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1.
Medicine (Baltimore) ; 99(18): e19738, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358347

RESUMO

RATIONALE: Scrotal swelling is a rare complication of acute pancreatitis. It had been explained by fluid accumulation in scrotum originated from abdomen. Here we demonstrated a case of recurrent pancreatitis with hydrocele caused by impaired testicular venous drainage. PATIENT CONCERNS: A 53-year-old man presented with sudden onset epigastric pain after an alcohol binge. Recurrent acute pancreatitis was confirmed by medical history, physical examination, elevated lipase level and abdominal computed tomography (CT) scan. Right scrotal swelling was noticed on the next day. DIAGNOSIS: The scrotal ultrasonography demonstrated fluid accumulation around the testis and varicocele consistent with scrotal hydrocele. CT scans of the abdomen and pelvis showed encasement of the right testicular vein by pancreatic phlegmon. INTERVENTIONS: The patient was subject to Nulla per os, hydration, and opioid analgesics for pancreatitis. No intervention was performed for scrotal swelling. OUTCOMES: Hydrocele gradually resolved along with acute pancreatitis. LESSONS: Pancreatic phlegmon compromised testicular venous return which led to scrotal hydrocele and posed a threat to fertility. The study has provided a novel pathologic linkage. This complication should be taken into account.


Assuntos
Pancreatite/etiologia , Hidrocele Testicular/etiologia , Testículo/irrigação sanguínea , Doenças Vasculares/complicações , Doença Aguda , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva
2.
Anticancer Res ; 40(5): 2861-2864, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366435

RESUMO

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 Jovem
4.
PLoS Negl Trop Dis ; 14(3): e0008003, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32210436

RESUMO

BACKGROUND: Lymphatic filariasis (LF) is endemic in 72 countries of Africa, Asia, Oceania, and the Americas. An estimated 25 million men live with the disabling effects of filarial hydrocele. Hydrocele can be corrected with surgery with few complications. For most men, hydrocelectomy reduces or corrects filarial hydrocele and permits them to resume regular activities of daily living and gainful employment. METHODOLOGY AND PRINCIPAL FINDINGS: This study measures the economic loss due to filarial hydrocele and the benefits of hydrocelectomy and is based on pre- and post-operative surveys of patients in southern Malawi. We find the average number of days of work lost due to filarial hydrocele and daily earnings for men in rural Malawi. We calculate average annual lost earnings and find the present discounted value for all years from the time of surgery to the end of working life. We estimate the total costs of surgery. We compare the benefit of the work capacity restored to the costs of surgery to determine the benefit-cost ratio. For men younger than 65 years old, the average annual earnings loss attributed to hydrocele is US$126. The average discounted present value of lifetime earnings loss for those men is US$1684. The average budgetary cost of the hydrocelectomy is US$68. The ratio of the benefit of surgery to its costs is US$1684/US$68 or 24.8. Sensitivity analysis demonstrates that the results are robust to variations in cost of surgery and length of working life. CONCLUSION: The lifetime benefits of hydrocelectomy-to the man, his family, and his community-far exceed the costs of repairing the hydrocele. Scaling up subsidies to hydrocelectomy campaigns should be a priority for governments and international aid organizations to prevent and alleviate disability and lost earnings that aggravate poverty among the many millions of men with filarial hydrocele.


Assuntos
Filariose Linfática/complicações , Utilização de Procedimentos e Técnicas/economia , Procedimentos Cirúrgicos Operatórios/economia , Hidrocele Testicular/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Humanos , Malaui , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
5.
FP Essent ; 488: 16-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31894951

RESUMO

In children, inguinal hernias, hydroceles, and cryptorchidism typically are associated with a patent processus vaginalis. Inguinal hernias occur in 3.5%-5% of full-term newborns and 9%-11% of premature newborns. Inguinal hernias are characterized by an intermittent mass in the groin that may be reducible or incarcerated. Incarcerated hernias usually are painful, can cause vomiting, and require prompt intervention. The definitive treatment is surgery, and urgency depends on symptoms and ability to reduce the hernia. Hydrocele is an accumulation of serous fluid in the tunica vaginalis around the testicle that presents as a painless, fluctuant mass. Most hydroceles resolve spontaneously by age 1 year. Cryptorchidism occurs when one or both testes do not migrate to the scrotum. The diagnosis is made via history and physical examination. Spontaneous descent of the testis may occur before age 6 months but referral to a surgical subspecialist is indicated if descent does not occur.


Assuntos
Criptorquidismo , Hérnia Inguinal , Hidrocele Testicular , Criança , Humanos , Lactente , Recém-Nascido , Masculino
6.
Urology ; 135: 159-164, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31626858

RESUMO

OBJECTIVE: To describe a minimal-incision modified fenestration technique (MIMFeT) for symptomatic hydroceles utilizing local anesthesia. METHODS: A database was maintained for men undergoing in-office MIMFeT for symptomatic hydroceles between June 2015 and August 2018. Following local anesthesia, the hydrocele was sequentially everted through a small upper hemiscrotal incision, excised, and oversewn without delivering the testicle through the wound. Patient demographics and clinical outcomes were subsequently reviewed. RESULTS: A total of 54 men (median age 67) underwent MIMFeT under local anesthesia for symptomatic hydrocele. Median estimated hydrocele size was 250 mL (IQR 150;500). Medical comorbidities included coronary artery disease (12%), hypertension (43%), diabetes (13%), and current antiplatelet or anticoagulant (44%) use. Six patients (11%) were deemed unsafe for monitored or general anesthesia. About 48 patients had follow-up data available (median 9 months; IQR 2-18). Mild recurrent scrotal swelling occurred in 4 patients (8%) and 9/48 (18%) experienced postoperative complications including hematoma (n = 2), prolonged pain (n = 3), wound infection (n = 2), and partial incisional separation (n = 2). No patient required repeat hydrocelectomy. CONCLUSION: Our early results suggest that the MIMFeT for management of symptomatic hydroceles can be safely performed in the office setting under local anesthesia, including in those patients who are determined to be unsafe for monitored and general anesthesia.


Assuntos
Anestesia Local , Complicações Pós-Operatórias/epidemiologia , Escroto/cirurgia , Hidrocele Testicular/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Idoso , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Técnicas de Sutura , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
7.
Hinyokika Kiyo ; 65(9): 389-392, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31697883

RESUMO

A 53-year-old man visited a doctor due to left inguinal enlargement. He was diagnosed with left inguinal hernia with omentum as the content by a computed tomography (CT)scan. He underwent open inguinal hernia repair ; however, an inguinal tumor was diagnosed intraoperatively and was resected as much as possible. Although the tumor resection was macroscopically incomplete, he was followed up without any treatment because the tumor was histologically diagnosed as lipoma. Sixteen months after surgery, a 15 cm inguinal mass and a 7 cm left intrascrotal mass were detected by follow-up CT, and he was referred to our hospital. He underwent open surgery for wide excision of the tumor with a diagnosis of spermatic cord liposarcoma and left hydrocele of testis. The spermatic cord tumor was histologically diagnosed as well differentiated liposarcoma. He has been alive without recurrence for more than 10 months after surgery. It is sometimes difficult to distinguish a spermatic cord liposarcoma from inguinal hernia by imaging examinations.


Assuntos
Neoplasias dos Genitais Masculinos , Hérnia Inguinal , Lipossarcoma , Cordão Espermático , Hidrocele Testicular , Diagnóstico Diferencial , Neoplasias dos Genitais Masculinos/diagnóstico , Hérnia Inguinal/diagnóstico , Humanos , Lipossarcoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
8.
PLoS Negl Trop Dis ; 13(7): e0007542, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31306409

RESUMO

BACKGROUND: The Bangladesh Lymphatic Filariasis (LF) Elimination Programme has made significant progress in interrupting transmission through mass drug administration (MDA) and has now focussed its efforts on scaling up managing morbidity and preventing disability (MMDP) activities to deliver the minimum package of care to people affected by LF clinical conditions. This paper highlights the Bangladesh LF Programme's success in conducting a large-scale cross-sectional survey to determine the number of people affected by lymphoedema and hydrocoele, which enabled clinical risk maps to be developed for targeted interventions across the 34 endemic districts (19 high endemic; 15 low endemic). METHODOLOGY/PRINCIPAL FINDINGS: In the 19 high endemic districts, 8,145 community clinic staff were trained to identify and report patients in their catchment area. In the 15 low endemic districts, a team of 10 trained field assistants conducted active case finding with cases reported via a SMS mHealth tool. Disease burden and prevalence maps were developed, with morbidity hotspots identified at sub-district level based on a combination of the highest prevalence rates per 100,000 and case-density rates per square kilometre (km2). The relationship between morbidity and baseline microfilaria (mf) prevalence was also examined. In total 43,678 cases were identified in the 19 high endemic districts; 30,616 limb lymphoedema (70.1%; female 55.3%), 12,824 hydrocoele (29.4%), and 238 breast/female genital swelling (0.5%). Rangpur Division reported the highest cases numbers and prevalence of lymphoedema (26,781 cases, 195 per 100,000) and hydrocoele (11661 cases, 169.6 per 100,000), with lymphoedema predominately affecting females (n = 21,652). Rangpur and Lalmonirhat Districts reported the highest case numbers (n = 11,199), and prevalence (569 per 100,000) respectively, with five overlapping lymphoedema and hydrocoele sub-district hotspots. In the 15 low endemic districts, 732 cases were identified; 661 lymphoedema (90.2%; female 39.6%), 56 hydrocoele (7.8%), and 15 both conditions (2.0%). Spearman's correlation analysis found morbidity and mf prevalence significantly positively correlated (r = 0.904; p<0.01). CONCLUSIONS/SIGNIFICANCE: The Bangladesh LF Programme has developed one of the largest, most comprehensive country databases on LF clinical conditions in the world. It provides an essential database for health workers to identify local morbidity hotspots, deliver the minimum package of care, and address the dossier elimination requirements.


Assuntos
Sistemas de Gerenciamento de Base de Dados , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Filariose Linfática/terapia , Objetivos , Animais , Bangladesh/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Análise de Dados , Gerenciamento de Dados , Doenças Endêmicas , Feminino , Pessoal de Saúde/educação , Humanos , Linfedema/epidemiologia , Masculino , Administração Massiva de Medicamentos , Microfilárias , Morbidade , Prevalência , Telemedicina/métodos , Hidrocele Testicular/epidemiologia
9.
Urology ; 132: e5-e7, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31233817

RESUMO

Acute pancreatitis is a common diagnosis. Although extremely rare, extravasated pancreatic fluid has the potential to third space into the peritoneal cavity or retroperitoneal space. We report the case of a 33-year-old male with idiopathic subacute pancreatitis who developed acute scrotal pain and swelling. Computer tomography of the abdomen/pelvis revealed tracking of peritoneal fluid into the scrotum consistent with a pancreatic hydrocele, confirmed by ultrasound. He was taken to the operating room for exploration and evacuation of the scrotal hydrocele. This case highlights the importance of active surveillance for the potential development of a scrotal hydrocele in acute pancreatitis.


Assuntos
Pancreatite/complicações , Hidrocele Testicular/etiologia , Adulto , Humanos , Masculino
10.
Hernia ; 23(6): 1279-1289, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31129795

RESUMO

BACKGROUND: Congenital inguinal hernia (CIH) is a commonly performed surgical procedure in infants and children. Single port laparoscopic hernia repair using percutaneous internal inguinal ring (IIR) suturing procedure is a widely employed technique for indirect inguinal hernia repair in children. The majority of extracorporeal techniques use extracorporeal knotting and burying the knot subcutaneously. This may result in many drawbacks. The aim of this multicenter study is to introduce a new technique for pediatric inguinal hernia repair using only needles without any laparoscopic instruments. PATIENTS AND METHODS: This is a multicenter study which was conducted at Pediatric Surgical Departments of Al-Azhar, Mansoura, Alexandria and Tanta Universities during the period from January 2015 to June 2017. 314 patients with CIH underwent Needlescopic Assisted Internal Ring Suturing (NAIRS) after cauterization of the hernia sac at its neck. The main outcome measures were: feasibility, safety of the technique, operative time, recurrence rate, hydrocele and cosmetic results. RESULTS: A total of 314 patients with CIH were corrected by NAIRS. They were 232 males and 82 females. The mean age was 28.12 ± 1.3 months (range 6-120 months). The mean operative time was 12.6 ± 1.7 min (range 8-15 min) for unilateral cases and 18.6 ± 1.7 min (range 14-20 min) for the bilateral repairs. All cases were completed laparoscopically without major intraoperative complications. No recurrence was detected in this study. No wound complications or umbilical hernias developed. Hydrocele occurred in five males (2.16%), without detection of testicular atrophy or iatrogenic ascent of the testis. CONCLUSION: This preliminary study showed that NAIRS after cauterization of the neck of the hernia sac in infants and children is safe, feasible, reproducible with excellent cosmetic results.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Canal Inguinal/cirurgia , Laparoscopia/métodos , Criança , Pré-Escolar , Feminino , Hérnia Inguinal/congênito , Herniorrafia/instrumentação , Humanos , Lactente , Laparoscopia/instrumentação , Masculino , Estudos Prospectivos , Técnicas de Sutura , Hidrocele Testicular/cirurgia
11.
Scand J Urol ; 53(2-3): 134-138, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30990342

RESUMO

Objectives: To estimate the incidence of men seeking specialized care and receiving treatment for hydro or spermatocele complaints. Also, to determine the risk of complications of treatment. Materials and methods: The total number of men living in Sweden each year from 2005 to 2014 was used to calculate incidence and age distribution of adult (≥18 years) men seeking specialized healthcare with either hydro or spermatocele. This was done by using nationwide registries, mandatory by law. They contain information on primary or discharge diagnosis, procedure codes and antibiotic prescriptions. Also, complication rates comparing aspiration (with or without sclerotherapy) and conventional surgery were analysed. Results: The incidence of men with either hydro or spermatocele diagnosis in specialized healthcare was ∼100/100,000 men. The treatment incidence was 17/100,000 men. Orchiectomy was used as primary treatment in 2.4% of cases. The risk of experiencing a complication was clinically and statistically significantly increased with conventional surgery as compared with aspiration, 17.5% (1607/9174) vs 4.6% (181/3920), corresponding to relative risk of 3.79 (95% CI = 3.27-4.40). Hematoma and infections were the most common complications. Conclusion: Hydro and spermatoceles are common, affecting elderly men. Aspiration seems advantageous with respect to complications and can be recommended due to the benign course of the disease. The indication for conventional surgery might be questioned such as the use of orchiectomy as primary treatment.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Espermatocele/epidemiologia , Hidrocele Testicular/epidemiologia , Procedimentos Cirúrgicos Urológicos Masculinos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Hematoma/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Orquiectomia , Paracentese , Escleroterapia , Espermatocele/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Suécia/epidemiologia , Hidrocele Testicular/cirurgia , Adulto Jovem
12.
Hernia ; 23(6): 1253-1259, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31004237

RESUMO

BACKGROUND: Open herniotomy has been the gold standard of pediatric hernia treatment with the advantages of simplicity in surgical technique, fast post operative recovery, and minimal recurrence rate, but its inability to prevent hernia development from a contralateral patent processus vaginalis (PPV) after a unilateral herniotomy is its major drawback. By contrast, laparoscopic hernia repair has the advantage of contralateral internal ring inspection, and, therefore, has become popular in recent years, although open herniotomy is still the favorable surgical technique among many surgeons. A simple and reliable tool to detect contralateral PPV will be valuable to surgeons who practice conventional open hernia surgery on children, although ultrasound has been applied for this purpose, but there is no long-term data to support such application. METHOD: The author performed a preoperative ultrasound on the contralateral groins of children undergoing unilateral herniotomy or PPV ligation. If the ultrasound showed no evidence of contralateral PPV, no contralateral surgery was performed. Those patients were then followed up after a long period of time to see whether contralateral hernia or hydrocele was developed or not. RESULTS: 322 pediatric patients were studied from 2006 to 2012. In 96 of the cases (30%), contralateral PPV were identified with ultrasound, and 95% of which were affirmed intraoperatively. In the remaining 226 patients who were without evidence of contralateral PPV, only unilateral surgeries were offered. One of these patients later developed contralateral hernia and required another surgery. The remaining patients were phoned up after a median period of 9 years. 114 of them could be contacted and none of them had developed contralateral hernia or hydrocele. CONCLUSIONS: Ultrasound groin is a valuable tool as an adjunct in pediatric hernia management by detecting contralateral PPV with high accuracy. Surgeon can offer unilateral or bilateral hernia surgery according to the ultrasound finding, and the incidence of contralateral hernia development is negligible. Preoperative ultrasound groin with selective contralateral PPV closure in children can be an alternative to routine laparoscopic hernia repair in avoiding contralateral hernia or hydrocele development. LEVEL OF EVIDENCE: Level 3. TYPE OF STUDY: Retrospective study.


Assuntos
Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/cirurgia , Doenças Peritoneais/diagnóstico por imagem , Doenças Peritoneais/cirurgia , Hidrocele Testicular/diagnóstico por imagem , Hidrocele Testicular/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Herniorrafia/métodos , Humanos , Lactente , Recém-Nascido , Laparoscopia , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Ultrassonografia
13.
Hernia ; 23(6): 1267-1273, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30993474

RESUMO

OBJECTIVE: The aim of this study is to evaluate the surgical outcomes of single-port laparoscopic percutaneous extraperitoneal closure of inguinal hernia using "two-hooked" core needle apparatus in children. METHODS: This study was conducted at Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine between January 2016 and June 2018. Five hundred and eighteen patients under the age of 12 years with inguinal hernias were subjected to single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC) using non-absorbable suture by "two-hooked" core needle apparatus. Description of the technique is as follows: Under general anesthesia, a 0.5-0.8 cm trans-umbilical skin incision was done for insertion of a 0.5 cm port. A "two-hooked" core needle apparatus was used for insertion of a non-absorbable suture around internal ring. The suture knot was tied extracorporeally. RESULTS: Among 518 child patients with inguinal hernias, there were 406 males and 112 females with a mean age of 4.6 ± 3.5 years. One hundred and six cases were subjected to bilateral surgery including 91 cases of contralateral patent processus vaginalis (PPV). Three cases converted to open surgery and additional 0.5 cm port was done in five cases. The mean operative time was 13.2 ± 3.5 min for unilateral hernia repair and 16.9 ± 4.6 min for bilateral cases. All patients achieved full recovery without complications such as surgical site infection (SSI), testicular atrophy, or iatrogenic ascent of the testis. At the mean follow-up time of 18.72 ± 5.27 months, two cases had recurrences (0.39%) and one case had postoperative hydrocele (0.19%). CONCLUSION: SPLPEC of inguinal hernia using "two-hooked" core needle apparatus in children is a feasible and reliable minimal invasive procedure. It has the advantages of short operating time, low complication rate, low recurrence rate and better cosmetic result.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/instrumentação , Laparoscopia/métodos , Peritônio/cirurgia , Hidrocele Testicular/cirurgia , Criança , Pré-Escolar , Feminino , Herniorrafia/métodos , Humanos , Lactente , Masculino , Agulhas , Estudos Retrospectivos
14.
J Surg Res ; 241: 57-62, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31009886

RESUMO

INTRODUCTION: Nonmedical opioid use is a major public health problem. There is little standardization in opioid-prescribing practices for pediatric ambulatory surgery, which can result in patients being prescribed large quantities of opioids. We have evaluated the variability in postoperative pain medication given to pediatric patients following routine ambulatory pediatric surgical procedures. METHODS: Following IRB approval, pediatric patients undergoing umbilical hernia repair, inguinal hernia repair, hydrocelectomy, and orchiopexy from 2/1/2017 to 2/1/2018 at our tertiary care children's hospital were retrospectively reviewed. Data collected include operation, surgeon, resident or fellow involvement, utilization of preoperative analgesia, opioid prescription on discharge, and patient follow-up. RESULTS: Of 329 patients identified, opioids were prescribed on discharge to 37.4% of patients (66.3% of umbilical hernia repairs, 20.6% of laparoscopic inguinal hernia repairs, and 33.3% of open inguinal hernia repairs [including hydrocelectomies and orchiopexies]). For each procedure, there was large intrasurgeon and intersurgeon variability in the number of opioid doses prescribed. Opioid prescription ranged from 0 to 33 doses for umbilical hernia repairs, 0 to 24 doses for laparoscopic inguinal repairs, and 0 to 20 doses prescribed for open inguinal repairs, hydrocelectomies, and orchiopexies. Pediatric surgical fellows were less likely to discharge a patient with an opioid prescription than surgical resident prescribers (P < 0.01). In addition, surgical residents were more likely to prescribe more than twelve doses of opioids than pediatric surgical fellows (P < 0.01). Increasing patient age was associated with an increased likelihood of opioid prescription (P < 0.01). There were two phone calls and two clinic visits for pain control issues with equal numbers for those with and without opioid prescriptions. CONCLUSIONS: There is significant variation in opioid-prescribing practices after pediatric surgical procedures; increased awareness may help minimize this variability and reduce overprescribing. Training level has an impact on the frequency and quantity of opioids prescribed.


Assuntos
Analgésicos Opioides/uso terapêutico , Ambulatório Hospitalar/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Adolescente , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Herniorrafia/efeitos adversos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Masculino , Epidemia de Opioides/etiologia , Epidemia de Opioides/prevenção & controle , Orquidopexia/efeitos adversos , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Hidrocele Testicular/cirurgia , Estados Unidos/epidemiologia
15.
Pediatr Surg Int ; 35(5): 591-595, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30729303

RESUMO

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 , Ultrassonografia
16.
BMJ Case Rep ; 12(2)2019 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-30787023

RESUMO

Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the diagnosis is frequently delayed or may be missed. In this case, the initial clinical presentation was typical for bacterial epididymo-orchitis in a 38-year-old man. When the patient failed to improve with standard treatment including broadening of antibiotics, the diagnosis was re-considered because some unusual signs suggested testicular malignancy or lymphoma. Further, history-taking and subsequent cross-sectional imaging with CT/MRI identified co-existent pulmonary nodularity, thoracic and abdominal lymphadenopathy and bony changes that, together, raised the suspicion of TB. Mycobacterium tuberculosis was confirmed on DNA-based testing of the hydrocele fluid, although standard acid-fast bacilli culture was negative. This case prompted a review of the literature to explore the optimal steps in the investigation and diagnosis of this rare disease.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Dor/diagnóstico , Doenças Testiculares/microbiologia , Hidrocele Testicular/microbiologia , Tuberculose Urogenital/tratamento farmacológico , Cavidade Abdominal/diagnóstico por imagem , Cavidade Abdominal/microbiologia , Cavidade Abdominal/patologia , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Epididimite/diagnóstico , Epididimite/tratamento farmacológico , Humanos , Linfadenopatia/microbiologia , Linfadenopatia/patologia , Imagem por Ressonância Magnética , Masculino , Orquite/diagnóstico , Orquite/tratamento farmacológico , Dor/etiologia , Doenças Testiculares/diagnóstico , Hidrocele Testicular/genética , Testículo/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Urogenital/diagnóstico , Tuberculose Urogenital/microbiologia
17.
Arch Esp Urol ; 72(1): 85-88, 2019 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-30741658

RESUMO

OBJECTIVE: Paratesticular mesothelioma isan infrequent tumor and only 250 cases have been published.It originates in the scrotal tunica vaginalis. It represents0.3-1.4% of mesotheliomas and it predominates inpatients with history of asbestos exposure and old age. Itsdiagnosis is usually casual. Our objective is to present thecases that occurred in our service with malignant paratesticularmesothelioma and to carry out a review of the currentliterature on this pathology. METHODS: We report two cases diagnosed with malignantparatesticular mesothelioma that happened in the lasttwo years. RESULT: The first case was a 73-year-old male with asymptomatichydrocele. The second was a 57-year-oldmale who had testicular pain and hydrocele. Both werediagnosed of mesothelioma after hydrocelectomy. The firsttreatment was radical orchiectomy in both cases. The firstpatient did not need more treatments. The second patientpresented pulmonary nodules, lymphadenopathy and localrelapse, which was treated with chemotherapy and localresection. CONCLUSION: Paratesticular mesothelioma is an infrequenttumor. Scrotal mass associated with hydrocele is thetypical form of presentation. Surgical treatment consists ofradical orchiectomy. They have poor prognosis because inmost cases there is rapid local and dissemination.


Assuntos
Neoplasias Pulmonares , Mesotelioma , Hidrocele Testicular , Neoplasias Testiculares , Idoso , Humanos , Masculino , Mesotelioma/diagnóstico , Neoplasias Testiculares/diagnóstico
18.
J Laparoendosc Adv Surg Tech A ; 29(4): 564-567, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30676243

RESUMO

BACKGROUND: Laparoscopic Palomo varicocelectomy is one the most common approaches adopted to treat pediatric varicocele, but postoperative hydrocele still remains a potential problem with this procedure. This study aimed to evaluate the outcome of a new technique of lymphography using indocyanine green (ICG)-enhanced fluorescence to perform lymphatic sparing laparoscopic Palomo varicocelectomy. PATIENTS AND METHODS: The records of 25 patients who underwent laparoscopic left varicocelectomy in our unit from March 2017 to March 2018 were retrospectively evaluated. The average patients' age was 13.7 years (range 12-16). All patients had a high degree varicocele associated with left testicular hypotrophy and symptoms. All procedures were performed in laparoscopy using three trocars. After trocars' positioning, 2 mL of ICG solution was directly injected into the left testicle. Using ICG fluorescence, the lymphatic vessels were clearly identified and spared, and then the entire spermatic bundle was clipped and divided according to Palomo's principle. RESULTS: The average operative time was 18 minutes (range 10-25). No conversions to open surgery and no allergy or other adverse reactions induced by ICG were reported. At a maximum follow-up of 18 months, no recurrence of varicocele or postoperative hydrocele was recorded. CONCLUSIONS: Our preliminary experience showed that ICG fluorescence lymphography is a safe and effective option to perform lymphatic sparing laparoscopic Palomo varicocelectomy in children and adolescents with high degree varicocele. The intratesticular injection of ICG and use of fluorescence vision allowed identification of lymphatic vessels in 100% of cases. No allergy to ICG or postoperative hydrocele was reported in our experience.


Assuntos
Verde de Indocianina/administração & dosagem , Laparoscopia/métodos , Linfografia/métodos , Tratamentos com Preservação do Órgão/métodos , Varicocele/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Criança , Conversão para Cirurgia Aberta/estatística & dados numéricos , Corantes Fluorescentes/administração & dosagem , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/prevenção & controle , Recidiva , Estudos Retrospectivos , Hidrocele Testicular/prevenção & controle , Testículo/cirurgia
19.
Hernia ; 23(4): 663-669, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30377856

RESUMO

PURPOSE: Recurrence is a concerning area in pediatric inguinal hernia repair. Various laparoscopic repair methods are available to treat recurrent pediatric inguinal hernia. We analyzed previous laparoscopic hernia repairs and report the outcomes of laparoscopic inguinal hernia reoperations in patients with recurrent inguinal hernia. METHODS: Fifty-one patients who presented for recurrent inguinal hernia after laparoscopic hernia repair from September 2012 to May 2017 were retrospectively evaluated. Previous laparoscopic procedures were analyzed with respect to sac removal (removal vs. leaving in place), suture material (absorbable vs. nonabsorbable), and high ligation method (purse string vs. multiple stitches). We removed the hernia sac from all patients and performed suture repair of the muscular arch of the internal inguinal ring using nonabsorbable material. RESULTS: All patients (38 male, 13 female) had indirect inguinal hernias. No conversion to open surgery occurred. Forty-three (84.3%) patients developed recurrence within 1 year after the previous operation [mean 8.7 ± 6.9 (range 3-33) months]. Twenty patients had concurrent hydroceles (39.2%); 16 were cord hydroceles and 4 were canal of Nuck hydroceles. In the previous operations, the hernia sac was not removed in 100% (51/51) of patients, absorbable suture material was used in 58.8% (30/51), and purse string high ligation was performed in 88.2% (45/51). No re-recurrence developed during a mean follow-up of 25.0 ± 12.6 (range 13-54) months. CONCLUSION: Laparoscopic reoperation with hernia sac removal and suture repair of the muscular arch of the internal inguinal ring with nonabsorbable material is an effective operation with few recurrences and complications.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia , Laparoscopia , Reoperação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Canal Inguinal/cirurgia , Ligadura , Masculino , Recidiva , Estudos Retrospectivos , Suturas , Hidrocele Testicular/cirurgia , Resultado do Tratamento
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