteristics including complications and recurrence rates were gathered and compared between different surgical techniques. RESULTS: A total of 234 patients were identified. puH was performed in 93 (40%) cases and HRE in 141 (60%) patients. Patients in the HRE group were older (median age: 62 vs. 38 years, p < 0.001), had a higher ASA-Score (p < 0.001), were more often on platelet aggregation inhibitors (19% vs. 7.5%, p = 0.01), and had a longer median operative time (75 vs. 64 min, p < 0.001). During a median follow-up of 46 months, a similar number of recurrent hydroceles were found for puH (7 [7.5%]) and HRE (6 [4.5%]) (p = 0.3). Complications were observed in 19 (20%) cases after puH compared to 25 (18%) cases after HRE (p = 0.6). Patients after puH experienced more often severe complications (Clavien-Dindo Grade 3b) compared to the HRE group (5 vs. 12%, p = 0.046). CONCLUSION: puH and HRE showed similar results in terms of overall low recurrence rates and also in terms of postoperative complications, even though patients who underwent puH experienced slightly higher severe complications. Both procedures are safe and effective, but it seems that HRE does not provide a relevant clinical benefit in comparison to puH for the management of men with secondary hydroceles.
Assuntos
Epididimo , Hidrocele Testicular , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Epididimo/cirurgia , Etnicidade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Hidrocele Testicular/cirurgia , Hidrocele Testicular/complicaçõesRESUMO
Abdominoscrotal hydrocele (ASH) is a variant of hydrocele that rarely occurs in adults. ASH has two sacs, one in the scrotum and one in the abdomen connected through the inguinal canal. Abdominoscrotal haematocele is a rare complication of ASH. We report a 57-year-old male patient who presented to a tertiary care hospital in Puducherry, India, in 2019 with complaints of swelling in the scrotum for 15 years and abdominal pain for two months. Both the swellings were soft and cross fluctuation was present. Imaging confirmed the diagnosis of ASH. During a diagnostic laparoscopy, the abdominal sac was decompressed and found to have thick brownish fluid suggestive of haematocele. It was demonstrated that both sacs were connected. Due to difficulty in the dissection of the sac, the procedure was converted to an open procedure. Both the sacs were excised and Lytle's repair was done for the dilated internal ring. The patient recovered and no recurrence of any swelling in the abdomen or scrotum was found at the end of a one-year follow-up.
Assuntos
Laparoscopia , Hidrocele Testicular , Abdome , Adulto , Edema , Humanos , Masculino , Pessoa de Meia-Idade , Escroto/cirurgia , Hidrocele Testicular/complicações , Hidrocele Testicular/diagnóstico , Hidrocele Testicular/cirurgiaRESUMO
BACKGROUND/AIM: Hydrocele testis is a common disease with a prevalence of 1% in adults. Although it can be diagnosed by physical examination, scrotal ultrasound represents a standard diagnostic tool, to exclude underlying pathologies among them testicular or scrotal malignancies. PATIENTS AND METHODS: We conducted a retrospective analysis of 156 patients aged between 20 and 60 years who underwent surgical hydrocelectomy between 2003 and 2018. Pre-surgical ultrasound, histological results, complications and patients' characteristics were analysed. RESULTS: Malignancies were found in 0% of patients in the pre-surgical ultrasound. Interestingly, we found a higher incidence of hydrocele testis in patients with increasing age and 27% presented with symptoms other than painless enlargement of the scrotum. Among them recurrent pain was the most common. Surgical complications occurred in only 3.2%. CONCLUSION: Testicular cancer is an important differential diagnosis of hydrocele testis. However, in our study no case of incidental testicular cancer or scrotal malignancy was found in the pre-surgical ultrasound.
Assuntos
Escroto/diagnóstico por imagem , Hidrocele Testicular/complicações , Neoplasias Testiculares/etiologia , Ultrassonografia/métodos , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Hidrocele Testicular/patologia , Neoplasias Testiculares/patologia , Adulto JovemRESUMO
PURPOSE: To describe the correlation between acute scrotum pain and tension hydrocele, focusing on US and Doppler features. METHODS AND MATERIALS: We evaluated retrospectively a series of five patients with a long history of hydrocele who were referred to our institutions for increasing acute scrotal pain. Patients were approached with gray scale US of both testes, as well as with color-Doppler and spectral analysis, comparing the results with those after aspiration and symptoms relief. RESULTS: All patients had a "simple" hydrocele with no internal septa; the involved testicles had a "flattened" appearance and parenchymal Doppler signals showed increased intratesticular vascular resistance. One patient had a low diastolic flow, compared to the contralateral testis, with an increased RI value, one had no diastolic flow, two patients had retrograde diastolic flow, and the remaining one had no intratesticular flow visible. After decompression, there were disappearance of pain and improved flow with normalization of testicular vascularity; post-ischemic hyperemia was appreciated in the two patients examined immediately after fluid aspiration, while normal flow was seen in three studies carried out the day after. CONCLUSION: To conclude, tension hydrocele is a rare condition that produces alterations of form and circulation of testicles, increase of intraparenchymal vascular resistances and strong and continuous pain, mimicking a testicular torsion. The increase in pressure produces an effect similar to that observed in a compartment syndrome. US findings, together with clinical assessment, indicate when emergency decompression may be appropriate to relieve testicular ischemia.
Assuntos
Doenças dos Genitais Masculinos , Torção do Cordão Espermático , Hidrocele Testicular , Humanos , Masculino , Estudos Retrospectivos , Escroto/diagnóstico por imagem , Torção do Cordão Espermático/diagnóstico por imagem , Hidrocele Testicular/complicações , Hidrocele Testicular/diagnóstico por imagemRESUMO
PURPOSE: Many trials have been done to make sure probability of metachronous contralateral side hernia (MCH) and contralateral patent processus vaginalis (CPPV). But the necessity of contralateral side exploration is still on debate. The aim is to investigate the risk factors for the consideration of contralateral examination on operation. MATERIALS AND METHODS: The study was designed as retrospectively. Patients with unilateral inguinal hernia from January 2010 to May 2015 were enrolled. Pre-operative ultrasonography was done in all patients. Patients with obvious contralateral side hernia on pre-operative US were excluded. The presence of CPPV was evaluated by transinguinal laparoscopy during the operation. RESULTS: In univariate analysis, hernial sac size only shows difference (P value: 0.001). The others, location of the hernia, age at surgery, gestational age (preterm), low birth weight and parent's age, did not show statistically significant differences. Multivariate analysis also demonstrates CPPV is more common in patients with large hernial sac (Odds ratio: 2.727, 95% confidence interval 1.495-4.974, P value: 0.001). CONCLUSION: We propose that surgeons should consider contralateral evaluation during operation in case with large ipsilateral hernial sac, although CPPV was not detected by pre-operative US.
Assuntos
Hérnia Inguinal/complicações , Cuidados Intraoperatórios/métodos , Laparoscopia , Hidrocele Testicular/complicações , Hidrocele Testicular/diagnóstico , Adolescente , Criança , Pré-Escolar , Hérnia Inguinal/cirurgia , Humanos , Lactente , Masculino , Razão de Chances , Cuidados Pré-Operatórios , República da Coreia , Estudos Retrospectivos , Fatores de Risco , Hidrocele Testicular/cirurgia , UltrassonografiaRESUMO
BACKGROUND: The management of contralateral patent processus vaginalis (CPPV) in children with unilateral inguinal hernia is still controversial. The objective of this study was to verify the relationship between metachronous contralateral inguinal hernia (MCIH) and CPPV, and the risk factors of MCIH. METHODS: Children with unilateral inguinal hernia from three medical centers underwent either open or laparoscopic repairs. Clinical information, including demographics, morphological characteristics of CPPV, follow-up outcomes were collected. RESULTS: Among 2942 patients (92.2%) who received open repair with successful follow-up, 185 (6.29%) developed MCIHs [125 (10.9%) on the right side and 60 (3.3%)] on the left including 156 (7.07%) younger than 3 years old and 29 (3.94%) older than 3 years old. Patients younger than 3 years old with primary left inguinal hernias more easily develop MCIHs and the difference is statistically significant. Among 5370 patients (96.0%) who received laparoscopic repair with successful follow-up, the morphology of ipsilateral patent processus vaginalis were cavernous type in 5318 (99%) and 52 (1%) were fissure type. CPPVs were identified in 2233 (41.5%) cases [1256 (35.01%) on the left side and 977 (54.80%) on the right side, P < 0.001]; 1503 cases were cavernous type (1276 cases younger than 3 years old and 227 cases older than 3 years old) and 730 cases were fissure type (422 cases younger than 3 years old and 308 cases older than 3 years old). The probability of occurence of cavernous type and CPPV in children younger than 3 years old was higher than that in children older than 3 years old. CONCLUSIONS: Not all CPPVS progress into an MIH, and approximate one of 15 CPPVs would progress into MIH. If patient with initial left-sided inguinal hernia is younger than 3 years old, when the morphology of CPPV is cavernous type identified by laparoscopic exploration, the contralateral repair would be recommended.
Assuntos
Hérnia Inguinal/complicações , Hidrocele Testicular/complicações , Criança , Pré-Escolar , Feminino , Hérnia Inguinal/patologia , Hérnia Inguinal/cirurgia , Humanos , Incidência , Laparoscopia , Masculino , Doenças Peritoneais/complicações , Fatores de Risco , Hidrocele Testicular/patologia , Hidrocele Testicular/cirurgiaAssuntos
Abscesso Abdominal/diagnóstico por imagem , Edema/etiologia , Dor/etiologia , Escroto/patologia , Hidrocele Testicular/diagnóstico por imagem , Abscesso Abdominal/complicações , Abscesso Abdominal/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Edema/diagnóstico por imagem , Serviço Hospitalar de Emergência , Humanos , Masculino , Escroto/diagnóstico por imagem , Hidrocele Testicular/complicações , Hidrocele Testicular/tratamento farmacológico , Hidrocele Testicular/patologia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Paratesticular mesothelioma is a rare differential diagnosis in the presence of scrotal hydrocele. A 17-year-old boy presented with a 3-year history of progressive hydrocele. Sonography revealed a large left paratesticular mass within the hydrocele. Serum tumor markers were negative. Left hydrocelectomy was performed and pathological analysis of the epididymal mass revealed a well-differentiated papillary mesothelioma. We discuss the sonographic and pathological findings of this rare neoplasm.
Assuntos
Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Mesotelioma/complicações , Mesotelioma/diagnóstico por imagem , Infecções por Papillomavirus/diagnóstico , Neoplasias Testiculares/complicações , Neoplasias Testiculares/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Biópsia , Diagnóstico Diferencial , Diatermia , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Mesotelioma/cirurgia , Mesotelioma Maligno , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/terapia , Hidrocele Testicular/complicações , Hidrocele Testicular/diagnóstico por imagem , Hidrocele Testicular/cirurgia , Neoplasias Testiculares/cirurgia , Testículo/diagnóstico por imagem , Testículo/cirurgia , Testículo/virologiaRESUMO
Papillary cystadenoma of the epididymis (PCE) is a rare benign epithelial tumor remarkable for its association with von Hippel-Lindau disease. A 12-year-old boy consulted for a progressive enlargement of the left testicle. At time of surgery, the whole epididymis was enlarged. Pathologic diagnosis was PCE with a focus on borderline malignancy. Scrotal left epididymectomy was performed. von Hippel-Lindau disease screening was negative. No relapse has been detected 2 years later. In case of atypical clinical examination of a hydrocele, unusual presentations such as PCE should be considered. The main differential diagnoses were adenomatoid tumor, nonpapillary cystadenoma, and metastatic clear cell renal carcinoma.
Assuntos
Cistadenoma Papilar/complicações , Epididimo , Neoplasias dos Genitais Masculinos/complicações , Hidrocele Testicular/complicações , Criança , Cistadenoma Papilar/diagnóstico , Cistadenoma Papilar/cirurgia , Neoplasias dos Genitais Masculinos/diagnóstico , Neoplasias dos Genitais Masculinos/cirurgia , Humanos , MasculinoRESUMO
BACKGROUND: Lymphatic filariasis (LF) is best known for the disabling and disfiguring clinical conditions that infected patients can develop; providing care for these individuals is a major goal of the Global Programme to Eliminate LF. Methods of locating these patients, knowing their true number and thus providing care for them, remains a challenge for national medical systems, particularly when the endemic zone is a large urban area. METHODOLOGY/PRINCIPLE FINDINGS: A health community-led door-to-door survey approach using the SMS reporting tool MeasureSMS-Morbidity was used to rapidly collate and monitor data on LF patients in real-time (location, sex, age, clinical condition) in Dar es Salaam, Tanzania. Each stage of the phased study carried out in the three urban districts of city consisted of a training period, a patient identification and reporting period, and a data verification period, with refinements to the system being made after each phase. A total of 6889 patients were reported (133.6 per 100,000 population), of which 4169 were reported to have hydrocoele (80.9 per 100,000), 2251 lymphoedema-elephantiasis (LE) (43.7 per 100,000) and 469 with both conditions (9.1 per 100,000). Kinondoni had the highest number of reported patients in absolute terms (2846, 138.9 per 100,000), followed by Temeke (2550, 157.3 per 100,000) and Ilala (1493, 100.5 per 100,000). The number of hydrocoele patients was almost twice that of LE in all three districts. Severe LE patients accounted for approximately a quarter (26.9%) of those reported, with the number of acute attacks increasing with reported LE severity (1.34 in mild cases, 1.78 in moderate cases, 2.52 in severe). Verification checks supported these findings. CONCLUSIONS/SIGNIFICANCE: This system of identifying, recording and mapping patients affected by LF greatly assists in planning, locating and prioritising, as well as initiating, appropriate morbidity management and disability prevention (MMDP) activities. The approach is a feasible framework that could be used in other large urban environments in the LF endemic areas.
Assuntos
Filariose Linfática/epidemiologia , Pessoal de Saúde/educação , Telemedicina/métodos , Hidrocele Testicular/epidemiologia , Envio de Mensagens de Texto/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Filariose Linfática/complicações , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Morbidade , Índice de Gravidade de Doença , Inquéritos e Questionários , Tanzânia/epidemiologia , Hidrocele Testicular/complicações , População Urbana , Adulto JovemRESUMO
BACKGROUND: Single-site laparoscopic percutaneous extraperitoneal closure (SLPEC) of hernia sac/processus vaginalis has been widely performed for repair of inguinal hernia/hydrocele in children. However, a variety of surgical instruments and techniques were used, and significant differences existed among the SLPEC reports. METHODS: A literature search was performed for all available studies concerning SLPEC for pediatric inguinal hernia/hydrocele in PubMed, Embase and Cochrane library. The surgical details and operative outcomes were pooled and analyzed with software StataSE 12.0. RESULTS: 49 studies fulfilled the predefined inclusion criteria of this review and 37 studies were finally included in the meta-analysis. The mean incidence of CPPV was 29.1% (range 5.73-43.0%). The average of mean operative time was 19.56 min (range 8.30-41.19 min) for unilateral SLPEC and 27.23 min (range 12.80-48.19 min) for bilateral SLPEC. The total incidence of injury, conversion, recurrence, hydrocele formation, knot reaction, severe pain, and scrotal swelling was 0.32% (range 0-3.24%), 0.05% (range 0-0.89%), 0.70% (range 0-15.5%), 0.23% (range 0-3.57%), 0.33% (range 0-3.33%), 0.05% (range 0-4.55%), and 0.03% (range 0-1.52%), respectively. There was no development of testicular atrophy. Subgroup analyses showed an inverse correlation between the injury incidence and adoption of assisted forceps, hydrodissection, and blunt puncture device, between the conversion rate and adoption of hydrodissection, between the recurrence/hydrocele incidence and adoption of assisted forceps, hydrodissection, nonabsorbable suture and the preventive measures to avoid ligating the unnecessary subcutaneous tissues, and between the rate of knot reaction and adoption of assisted forceps, hydrodissection, and the preventive measures. CONCLUSIONS: SLPEC was a well-developed procedure for repair of pediatric inguinal hernia/hydrocele. Adoption of assisted forceps, hydrodissection, nonabsorbable suture, and the preventive measures to avoid ligating the unnecessary subcutaneous tissues could significantly reduce the intra- and postoperative complications.
Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Hidrocele Testicular/cirurgia , Hérnia Inguinal/complicações , Herniorrafia/instrumentação , Humanos , Laparoscopia/instrumentação , Masculino , Peritônio/cirurgia , Hidrocele Testicular/complicações , Resultado do TratamentoRESUMO
We report a case of metachronous bilateral testicular tumors combined with hydrocele. A 46-year-old male presented with frequently recurrent left hydrocele. His medical history included a stage IIA right testicular tumor,which had been treated with right high orchiectomy and retroperitoneal lymph node dissection 22 years ago. Magnetic resonance imaging (MRI) showed hydrocele and a low intensity area in the left testis,and the patient underwent left high orchiectomy. After cytological examination of the hydrocele it was categorized as class V,and after a pathological study it was diagnosed as seminoma and embryonal carcinoma. Since postoperative computed tomography showed lung metastasis,treatment with bleomycin,etoposide,and cisplatin (BEP) was indicated. Three courses of BEP produced a complete response. No recurrent testicular tumor was seen at 3 months after the BEP therapy. A metachronous testicular tumor should be considered in patients with a history of testicular tumors who frequently develop recurrent hydrocele.
Assuntos
Hidrocele Testicular/cirurgia , Neoplasias Testiculares/diagnóstico por imagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Humanos , Neoplasias Pulmonares/secundário , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Orquiectomia , Recidiva , Hidrocele Testicular/complicações , Neoplasias Testiculares/complicações , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/cirurgiaRESUMO
The surgical repair of inguinal hernia and hydrocele is one of the most common operations performed in pediatric surgery practice. This article reviews current concepts in the management of inguinal hernia and hydrocele based on the recent literature and the authors׳ experience. We describe the principles of clinical assessment and anesthetic management of children undergoing repair of inguinal hernia, underlining the differences between an inguinal approach and minimally invasive surgery (MIS). Other points discussed include the current management of particular aspects of these pathologies such as bilateral hernias; contralateral patency of the peritoneal processus vaginalis; hernias in premature infants; direct, femoral, and other rare hernias; and the management of incarcerated or recurrent hernias. In addition, the authors discuss the role of laparoscopy in the surgical treatment of an inguinal hernia and hydrocele, emphasizing that the current use of MIS in pediatric patients has completely changed the management of pediatric inguinal hernias.
Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia , Hidrocele Testicular/cirurgia , Criança , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico , Humanos , Masculino , Hidrocele Testicular/complicações , Hidrocele Testicular/diagnósticoRESUMO
OBJECTIVES: To assess the incidence of anatomical anomalies in patients with retractile testis. MATERIALS AND METHODS: We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p<0.05). RESULTS: The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116). CONCLUSIONS: Retractile testis is not a normal variant with a significant risk of patent processos vaginalis and epididymal anomalies.
Assuntos
Criptorquidismo/complicações , Epididimo/anormalidades , Feto/embriologia , Hidrocele Testicular/complicações , Testículo/anormalidades , Criança , Pré-Escolar , Criptorquidismo/embriologia , Criptorquidismo/cirurgia , Epididimo/cirurgia , Idade Gestacional , Humanos , Lactente , Masculino , Estudos Prospectivos , Hidrocele Testicular/cirurgia , Testículo/embriologiaRESUMO
ABSTRACT Objectives: To assess the incidence of anatomical anomalies in patients with retractile testis. Materials and Methods: We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p <0.05). Results: The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116). Conclusions: Retractile testis is not a normal variant with a significant risk of patent processus vaginalis and epididymal anomalies.
Assuntos
Humanos , Masculino , Lactente , Pré-Escolar , Criança , Testículo/anormalidades , Criptorquidismo/complicações , Epididimo/anormalidades , Feto/embriologia , Hidrocele Testicular/complicações , Testículo/embriologia , Estudos Prospectivos , Idade Gestacional , Criptorquidismo/cirurgia , Criptorquidismo/embriologia , Epididimo/cirurgia , Hidrocele Testicular/cirurgiaRESUMO
BACKGROUND: Abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by a fluid-filled mass with inguinoscrotal and abdominal components. Controversy exists regarding the best management. We conducted a systematic review of the literature with special interest in presentation, management and outcomes. METHODS: A search was conducted of the MEDLINE/PubMed, Embase, Ovid, Web of Science and Scopus databases. Two authors independently extracted data and assessed the risk of bias in each study. RESULTS: We found 18 case series that met selection criteria, describing 116 patients with 146 hydroceles. Unilateral ASH was found in 59% of cases with almost even distribution between left and right-sided hydroceles. Ipsilateral undescended testicle, testicular dysmorphism, and contralateral pathology (inguinal hernia) often accompanied ASH. Management was always surgical. The most common approaches were inguinal (67.2%), combined laparoscopic + inguinal (11.2%), and scrotal (10.3%). Complications were poorly reported, but were generally minor. There were a decreased number of complications with the scrotal approach because of avoidance of a difficult inguinal dissection. CONCLUSIONS: ASH is a rare entity treated most commonly via an inguinal approach. However, consideration should be given to combining with an extraperitoneal or laparoscopic approach given coexisting pathology, or to the scrotal approach for reducing morbidity.
Assuntos
Hidrocele Testicular , Abdome , Humanos , Laparoscopia , Masculino , Complicações Pós-Operatórias , Escroto/cirurgia , Hidrocele Testicular/complicações , Hidrocele Testicular/diagnóstico , Hidrocele Testicular/patologia , Hidrocele Testicular/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: microRNAs (miRs)-371-3 are suggested to be novel biomarkers of germ cell tumors (GCTs), but their specificity is unresolved. We aimed at clarifying the origin of miR 371a-3p by measuring this miR in peripheral vein blood, and in fluids present in the vicinity of GCTs. METHODS: miR-371a-3p levels were measured by quantitative PCR in 9 tumor surrounding hydroceles and in cubital vein blood (CVB) and testicular vein blood (TVB) of 64 GCT patients, 51 with clinical stage (CS) 1, 13 with CS2-3. Thirty three CS1 cases had also postoperative CVB measurement. TVB miR levels were compared with those of CVB. Associations with clinical factors were analyzed statistically. RESULTS: TVB miR levels were 294-fold, 80-fold and 4.6-fold higher than those in CVB of CS1 patients, CS2-3 patients and controls, respectively. Neoplastic hydrocele fluid comprised of very high miR levels. In CS1, miR levels dropped to normal postoperatively. Statistically, CVB miR levels are significantly associated with tumor size (p = 0.0211) and testis length (p = 0.0493). TVB miR levels are associated with testis length (p = 0.0129). CONCLUSIONS: This study provides evidence for the origin of circulating miR 371a-3p molecules from GCT cells. miR-371a-3p represents a specific serum biomarker for germ cell cancer.