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The development of laparoscopic processus vaginalis repair has provided an alternative approach to the management of inguinal hernia and hydroceles in children. Here we describe our new technique for laparoscopic extraperitoneal ligation of processus vaginalis with subumbilical single-port using a modified Kirschner pin. A 5-mm trocar for an operative laparoscope was placed through an infraumbilical incision. A Kirschner pin with a hole in one flat terminal was inserted at the point of the internal inguinal ring. The processus vaginalis was closed extracorporeally by a non-absorbable suture, which was introduced into the abdomen through the Kirschner pin performing dissection within the extraperitoneal space in a series of movements. When a contralateral patent processus vaginalis is present, laparoscopic-assisted extracorporeal ligation is performed during the same operation. Between September 2010 and September 2012, 211 children (130 cases of inguinal hernia and 81 cases of hydrocele) underwent processus vaginalis repair using this novel technique. A contralateral patent processus vaginalis was present and thus simultaneously closed in 20 patients with unilateral inguinal hernias and 12 patients with unilateral hydroceles. The mean operative time was 18 min (8–35 min). The mean follow-up period is 12 months (range 5–24 months), and no recurrence and complications has been observed to date. This article describes a unique technique of extracorporeal circuit ligation of processus vaginalis using a minimally invasive technique as afforded by a reused modified Kirschner pin. Single-port laparoscopic processus vaginalis repair using this instrument is feasible and seems to be safe.

Purpose There is a tendency for the majority of surgeons to open the inguinal canal in children over two years old when performing inguinal hernia repair. On the other hand, in small children, most surgeons perform the herniotomy superficially to the external ring, as in Mitchell-Banks' technique (MBT). Our aim was to compare the Ferguson hernioplasty (FH) and Mitchell-Banks' technique in terms of recurrence and complication rates in older children. Methods We retrospectively reviewed the office medical records of children who were at least two years old and who underwent a herniotomy procedure for inguinal hernia between 1997 and 2012. Results The 4520 inguinal herniotomy procedures in boys who were over two years old were included in this study. Of these cases, 1607 cases (40.2%) were operated on by a FH with opening the inguinal canal, and 2388 cases (59.8%) by MBT superficially to the external ring. The median ages were 5.1years (range, 2.0–16.2) in the FH group and 4.6years (2.0–14.6) in the MBT group. The total complication rates were 2.3% in the FH group and 2.9% in the MBT group ( P >.05). Early complications such as wound infection, scrotal edema, and hematoma were seen in 13 (0.8%), 15 (1%), and 10 (0.6%) in the FH group, and 12 (0.5%), 18 (0.7%), and 15 (0.6%) in the MBT group, respectively ( P >.05). Late complications such as recurrence, trapped undescended testis, and testicular atrophy were seen in 2 (0.12%), 1 (0.06%), and 2 (0.12%) in the FH group, and 3 (0.12%), 1 (0.04%), and 2 (0.08%) in the MBT group ( P >.05). Conclusion The Mitchell-Banks technique is a simple and safe procedure in older boys.

Objective To elucidate alternative pathways in testicular development, we attempted to clarify the genetic characteristics of SRY -negative XX testes. Materials and Methods We previously reported 5 cases of SRY -negative 46,XX testicular disorders of sex development and demonstrated that coordinated expression of genes such as SOX9 , SOX3 , and DAX1 was associated with testicular development. We performed a case-control study between the aforementioned boy with 46,XX testicular disorders of sex development and an age-matched patient with hydrocele testis (46,XY). During their consecutive surgeries, testicular biopsy specimens were obtained. Genes with differential expression compared with XY testis were identified using polymerase chain reaction (PCR)–based subtractive hybridization and sequencing. For validation of differential gene expression, real-time RT-PCR was performed using gene-specific primers. The distribution of candidate proteins in the testicular tissue was clarified by immunohistochemistry in human and rodent specimens. Moreover, in vitro inhibitory assays were performed. Results We identified 13 upregulated and 7 downregulated genes in XX testis. Among the candidate genes, we focused on ROCK1 (Rho-associated, coiled-coil protein kinase 1) in the upregulated gene group, because high expression in XX testis was validated by real-time RT-PCR. ROCK1 protein was detected in germ cells, Leydig cells, and Sertoli cells by immunohistochemistry. Moreover, the addition of specific ROCK1 inhibitor to Sertoli cells decreased SOX9 gene expression. Conclusion On the basis of in vitro inhibitory assay, it is suggested that ROCK1 phosphorylates and activates SOX9 in Sertoli cells. Testes formation might be initiated by an alternative signaling pathway attributed to ROCK1 , not SRY , activation in XX testes.

To explore the feasibility and clinical efficacies of umbilical one-trocar laparoendoscopic surgery versus trans-umbilicus and abdominal wall two-trocar laparoendoscopic surgery in the treatment of pediatric hydrocele.Retrospective comparative analysis was conducted for 78 cases of hydrocele undergoing laparoscopic surgery at our hospital from January 2012 to May 2012. They were divided into two groups of umbilical one-trocar laparoscopic surgery (one-trocar, n = 32) and trans-umbilicus and abdominal wall two-trocar laparoscopic surgery (two-trocar, n = 46). And their profiles of operative duration, post-operative hospital stay and treatment cost were compared.All procedures were successful. No case converted into open surgery. Visual field of both methods was similar, but two-trocar group had a flexible visual angle. During a follow-up period of 3 - 6 months, there was no occurrence of postoperative complications. The average operative duration was (20 ± 10) min at one side and (31 ± 11) min at both sides in one-trocar group versus (20 ± 8) min and (29 ± 9) min in two-trocar group. There were no statistical significance (all P0.05). Cost in one-trocar group was (5199 ± 599) yuan RMB and (5117 ± 684)yuan RMB in two-trocar group (P0.05).Trans-umbilicus laparoendoscopic one-trocar surgery is both feasible and safe in the treatment of pediatric hydrocele. Compared with two-trocar laparoscopic surgery, both approaches are similar in terms of operative duration, post-operative hospital stay and treatment cost. Since there is a single hidden navel scar, the former is labor-saving, may be handled by one operator and offers better cosmetic outcomes.

We present two cases of a prenatal diagnosis of inguinal hernia and the fetal outcome. Initial differential diagnosis included sacrococcygeal teratoma and testicular termatoma, while the final diagnosis was scrotal-inguinal hernia based on sonographic visualization of bowel loop movement in the scrotal mass.

Hydrocoele is an abnormal quantity of serous fluid within the tunica vaginalis. It can be primary or secondary. The primary can in turn be congenital or acquired. Objective of this study was to see the frequency of primary hydrocoeles in children presenting to Ayub Teaching Hospital, Abbottabad.This prospective study was conducted in Surgical 'B' Unit, Ayub Teaching Hospital, Abbottabad, from Feb 2007 to Feb 2009. All Children above 6 months age with hydrocoeles and operated were included in this study. All details were recorded on a proforma. The collected data were analysed, results calculated, and conclusions drawn.In all 186 operated cases, the maximum (58, 37%) incidence was in 2-3 years age group. Injury to the vas occurred in 1 (0.7%) case, infection rate was 0% and scrotal haematoma occurred in 18% cases.Children with hydrocoeles should be operated after 6 months age. Herniotomy is the only satisfactory treatment and in expert hands complications are very rare.

This study aimed to compare laparoendoscopic single-site varicocelectomy (LESSV) with multiport laparoscopic varicocelectomy (MLV) in terms of intraoperative parameters and postoperative outcomes.A retrospective case-control study investigated 10 male adolescents and 89 adults who underwent either LESSV or MLV at the authors' center. The reusable X-Cone single port was inserted transumbilically. A 5-mm 30° telescope was used together with a straight and a prebent laparoscopic instrument. The MLV procedure was performed using two 5-mm ports and one 10-mm port.Between January 2009 and November 2012, 20 patients underwent LESSV and 79 patients underwent MLV. The demographic data were comparable between the two groups. The mean operating time was 59.1 ± 15.5 min for LESSV and 51.2 ± 14.4 min for MLV (P = 0.04). In the LESSV group, no conversion to MLV was necessary. The hospital stay was 1.6 ± 0.7 days in the LESSV group versus 1.8 ± 0.5 days in the MLV group (P = 0.17). The postoperative pain scores did differ between the two groups. By day 2, significantly more patients in the LESSV group than in the MLV group fully recovered their normal physical activity (P = 0.02). Comparison of pre- and postoperative values showed relief of testicular pain and improvement of semen parameters for the majority of the patients. The overall incidence of complications was distributed equally between the two groups as follows: paresthesia of the upper thigh (8 %), wound infection (5 %), epididymitis (3 %) and hydrocele (4 %). All the patients in the LESSV group were fully satisfied with their cosmetic results compared with only 76 % of the patients in the MLV group (P = 0.01).The LESSV procedure performed with the reusable X-Cone is as safe and efficient as MLV. After LESSV, the parameters measuring postoperative patient satisfaction are significantly improved. Given its reusable components, including prebent laparoscopic instruments, the X-Cone platform is a cost-effective alternative to disposable or homemade single ports.

To detect systematically visible urogenital malformations (VUGM) in adolescents and describe their epidemiological and clinical aspects.It was a cross sectional, descriptive and analytical study, conducted from February to August 2012. Upon 2724 adolescents from 10 to 19 years old, of the public secondary schools of Cotonou. Among the 26,594 registered pupils, 2724 were included and examined after a randomized sampling of 30 clusters.The mean age of the pupils was of 15 ± 2.30 years (11-19 years), with a peak at 18 years. The prevalence of the VUGM was slightly higher (9.57%) in individuals those had parents with low socioeconomic level. The prevalence of the VUGM was high in Yoruba and related (P=0.02). It was stronger (9.84%) among subjects in puberty period's than in pre-puberty (6.69%) (P=0.03). From the 253 having VUGM, 78 (30.83%) had 146 functional signs. It was indexed 266 affections and of malformatives associations in 21 pupils (8.30%). Varicocele was the most frequent (5.47%), followed by inguinal hernia (0.99%), hydrocele (0.88%), anomalies of testis migration (0.59%), cyst of spermatic cord (0.51%), insulated testicular hypotrophy (0.48%), micro-penile (0.33%), hypospadias (0.22%), penile curvature (0.22%) and epididymis cyst (0.07%).Among patients who had VUGM, the majority had at least a varicocele, which occupies so far the first place within these malformations at the adolescents in Cotonou.

Ultrasonography (US) is the imaging modality of choice for the evaluation of scrotal disease. It provides high anatomical detail and in most cases, it is essential to enable a correct diagnosis and to obtain the right management of the patient. Color Doppler ultrasonography is a non invasive technique that aids important information about testicular perfusion, necessary in reaching a specific diagnosis in many pathologic conditions; moreover contrast-enhanced ultrasonography (CEUS), recently introduced in the clinical practice, may be considered an additional tool in the classification and differentiation of testicular pathology. The purpose of this review, is to provide the state of the art on the role of ultrasonography in the evaluation of different scrotal pathologies including vaginal process' disorders, acute scrotum, varicocele, hydrocele, chronic inflammatory diseases and testicular tumours.

A case of malignant mesothelioma of the tunica vaginalis testis diagnosed by preoperative cytology of hydrocele fluid is reported. In our view this is only the second case diagnosed by preoperative cytology. The unique feature of this case, the characteristic ultrasound appearance, was recognized and confirmation by aspiration cytology led directly to radical orchiectomy, thus avoiding hydrocelectomy, hemiscrotectomy and possible local recurrence. Aetiopathogenesis and management options of this rare tumour are discussed, with a review of the literature.

Between May 1, 1992 and August 1, 1995, 599 consecutively treated children under 10 years of age evaluated by the authors for a known inguinal hernia were involved in a prospective protocol to determine whether diagnostic laparoscopy has a place for evaluation of the contralateral inguinal region. The experience with the first 221 patients was reported at the 1993 AAP meeting. In this total experience, 81 patients had known bilateral inguinal hernias and did not require diagnostic laparoscopy. Five hundred eighteen patients had a unilateral inguinal hernia with the status of the contralateral region being unknown. Between May 1, 1992 and May 1, 1994, 368 children underwent evaluation using an umbilical approach. However, for the past 14 months, 150 patients have undergone the diagnostic laparoscopy through the ipsilateral hernia sac. Among the children under 1 year of age, 98 were found to have a unilateral hernia and also a contralateral patent processus vaginalis (CPPV) and 110 had a unilateral hernia. Of the children older than age 1, 116 had a unilateral hernia and CPPV and 194 had only a single hernia. After induction of anesthesia, it was suspected on clinical examination that 195 of the 518 patients had a CPPV. However, laparoscopy showed that only 94 (48%) had a CPPV. In the remaining 323 patients, the surgeon believed that a CPPV was not present based on the examination. This negative finding was verified in only 198 patients (61%), but a surprising 125 (39%) did have CPPV documented at the time of endoscopy. Insufflation alone was very unreliable for documenting the presence of CPPV. Of the 214 patients for whom CPPV on the contralateral side was documented during laparoscopy, only 41 (19%) had a positive finding on insufflation. This experience has convinced the authors that diagnostic laparoscopy is the most accurate means to ascertain whether a patient should undergo contralateral inguinal exploration. In addition, laparoscopy through the ipsilateral inguinal sac is now the preferred approach.

The long-term outcome of 106 patients treated for hydrocele with the sclerosing agent sodium tetradecyl sulphate was examined. In a questionnaire distributed at a mean time of 40 months after therapy 83/86 (96%) of the eligible patients responded and 95% of them were satisfied with the treatment and its long term results. The treatment associated pain was evaluated on a visual analogue scale (0-10) the mean pain score was found to be 1.8 and the mean duration of the pain 2.4 days. When all hydroceles were considered the overall success rate was 88%. Side-effects were minor apart from two patients (1.9%) with diabetes mellitus who had an intense inflammatory reaction necessitating orchidectomy after sclerotherapy.

The efficacy of 2 strategies for the control of bancroftian filariasis using diethylcarbamazine (DEC) mass chemotherapy delivered through community participation was evaluated and compared in 2 endemic communities in Tanzania with pre-treatment microfilarial (mf) prevalences of 34.7% and 31.0%, and mf geometric mean intensities (GMI) of 1122 mf/mL and 933 mf/mL, respectively. In the first community, all individuals agedor = 1 year were offered treatment for one year with a low monthly dose (50 mg DEC to children aged15 years and 100 mg DEC to adults agedor = 15 years; given independently of body weight), and in the second community all households were offered 0.33% w/w DEC-medicated cooking salt for one year. Both treatment strategies resulted in dramatic reductions in the mf loads. Among those microfilaraemic before treatment, the low monthly dose and the DEC-medicated salt gave mf clearance rates of 55.3% and 92.1%, respectively, and the pre-treatment mf GMIs were reduced by 99.4% and 99.9%, respectively, one year after starting treatment. At community level, the mf prevalences were reduced to 15.8% and 2.4% (reductions of 54.5% and 92.3%) and the mf GMIs were reduced to 100 mf/mL and 32 mf/mL (reductions of 91.1% and 96.6%), one year after starting treatment with the low monthly dose and DEC-medicated salt respectively. Males with hydrocele before treatment improved remarkably one year after the start of treatment. Since both strategies were simple to administer and well accepted by the communities, they appear highly feasible for integration into large scale control programmes based on community participation.

The efficacy of 2 strategies for control of bancroftian filariasis using mass diethylcarbamazine (DEC) chemotherapy was evaluated and compared in 2 endemic communities in Tanzania with pre-treatment microfilarial (mf) prevalences of 28.5% and 17.7%, and mf geometric mean intensities (GMI) of 588 mf/mL and 251 mf/mL, respectively. All individuals in the first community were offered DEC treatment with 6 mg/kg body weight given daily for 12 d (standard treatment). The second community was offered DEC treatment with 2 single doses of 6 mg/kg body weight given with an interval of 6 months (semi-annual single-dose treatment). Among those who were microfilaraemic before treatment, the mf clearance rates were 51.2% and 36.0%, and the mf GMIs were reduced by 98.6% and 92.2% one year after the start of the standard and the semi-annual regimens, respectively. At community level, the standard strategy and the semi-annual strategy reduced the mf prevalences to 15.1% and 11.6% (reductions of 47.0% and 34.5%) and the mf GMIs to 112 mf/mL and 102 mf/mL (reductions of 81.0% and 59.4%, respectively) one year after start of treatment. Both regimens resulted in remarkable improvements in small hydroceles among males presenting this condition before treatment. The lower efficacy of the semi-annual single-dose treatment in relation to the standard treatment in reducing microfilaraemias might be compensated for by continuing semi-annual treatments for a slightly longer period of time. Considering that the semi-annual treatment is easy to administer and more acceptable to the treated individuals, it may in the long run be a more feasible strategy for mass DEC chemotherapy than the standard treatment.

Oligonucleotide primers were designed to amplify a 490-basepair DNA fragment in the 5' end of the pWb 12 repeated DNA sequence in Wuchereria bancrofti for specific amplification of W. bancrofti DNA by the polymerase chain reaction (PCR). A single microfilaria in 100 microliter of blood or added to 1 ml of blood, a single third-stage larva in a pool of 20 uninfected mosquitoes, or 0.4 pg of W. bancrofti genomic DNA added to 100 microliter of human blood or serum can be detected by this PCR method. The parasite DNA in human blood and hydrocele samples and in mosquitoes was isolated free of any PCR inhibitors using simple purification techniques. Detection of PCR products was carried out by agarose gel electrophoresis, followed by staining with ethidium bromide and visualization under ultraviolet illumination. The results indicate that the PCR method is species-specific, rapid, and more sensitive than that of DNA probes and routine microscopy.

Background The purpose of this study is to evaluate the prevalence of hydrocele as a complication of Wilms tumor (WT) therapy and nephrectomy and to determine whether radiation therapy to the flank increases the risk. We hypothesize that radiation increases the risk of hydrocele formation in patients treated for WT. Methods A retrospective, medical review of the chart was completed on 57 male patients with WT diagnosed between 1985 and 2000. Results There is an increased prevalence of hydrocele in males that had a nephrectomy as part of their WT therapy. Conclusions Male survivors of WT are at risk for development of a subsequent hydrocele that appears to be related to their prior surgery. © 2003 Wiley-Liss, Inc.

Clinical and parasitological surveys for bancroftia filariasis were carried out in five endemic communities in north-eastern Tanzania, covering a population of 3086 individuals. High microfilarial (mf) prevalences (17.7%-34.7%) and mf geometric mean intensities (251-1122 microfilariae/ml) were observed in the communities. The mf prevalence generally increased with age, but often levelled out in the older age groups. Larger variability was observed in individual mf intensities and no clear association between mf geometric mean intensity and age or sex was seen. Hydrocele was the most common clinical manifestation (with a prevalence of 30.2%-40.0% in male subjects agedor = 20 years) followed by leg elephantiasis (with a prevalence of 2.0%-6.8% in all subjects agedor = 20 years). In four of the five communities, there was no significant difference in mf prevalence in males agedor = 20 years between those with and without hydrocele. In all the communities, the mf geomtric mean intensities in microfilaraemic males with and without hydrocele were not significantly different. The present study therefore did not indicate any association between hydrocele in males (the most common type of chronic clinical manifestation seen) and presence or absence of microfilaraemia. In contrast, only two (4.4%) of the 45 subjects with leg elephantiasis were microfilaraemic. In children aged 1-15 years, mf prevalence was significantly higher among those with microfilaraemic mothers (18.0%) than among those with amicrofilaraemic mothers (7.9%). The children of microfilaraemic mothers were therefore at 2.3-fold higher risk of becoming microfilaraemic than the children of amicrofilaraemic mothers. No relationship between the mf prevalence of the children and the mf status of their fathers was observed.

BACKGROUND We studied the clinical efficacy of sclerotherapy with injection of 3% polidocanol for hydrocele testis. METHODS From July, 1992 to March, 1995 sclerotherapy with single injection of polidocanol was performed for 11 patients with 12 hydrocele testis on an outpatient basis. We instilled 3 or 5ml of 3% polidocanol after complete removal of fluid in the hydrocele testis. RESULTS Complete disappearance on ultrasonography was observed in 75% of the hydrocele testis 6 months after this sclerotherapy. There was neither pain during instillation of 3% polidocanol nor any other complication. Two patients with fluid reaccumulation underwent hydrocelectomy 16 and 6 months after sclerotherapy, respectively. CONCLUSION This procedure seems to be a safe and useful technique as primary treatment for hydrocele testis.

Fibrous pseudotumors of the testicular tunics and paratesticular soft tissue are uncommon lesions. They typically arise as painless scrotal masses that may be associated with a hydrocele or history of trauma or infection. Although these lesions are clinically worrisome for a malignant neoplasm, they are thought to be reactive in nature, since they are composed of dense fibrous tissue with interspersed bland fibroblasts and myofibroblasts and mixed inflammatory cells. Once excised, these lesions behave in a benign fashion. Typically, these masses are multinodular, but in rare cases they are diffuse, bandlike myofibroblastic proliferations that encase the testis and are termed fibromatous periorchitis. Herein, we describe a 57-year-old man with a diffuse fibrous pseudotumor/fibromatous periorchitis that encased the left testis and adnexa and arose in close apposition to an inflamed hydrocele.

Previous studies have reported an increased incidence of complications following neonatal inguinal herniotomy (IH) in boys. The incidence and natural history of postoperative hydrocele in such cases has not been described. A prospective follow-up study of a consecutive series of male infants weighing less than 3 kg at the time of IH was undertaken. Regular follow-up examinations were scheduled for at least 1 year. Thirty-eight boys weighing less than 3 kg underwent IH during an 18-month period. One subsequently died from complications of prematurity. Complete follow-up data were available for 29/37 (78%) patients, yielding a total of 46 IHs. There were 2 recurrent hernias (4%), 2 unequivocally atrophic testes (4%), and 1 iatrogenic testicular ascent (2%). Five ipsilateral hydroceles complicated the postoperative course of 4 boys (14% of patients, 11% of herniotomies). Two of these were explored, but in neither case was a recurrent/residual patent processus vaginalis found. One hydrocele was aspirated without recurrence, and the remaining 2 resolved spontaneously. The complication rate in small infants undergoing neonatal IH is significantly higher than in older boys. The presence of a hydrocele after neonatal IH may simply reflect the accumulation of fluid in the distal hernia sac and, provided there is no evidence of a recurrent inguinal hernia, an expectant approach is recommended.

We demonstrated that hydrocele aspiration and sclerotherapy with doxycycline is an effective and safe nonsurgical treatment option for hydrocele correction.The medical records of patients who underwent hydrocele aspiration and sclerotherapy were analyzed in a retrospective cohort study for success rates as well as improvement in scrotal size and discomfort after a single hydrocele aspiration and sclerotherapy treatment. Patients who reported decreased scrotal size, improved physical symptoms and satisfaction with the procedure were considered as having success with hydrocele aspiration and sclerotherapy.A total of 29 patients (mean age 52.8 years) presenting with 32 nonseptated hydroceles underwent hydrocele aspiration and sclerotherapy with doxycycline between 2005 and 2012. Of the hydroceles 27 (84%) were successfully treated with a single aspiration and sclerotherapy procedure. Overall mean followup was 20.8 months. Three patients reported moderate pain which resolved in 2 to 3 days. Of those patients in whom hydrocele aspiration and sclerotherapy failed, 1 had hydrocele successfully resolved with a second aspiration and sclerotherapy treatment, 3 did not have success with a second procedure and underwent hydrocelectomy, and 1 wanted immediate surgical correction.Hydrocele aspiration and sclerotherapy was successful in correcting 84% of simple nonseptated hydroceles with a single treatment. This result is an increase from previously reported success rates involving a single hydrocele aspiration and sclerotherapy procedure with tetracycline (75%). The success rate of a single hydrocele aspiration and sclerotherapy procedure is similar to the reported success rates involving hydrocelectomy while avoiding the hospital expense and many other complications. We conclude that the hydrocele aspiration and sclerotherapy procedure is a reasonable, nonsurgical and underused treatment option for nonseptated simple hydroceles.

Purpose: Laparoscopic varicocelectomy according to the Palomo technique is the most common procedure adopted in children with testicular varicocele. This procedure involves the ligation of the internal spermatic cord and is associated with a 3%-5% incidence of recurrence and up to 30% incidence of hydroceles. We sought to determine the impact of lymphatic preservation on hydrocele formation and the success of varicocelectomy. Patients and Methods: We retrospectively evaluated 396 patients with a mean age of 13.2 years who underwent laparoscopic varicocelectomy. Patients were divided into two groups: those who underwent a lymphatic-sparing (LS) procedure using isosulfan blue scrotal intra-dartoic injection and those who underwent a non-LS (NLS) technique. The incidences of recurrence/persistence and postoperative hydrocele formation requiring surgery or aspiration were analyzed statistically using the chi-squared test. Results: Of 396 patients, 244 received a laparoscopic LS procedure, and 152 received an NLS operation. The LS patients in whom the lymphatic vessels were not identified (26/244 [10.6%]) were considered NLS repairs. The follow-up was at least 12 months. LS surgery (218 patients) was associated with a decreased incidence of postoperative hydrocele (0/218 [0%] versus 18/178 [10.1%]; chi-squared test=25.84, difference statistically significant). There was no significant difference in incidence of persistent or recurrent varicocele requiring reoperation following the initial procedure (5/218 [2.2%] versus 5/178 [2.8%]; chi-squared test=0.41, difference statistically not significant). Conclusions: Laparoscopic LS varicocelectomy using isosulfan blue is preferable to laparoscopic Palomo repair that does not preserve the lymphatics. It has a significantly lower incidence of postoperative hydroceles and still maintains a low incidence of persistence/recurrence.

To evaluate the quality of health-based information available to patients and their parents on the Internet regarding hydrocele, a common paediatric condition, an Internet search was performed and a questionnaire distributed.The top 100 websites from the five most accessed search engines were reviewed by entering the term "Hydrocele" into each search engine. Website authorship was determined by close examination of each website. Websites were assessed for accuracy and validity according to the Health On the Net Foundation Code (HONcode), DISCERN score and JAMA benchmark criteria, recognized scoring systems. A voluntary written questionnaire was distributed to parents of patients on two consecutive days outside a paediatric clinic.After duplicate and inaccessible sites had been excluded, 37 unique websites were identified: 11 were academic, eight were produced by physicians not affiliated with an academic institution, three were commercial, four were attached to discussion groups or social media sites, four were media related and seven were unspecified. There was a significant difference between the academic and the physician-related sites compared with the other categories, with academic and physician sites scoring highest on the recognized scoring systems (p = 0.0001). It was found that 56.7% of patients accessed the Internet regarding their condition and 33% believed this information to be accurate.The quality of health-related information overall is of a poor quality. Academic and physician-provided websites were shown to contain better quality information. Clinicians have a potential role not only to direct patients to appropriate sites, but also to help to develop content on the Internet.

Abdominoscrotal hydroceles (ASH) represent a difficult surgical problem in which a large scrotal hydrocele extends through the inguinal canal into the intraabdominal, extraperitoneal space, creating a widened internal ring that may be associated with an inguinal hernia.Patients with ASH were repaired using a combined laparoscopic-inguinal approach. Laparoscopic exploration was used to confirm the diagnosis, rule out associated hernia, assess for contralateral pathology, and confirm adequate peritoneal closure at the level of the internal ring, after a standard inguinal approach was used to repair the ASH.Eight patients are described with a median age of 13 months. One patient presented with bilateral ASH, and 5 patients had contralateral pathology, including simple hydrocele (n=3), undescended testicle (n=1), and inguinal hernia (n=2). Three patients were confirmed to have an ipsilateral inguinal hernia associated with their ASH. Postoperative complications included hematoma (n=2) and recurrent hydrocele (n=1). No patient developed ipsilateral or contralateral hernias following ASH repair (median follow-up, 3.2 years).Although laparoscopy is not essential, we have found it to be a useful adjunct to ensure accurate diagnosis and repair of abdominoscrotal hydroceles in children.

To compare the effects and postoperative complications of microscopic varicocelectomy (MV) and laparoscopic varicocelectomy (LV) in the treatment of varicocele.We assigned 72 varicocele patients to two groups of equal number to be treated by MV and LV. We compared the two groups in the semen parameters before and 3 months after surgery, postoperative complications, and pregnancy rates of the patients'wives.The operative time was significantly longer in the MV than in the LV group (P0.05). The postoperative hospital stay showed no significant difference between the MV and LV groups ([2.2 +/- 2.7] d vs [2.8 +/- 0.8] d). Sperm concentration, sperm motility and the percentage of grade a + b sperm were significantly increased in both groups after surgery (P0.05), but with no significant differences between the two. The pregnancy rate was 65.2% in the former and 57.1% in the latter. Postoperative hydrocele occurred in 5 cases in the LV, but none in the MV group. There were no statistically significant differences in recurrence between the two groups (P0.05).MV is superior to LV for its minimal invasiveness, economical anesthesia, faster recovery and lower rates of postoperative complications and recurrence.

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.

The aim of this work was to study the impact of anemia on surgical outcomes and the impact of instituting appropriate workup and treatment of anemia on surgical outcomes. We conducted a case–control retrospective chart review of all hernia repair, hydrocele repair, and hysterectomy cases at the SEARCH Hospital in Gadchiroli, India, from January 2008 to April 2010, and included 340 male and 112 female surgical patients. We also performed a prospective assessment of the impact of the institution of appropriate workup and treatment of anemia on the surgical outcomes for all hernia repair, hydrocele repair, and hysterectomy cases at SEARCH from May 2010 to May 2011 and included 138 male and 76 female surgical patients. The retrospective arm of the study included 340 males and 112 females with a median age of 39 and 41 years, respectively. The mean hemoglobin values were 12.50 (range = 8.8–15.4) for men and 10.39 (range = 5.2–14.8) for women. Patients with anemia had (1) increased incidence of spinal headache after inguinal hernia repair (p = 0.0266) and (2) increased incidence of fever after total hysterectomy (p = 0.0070). There was no statistically significant correlation between anemia and other outcomes (all p > 0.05). The prospective arm of the study included 138 males and 76 females with a median age of 35 and 40, respectively. The mean hemoglobin values were 11.8 (range = 6.4–14.8) for men and 10.6 (range = 6.9–12.8) for women. There was no statistically significant correlation between anemia and any surgical outcomes (p > 0.05). The incidence of complications in both the retrospective and the prospective arm was compared according to increasing severity of anemia across genders. Overall, there was no statistically significant increase in complication rates with increasing severity of anemia (p > 0.05). In the retrospective arm of this study, anemia was associated with increased incidence of spinal headache and fever. In the prospective arm of this study, there was no statistically significant correlation between anemia and any surgical outcome. The incidence of complications did not increase with the severity of anemia in either arm of the study. Further investigation is needed into the optimal management and treatment of anemia prior to surgery in resource-poor settings.

Background/Purpose The communicating hydrocele is caused by the failure of the processus vaginalis closure. After the patent processus vaginalis is closed, the hydrocele can subside spontaneously, but the mechanism responsible for the drainage of hydrocele has not been expounded. Former studies showed that lymphatic stomata between the mesothelial cells lining the peritoneum and pleura were responsible for the drainage of ascites and pleural effusion. Although the tunica vaginalis is also lined by mesothelial cells, the existence of lymphatic stomata in it has never been reported. Therefore, we investigated the presence and ultrastructure of lymphatic stomata in mouse tunica vaginalis. Methods We studied the ultrastructure of mouse tunica vaginalis by scanning and transmission electron microscopy. The submesothelial connective tissue with foramina were investigated after the mesothelial cells were digested by NaOH solution. Typan blue was used as a tracer to show the absorptive function of lymphatic stomata. Results The lymphatic stomata were found between the mesothelial cells. The trypan blue was directly absorbed by the lymphatic stomata. Milky spots which possessed immune function were observed, and the lymphatic stomata were found within the milky spots. Conclusion Our study is the first to report the presence and ultrastructure of lymphatic stomata in mouse tunica vaginalis. They might be related to the lymphatic drainage in the tunica vaginalis cavity.

A case of benign reactive pseudo-glandular mesothelial hyperplasia arising in the context of chronic vaginitis in presented: morphological and immunohistochemical investigations and differential diagnoses are described.

Primitive NHL represents 9% of testis tumours and the 85% is diagnosed in patient older thant 60 years old. Usually pain and a testis mass are the main manifestations. The Authors report the case of a 82 years-old man with bilateral hydrocele causing severe alteration in the deambulation. The cytology did not show blood cells or neoplastic cell in the FNAB. The US showed a complete modification in the testis. The patient underwent to surgery intervention of vaginalis tunic eversion and resection with the aim of control the symptoms. The histology on multiple biopsy of testis and epidydims bilaterally showed a large B-cell lymphoma. The patient was treated with 6 chemotheray cycles (Rituximab, Vincristine, Cyclophosphamide, Prednisone). Bilateral hydrocele is a rare clinical presentation of testis NHL. In this patient, blood and neoplastic cell absence in the cytology made difficult the differential diagnosis between inflammatory pathology and neoplasia. Hystopathologic study and immunologic pattern can make a certain diagnosis.

We report here a case of intrascrotal malignant mesothelioma, arising from the tunica vaginalis, which was diagnosed after surgery for hydrocele testis. A 52-year-old man underwent left hydrocelectomy for hydrocele testis. After pathological diagnosis as malignant mesothelioma from the specimen of tunica vaginalis, left radical orchiectomy was performed. The patient had no exposure to asbestos and there has been no evidence of recurrence.

Item does not contain fulltext OBJECTIVE: To contribute to the understanding of the etiology of undescended testis (UDT), by exploring a wide range of potential risk factors in a case-referent study. PATIENTS AND METHODS: Cases and referents were recruited at five hospitals and included 200 boys with surgically corrected UDT and 629 boys with persistent middle ear effusion. Risk factor data were obtained by postal questionnaires to both parents. Clinical data were collected from medical files. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were estimated using logistic regression. RESULTS: The main findings include associations between UDT and familial occurrence of the disorder: OR 3.1 (95%CI 1.9-4.9), low birth weight: 2.2 (1.1-4.3), twinning: 2.2 (0.9-5.4), gestational preeclampsia: 1.9 (0.8-4.4), use of oral contraceptives after conception: 3.6 (1.0-12.5), in vitro fertilization/intracytoplasmic sperm injection treatment: 2.2 (0.8-6.0), paternal subfertility: 1.8 (0.8-4.1), and maternal occupational exposure to cosmetics: 3.0 (0.9-10.0). Subgroup analyses indicated differences in ORs for several factors between cases with (n = 92) and without (n = 103) inguinal hernia or hydrocele. CONCLUSION: The findings point towards a role for genetic predisposition, placental insufficiency, and possibly exposure to specific endocrine disrupting substances in the etiology of UDT. Further research should take into account potential etiologic differences between subgroups of cases with UDT. 01 februari 2012

Metallothionein (MT) concentrations were measured in the seminal plasma of 4 fertile and 35 infertile men and in the hydrocele and spermatocele fluids. The relationship between MT content and sperm density, total number of sperm per ejaculate, sperm motility and abnormal form rates, leukocyte count and zinc levels in seminal plasma, as well as the relationship between MT and serum follicle-stimulating hormone, luteinizing hormone, testosterone, and prolactin were examined. MT was not detected in the hydrocele and spermatocele fluids. MT levels were related to zinc levels and to the leukocyte count in seminal plasma, but there was no correlation between MT and the other factors examined. This study supported previous findings that MT was secreted predominantly from the prostate and induced by inflammation of the prostate gland or seminal vesicles; the findings suggest that MT binds mainly to zinc and is one of the zinc-binding proteins in seminal plasma.

In a prospective randomized study, the “extrusion” operation modified by McGowan Jr. and Howley and the conventional “eversion” operations were compared with each other in terms of early and late postoperative complications in the treatment of idiopathic scrotal hydrocele. As early complications with the “extrusion” procedure a total of 4 (11.4%) cases were seen: 3 oedemas and 1 epididymitis; and with the “eversion” procedures there were 18 (51.4%) early complications: 3 haematomas, 12 oedemas and 3 wound infections (11.4 vs. 51.4%, p

Objective To establish the differences, if any, between the biochemical composition of idiopathic hydrocele fluid and the fluid normally present in the tunica vaginalis. Patients and methods Aspiration and sclerotherapy of 37 idiopathic hydroceles from patients who presented to this urology clinic were performed. The biochemical content of the fluid was compared with that of the tunica vaginalis fluid from a small group of controls (n = 8), taken from patients undergoing orchidectomy for carcinoma of the prostate. Results Differences in several measurements were recorded; in particular, there were significantly higher concentrations of calcium, albumin, total protein and creatine-kinase in the hydrocele group. The levels of potassium, aspartate transaminase, alanine transaminase and alkaline phosphatase were significantly lower in the hydrocele group. Conclusion Whether these differences have a role in the causation of an idiopathic hydrocele is, at this stage, speculative. A similar study on a larger scale would probably be more conclusive.

BACKGROUND In children, opioids are valuable both for their analgesic properties and for their salutary effect on emergence delirium. Although intraoperative administration of opioids is often cited as the cause of postoperative emesis, few data quantitating the magnitude of this effect exist. METHODS Patients undergoing inguinal surgery as outpatients were randomly assigned to one of two groups. One group received a single intravenous dose of morphine 0.1 mg/kg (morphine group), and the other (control) group had the identical anesthetic but instead received saline. Intravenous ketorolac was administered in response to verbal complaints of pain or a Children's Hospital of Eastern Ontario Pain Score greater than 9 on two successive evaluations performed at 5-min intervals. The authors compared the incidence of postoperative emesis and emergence, behavior, and pain scores between the two groups. RESULTS Patients in the morphine group (n = 48) were 5.6 +/- 2.8 yr old and weighed 20.8 +/- 7.8 kg, and those in the control group (n = 49) were 4.5 +/- 2.9 yr old and weighed 18.9 +/- 9.2 kg. More patients in the morphine group were cooperative and deeply asleep both on arrival and through the first 30 min of their stay in the postanesthesia care unit (PACU) (P < 0.05). Sixty-three percent of the children in the control group received ketorolac in the PACU compared with 20% of the morphine group (P < 0.01). The incidence of emesis for the 24 h after arrival in the PACU was 56% for those who received morphine compared with 25% in the control group (P < 0.01). CONCLUSIONS For children undergoing inguinal surgery, the administration of a single dose of intravenous morphine after the induction of anesthesia smooths emergence from anesthesia as assessed by improved cooperation and sedation in the PACU, decreases the need for postoperative analgesics, but increases the incidence of vomiting in the first 24 h after surgery.

It is often difficult to make an exact pathological diagnosis of extratesticular lesions detected on ultrasound. This study aimed to clarify the sonographic criteria required for a more accurate diagnosis by performing a correlative study of the ultrasonographic findings and pathologic diagnosis. Of the 268 scrotal ultrasound examinations with extratesticular lesions reviewed, 81 had the diagnosis confirmed on pathological or clinical grounds. The major pathological entities reviewed in the study were epididymitis, hydrocele, cystic lesions of the epididymis, post-vasectomy lesions and solid extratesticular lesions. The sonographic appearances in both acute and chronic epididymitis were reviewed. Clinical epididymitis had a typical clinical presentation and distribution confined to the epididymal tail and ductus deferens. This should allow a specific diagnosis to be made. Cystic lesions of the epididymis included true epididymal cysts and spermatoceles, but these entities were not distinguishable from each other sonographically. Late complications of vasectomy have been recognized clinically as the 'Late Post-Vasectomy Syndrome', and the pathological changes have also been described. In this study the corresponding sonographic appearances of sperm granulomata, dilated efferent ducts and spermatoceles are documented. Most solid extratesticular lesions are areas of fibrosis termed 'fibrous pseudotumours', but adenomatoid tumours and papillary cystadenomata are the most common neoplastic lesions. By obtaining pathological correlations for many sonographic extratesticular abnormalities, we have clarified a number of issues and made several new observations.

Humoral immune responses to filarial infection were investigated in 162 individuals, covering the full clinical and parasitological spectrum of bancroftian filariasis as seen in an endemic community of Kwale District, Kenya. Sera were tested for specific antifilarial antibodies (total immunoglobulins, IgM, IgGl, IgG4 and IgE) using ELISA. Most individuals showed an immunological response to the filarial antigen (prepared from adult Brugia pahangi). How these responses were related to the clinical manifestations, parasitological status and age was analysed by comparing the mean antibody levels among different categories of endemic individuals, and by comparing these to the levels in control groups from filariasis-free areas. IgM and IgE anti-filarial antibodies were detected with low specificity in unabsorbed sera. A higher specificity, clearly distinguishing the mean antibody levels in the endemic categories from those of control groups, was obtained for total specific immunoglobulins, and for IgE in sera absorbed with protein A. The most specific results were obtained for IgGl and IgG4; clear inter-category differences were observed for these classes. The mean level of specific IgG4 was significantly higher in microfilaraemic groups than in amicrofilaraemic groups, whereas the mean level of specific IgGl was significantly higher in amicrofilaraemic, symptomatic cases than in microfilaraemic, symptomatic cases. In most categories of endemic individuals, and for most antibody isotypes, the mean levels of specific antibodies tended to be higher (although not significantly) in the younger individuals than in the older individuals. Overall, the differences in the filarial antibody responses were more closely related to the presence or absence of microfilariae and to the age of the individuals than to the disease manifestations in this endemic population.

Malignant mesothelioma of the tunica vaginalis testis is a very rare tumor that is not usually diagnosed until surgery is undertaken. In only a few cases has the correct diagnosis been obtained preoperatively by cytologic examination of fluid from the hydrocele. We describe a case of mesothelioma of the tunica vaginalis testis that was suspected on sonography because of the presence of a hydrocele and focal nodularities. The diagnosis was confirmed preoperatively by ultrasound-guided fine-needle aspiration cytology aimed at 1 of the focal nodularities. Our patient was an 85-year-old man with concomitant cancer of the sigmoid colon; because of his age and the spread of his colon cancer, we did not remove the scrotal lesion. We recommend consideration of ultrasound-guided fine-needle aspiration cytology of the solid masses instead of the fluid from the hydrocele in cases of suspected malignant mesothelioma of the tunica vaginalis testis.

Our objective was to determine the accuracy of laparoscopic evaluation to detect a contralateral patent processus vaginalis (CPPV) at initial presentation for inguinal hernia (IH) repair and the rate of CPPV relative to age, sex, and initial hernia side. We performed a 5-year retrospective review of 1580 pediatric patients with unilateral IH in which surgeons selectively used laparoscopy to evaluate for a CPPV. There were 1205 boys and 303 girls; 980 (65%) presented with right IH (RIH) and 528 (35%) with left IH (LIH). Laparoscopic evaluation was performed in 459 (47%) patients presenting with RIH and 225 (43%) patients presenting with LIH. Laparoscopic evaluation was positive for CPPV in 32 per cent of patients with RIH and 42 per cent of patients with LIH (P = 0.0168). CPPV was associated with prematurity (P = 0.0003) and age younger than 6 months (P = 0.0001) but not with sex (P = 0.55). The future contralateral occurrence rate was 1.6 per cent and recurrence rate 0.2 per cent. This study supports the accuracy of CPPV evaluation by laparoscopy. Although the rate of CPPV decreases after 6 months of age, girls older than 2 years of age have a significantly higher rate of CPPV than boys, supporting laparoscopic evaluation in older girls.

Imatinib mesylate is a drug that has been approved for treatment of advanced gastrointestinal stromal tumors (GISTs) and patients with leukemia such as chronic myeloid or Philadelphia chromosome-positive acute lymphoblastic. Although it has been described only in one patient with testicular hydrocele and gynecomastia in the literature, several cases of male gynecomastia have been reported with the use of imatinib mesylate in chronic myeloid leukemia (GML). Generally, male mastoplasia resolves after discontinuation of imatinib treatment. We report a 73-year-old male with metastatic GISTs who developed gynecomastia and unilateral testicular hydrocele while receiving imatinib mesylate. Nine months after commencing imatinib treatment, gynecomastia and testicular hydrocele were determined. Hormone analyses requested showed serum testosterone levels below and serum estrogen levels above normal limits. During the first month after discontinuing imatinib mesylate treatment, serum testosterone level was normal and there was a partial regression in gynecomastia and testicular hydrocele. To our knowledge, this is the second report of male gynecomastia following imatinib mesylate treatment of a patient with GIST. In conclusion, male patients who are to receive treatment with imatinib mesylate may be monitored for serum testosterone levels and for other reproductive hormone profiles before initiation of the treatment and their breasts may be examined during follow-up visits.

A24-YEAR OLD MAN REPORTS PROGRESSIVE, RIGHT LOWER ABDOMINAL SWELLing and right scrotal enlargement over 2 years. He denies any pain or sudden changes in the size of the swelling. There is no history of trauma or urinary symptoms. Physical examination reveals a smooth, fluctuant, right abdominal swelling extending from the level of the umbilicus to the inguinal ligament (FIGURE 1). There is also a smooth, cystic swelling causing marked enlargement of the right half of the scrotum. There is no local warmth or tenderness. The left testis is within the scrotum, but the right testis is not palpable. When the patient is asked to cough, there is a palpable thrill. Palpation of the abdominal and scrotal swellings simultaneously reveals cross-fluctuation. Both the swellings are transilluminant. What Would You Do Next?

There is no question that therapy for a varicocele in cases of male infertility improves the ejaculate quality. New data provide hints for an additional influence on the pregnancy rates in infertile partnerships.