-
International Journal of Surgery Case... Feb 2024A hydrocele is typically a non-cancerous condition that arises from the accumulation of fluid between the layers of the vaginal process. Diagnosis primarily involves a...
INTRODUCTION AND IMPORTANCE
A hydrocele is typically a non-cancerous condition that arises from the accumulation of fluid between the layers of the vaginal process. Diagnosis primarily involves a physical examination. In instances where the condition is mistaken for other pathological conditions, additional investigations may be undertaken. Surgical intervention is typically deferred until after the age of one year, unless the hydrocele is significantly large.
CASE PRESENTATION
A case was presented of a 4-year-old boy who was referred to the hospital with a suspected deep inguinal hernia. Upon examination, it was determined that the mass was actually an encysted hydrocele of spermatic cord. The patient underwent a minimally invasive surgery to remove the spermatocele, and the procedure was successful.
CLINICAL DISCUSSION
This emphasizes the importance of obtaining a detailed patient history and conducting a comprehensive physical examination, which often provide sufficient information to make a diagnosis. In many instances, these initial steps can spare patients from undergoing additional tests that may be invasive or pose unnecessary risks.
CONCLUSION
It is important to note that in cases of hydroceles, conservative treatment, such as observation, is the primary approach before the age of one year. Surgery is typically reserved for older children or those with large hydroceles.
PubMed: 38277986
DOI: 10.1016/j.ijscr.2024.109299 -
Asian Journal of Surgery Apr 2024
Topics: Male; Humans; Spermatic Cord Torsion; Testis; Scrotum
PubMed: 38242781
DOI: 10.1016/j.asjsur.2023.12.208 -
Cellular Physiology and Biochemistry :... Jan 2024Ischemic reperfusion (I-R) injury is greatly influenced by the testicular torsion/detorsion process (TDP). In this instance, the anti-inflammatory properties of...
BACKGROUND/AIMS
Ischemic reperfusion (I-R) injury is greatly influenced by the testicular torsion/detorsion process (TDP). In this instance, the anti-inflammatory properties of plateletrich plasma (PRP) combined with tadalafil (Td) significantly promote tissue healing in the I-R injury model.
METHODS
Five groups of rats were created: the control group, the I-R group not receiving any therapy, the I-R group receiving a single dosage of Td (0.25 mg/kg, I.P.), the I-R group receiving a single dose of PRP (80 l, intratesticular), and the I-R group receiving both Td and PRP. Sperm morphology, motility, and histology were assessed. The levels of TNF-, BAX, antioxidant status, and testosterone were measured. Additionally, E-selectin expression was done.
RESULTS
PRP reduced oxidative stress, inflammation, and apoptosis while also boosting testosterone levels, which alleviated I-R injury. Otherwise, PRP reduces E-selectin expression, which modifies the pathways that control endothelial function. Td also partially demonstrated its testicular-protective activity at the same time.
CONCLUSION
PRP's proven anti-inflammatory, antioxidant, and antiapoptotic potentials make it a natural treatment for testicular harm caused by tadalafil. For the first time, it was demonstrated that PRP therapy restored the functionality of the vascular endothelium, specifically the control of E-selectin expression. Combining Td and PRP therapy may be a promising strategy for improving response to PDE5 inhibitors.
Topics: Humans; Rats; Male; Animals; Spermatic Cord Torsion; Tadalafil; E-Selectin; Antioxidants; Semen; Testis; Reperfusion Injury; Testosterone; Platelet-Rich Plasma; Ischemia; Anti-Inflammatory Agents; Malondialdehyde
PubMed: 38232236
DOI: 10.33594/000000680 -
Cureus Dec 2023Introduction Testicular torsion is an urological emergency. It is a time-sensitive condition in which twisting of the spermatic cord and testicular blood supply occurs,...
Introduction Testicular torsion is an urological emergency. It is a time-sensitive condition in which twisting of the spermatic cord and testicular blood supply occurs, causing acute onset severe scrotal pain. The incidence of testicular torsion is highest amongst prepubertal males; however, it can occur at any age. Every hour that passes from the onset of symptoms has been shown to decrease the salvageability rate of the torted testis. Another significant factor that impacts testicular salvage is the degree of torsion. Prompt surgical exploration of the scrotum and orchidopexy, if the testis is salvageable, is the mainstay of treatment. A major sequela following orchidopexy for torsion is the decrease in testicular volume. The aim of this study is to assess testicular volume loss post orchidopexy in patients who presented with testicular torsion, as well as to identify the significance of the degree of rotation and duration of torsion in post-fixation volume loss. Methods This is a retrospective study in which all patients who underwent scrotal exploration for a primary diagnosis of testicular torsion between June 1, 2016, to January 15, 2023, were reviewed. The information obtained included the patients' demographics such as age, duration of symptoms, and laterality. Ultrasound images were reviewed for pre- and postoperative findings which included confirmation of testicular torsion as well as testicular volume measurements. Patients were excluded if they underwent an orchidectomy, had a diagnosis other than testicular torsion once scrotal exploration was done, or did not perform a follow-up scrotal ultrasound. Additionally, patients who underwent an orchidopexy for undescended testis earlier in life were also excluded. For statistical analysis purposes, degrees of testicular torsion and time to surgery were classified into mild, moderate, and severe. Results A total of 109 patient records were reviewed within the specific time frame. Of these, 47 patients were excluded as per the exclusion criteria mentioned previously, which gave us a sample size of 62 patients. Our findings showed that increasing severity of the degree of torsion as well as the time for surgery have statistically significant (p-value <0.05) effects on postoperative testicular volume loss. However, it was noted that time to surgery has a more pronounced effect on the mean volume loss than the degree of torsion. Moreover, the analysis also showed that, on average, with every additional hour from the onset of symptoms to surgery, the approximate volume loss is 0.15 ml. However, once time exceeds the 4.5-hour mark, the mean volume loss is 0.4 ml for each additional hour. Conclusion The current study indicates that earlier surgical intervention and correction of torsion are associated with enhanced preservation of postoperative testicular volume. Both the degree of torsion and time to surgery influence mean volume loss; however, time to surgery has a greater impact on the mean volume loss. These results highlight the importance of early diagnosis and intervention in cases of testicular torsion to minimize the risk of long-term testicular volume loss.
PubMed: 38222190
DOI: 10.7759/cureus.50543 -
Cureus Dec 2023Para testicular or intra-scrotal Rhabdomyosarcomas (RMS) are rare. The spindle cell variant of rhabdomyosarcoma is the least common variant among embryonal subtypes....
Para testicular or intra-scrotal Rhabdomyosarcomas (RMS) are rare. The spindle cell variant of rhabdomyosarcoma is the least common variant among embryonal subtypes. They are mostly seen in childhood but rarely reported in adults. We present a case of a 56-year-old man who presented with a three-year history of painless left inguinoscrotal swelling, which he initially ignored and misinterpreted as an Inguinal hernia but later sought medical help upon a progressive increase in the size of the swelling. Clinically and radiologically, there was sparing of the left testis and spermatic cord with normal testicular tumor markers and no evidence of lymphadenopathy or metastasis. Surgical exploration was performed with complete excision of the mass, followed by histopathology and immunocytochemistry, confirming the diagnosis of spindle cell rhabdomyosarcoma. Prompt recognition, early diagnosis, and appropriate surgical treatment are the hallmarks of management. Regular and strict follow-up is needed due to the rarity of diagnosis.
PubMed: 38186500
DOI: 10.7759/cureus.50082 -
Scientific Reports Dec 2023This study aimed to investigate the clinical and social factors of delayed treatment for testicular torsion (TT) and to explore the risk factors of testicular excision...
This study aimed to investigate the clinical and social factors of delayed treatment for testicular torsion (TT) and to explore the risk factors of testicular excision in China. The clinical data of 1005 patients with TT who were admitted to 48 medical institutions in Chongqing city (China) from January 2012 to December 2021 were retrospectively analyzed. It was revealed that the misdiagnosis rates of non-senior (junior and middle) grade doctors and senior doctors were 25.1% and 9.6%, respectively. The proportion of TT patients who received timely treatment (within 6 h after onset of symptoms) was 23.8%. The results of the multivariable logistic regression analysis indicated that absent cremasteric reflex was a protective factor for delayed surgery of more than 6 h from onset of symptoms to surgery. Misdiagnosis, consultation with a non-urologist as the first consultant doctor, absence blood flow in color Doppler ultrasound, negative high-riding testis findings, the presence of fever, and non-manual detorsion were identified as risk factors associated with delayed surgery (more than 6 h from the onset of symptoms) for TT. Furthermore, misdiagnosis, non-urologist first-consultant doctor, absent blood flow in DUS, non-manual detorsion, fever, degree of cord twisting > 180, and the initial diagnosis in tertiary hospitals were risk factors for orchidectomy. Having TT on the right side, and the presence of nausea and vomiting were identified as protective factors for orchidectomy. Technical training in the diagnosis and treatment of TT should be extended to primary hospitals and doctors to significantly improve their accuracy in managing this condition.
Topics: Male; Humans; Spermatic Cord Torsion; Cross-Sectional Studies; Delayed Diagnosis; Retrospective Studies; China
PubMed: 38123616
DOI: 10.1038/s41598-023-49820-9 -
Cureus Nov 2023The inguinal canal lipoma, known as spermatic cord lipoma in men or round ligament lipoma in women, has a variable incidence (22.5% to 75%) during inguinal hernioplasty...
The inguinal canal lipoma, known as spermatic cord lipoma in men or round ligament lipoma in women, has a variable incidence (22.5% to 75%) during inguinal hernioplasty procedures. The presence of a true lipoma in this region is considered rare and often underestimated by surgeons. A young female patient was diagnosed with a large true inguinal canal lipoma. Resection was performed using both videolaparoscopic and conventional techniques, based on a careful preoperative evaluation of anatomical parameters. The high incidence of lipomas in the inguinal canal contributes, in part, to the interpretation of fatty masses as "lipomas" during herniorrhaphy procedures. However, many of these are actually extrusions of extraperitoneal adipose tissue, maintaining dimensions within the physiological limits of the region. This confusion in classification highlights the complexity of differentiating between true lipomas and adipose protrusions. Based on a case report enriched with distinct clinical features and images, we sought to exemplify a surgical approach to a large true inguinal canal lipoma. This report not only emphasizes the rarity of the pathology but also underscores the importance of an effective and differentiated surgical approach for true lipomas in this location.
PubMed: 38106746
DOI: 10.7759/cureus.48829 -
Revista Do Colegio Brasileiro de... 2023it is estimated that approximately 20 million people undergo inguinal hernia surgery annually in the world, with the Lichtenstein technique being the most performed... (Review)
Review
INTRODUCTION
it is estimated that approximately 20 million people undergo inguinal hernia surgery annually in the world, with the Lichtenstein technique being the most performed surgical procedure. The objective of this study is to analyze the knowledge of the technical principles used in the Lichtenstein technique.
METHOD
Survey-type intersectional study approved by the research ethics committee of São Camilo University Center (CAAE: 70036523.1.0000.0062). During the research period, 11,622 e-mails were sent to members of the main national surgical societies with research on the technical principles of Lichtenstein surgery. The survey was carried out using an electronic form with 10 multiple-choice questions. The form was answered anonymously on the SurveyMonkey and Google Forms platforms.
RESULT
744 responses were received to the electronic form. Based on this number of respondents, our survey has a confidence level of 95% with a margin of error of 3.5%. It was observed that there is no standardization of the technique among the majority of responders (53.4%). Many surgeons still perform digital dissection of the spermatic cord (47%). A small number of interviewees (15.2%) performed sutures with absorbable thread in the region of the internal oblique aponeurosis, while more than half (55.2%) continued to perform sutures with non-absorbable thread. Most surgeons use a small overlap or fix the mesh juxtaposed to the pubic symphysis (51%).
CONCLUSION
Our research identified that a small percentage of respondents adequately know the technical principles of Lichtenstein surgery. The result brings us new insights into the need to review Lichtenstein technique.
Topics: Humans; Male; Dissection; Groin; Hernia, Inguinal; Herniorrhaphy; Recurrence; Surgical Mesh
PubMed: 38088634
DOI: 10.1590/0100-6991e-20233655-en -
Asian Journal of Surgery Mar 2024
Topics: Male; Humans; Seminoma; Spermatic Cord Torsion; Cryptorchidism; Testicular Neoplasms
PubMed: 38065738
DOI: 10.1016/j.asjsur.2023.11.159 -
Archivos Espanoles de Urologia Nov 2023To investigate the correlation between temperature and testicular torsion in Jiaodong Peninsula which has temperate continental monsoon climate and is represented by...
BACKGROUND
To investigate the correlation between temperature and testicular torsion in Jiaodong Peninsula which has temperate continental monsoon climate and is represented by Yantai and its surrounding areas.
METHODS
A retrospective analysis was conducted by reviewing clinical data of 292 patients who were admitted and surgically confirmed to have testicular torsion in the Yantai Yuhuangding hospital medical complex between January 1, 2009, and August 31, 2022. Male patients who underwent circumcision (foreskin) were allocated to the control group. Temperature data were obtained from the China Meteorological Data Service Center. Chi-squared test or Fisher's exact test and one-way analysis of variance were employed to compare patient characteristics and climatic variables among the different groups. Pearson's correlation analysis was used to analyze the association between monthly average ambient temperature and monthly cumulative number of cases. Moreover, a logistic regression model was utilized to identify the independent factors of testicular torsion.
RESULTS
The mean age of patients with testicular torsion was 16.8 years. The number of cases was the highest in autumn. The temperature was the highest in summer and the lowest in winter ( < 0.01). Furthermore, the temperature difference (TD) in autumn was the highest in the four seasons groups ( < 0.01). The patients were divided into the high TD and low TD groups according to the mean TD (7.62 C) on the admission day. The high TD group had a higher number of patients than the low TD group, and the temperature was lower in the former group than in the latter group ( < 0.01). A roughly negative correlation was observed between ambient temperature and the number of cases (Pearson's r = -0.228, 95% confidence interval (CI): -0.366 to -0.079, = 0.003). Logistic regression analysis revealed that the independent risk factor for testicular torsion was TD on admission day (odds ratio, 1.82; 95% CI, 1.28-2.59; < 0.001).
CONCLUSIONS
To some extent, external temperature can affect the body surface temperature of patients and then induce testicular torsion. We concluded that testicular torsion easily occurs in the season in which the temperature drops and the TD is high.
Topics: Humans; Male; Adolescent; Spermatic Cord Torsion; Retrospective Studies; Temperature; Cold Temperature; Seasons
PubMed: 38053424
DOI: 10.56434/j.arch.esp.urol.20237609.84