-
BMC Urology May 2024Congenital inguinal hernia, hydrocele and undescended testis (UDT) are associated with patent processus vaginalis. The smooth muscles present in the processus vaginalis... (Comparative Study)
Comparative Study
BACKGROUND
Congenital inguinal hernia, hydrocele and undescended testis (UDT) are associated with patent processus vaginalis. The smooth muscles present in the processus vaginalis aid in the descent of the testis and undergo programmed cell death after testicular descent leading to obliteration. The persisting amount of smooth muscle in the processus vaginalis influences the clinical outcome as inguinal hernia, hydrocele or UDT. Therefore, a study was conducted to evaluate the processus vaginalis in these three conditions to observe the presence and phenotype of smooth muscle cells and the presence of myofibroblasts.
MATERIALS AND METHODS
The processus vaginalis sacs in patients with inguinal hernia, hydrocele and UDT were examined using light microscopy for the presence and distribution of smooth muscle cells and immunohistochemical staining for vimentin, desmin, and α-smooth muscle actin (SMA) to identify the smooth muscle phenotype. Transmission electron microscopy was also performed in all the sacs to observe the presence of myofibroblasts.
RESULTS
Seventy-eight specimens of processus vaginalis (from seventy-four patients), distributed as 47%, 27%, and 26% as inguinal hernia, hydrocele and UDT respectively, were included in the study. The sacs from inguinal hernia and hydrocele had significantly more presence of smooth muscles distributed as multiple smooth muscle bundles (p < 0.001). Desmin and SMA staining of smooth muscle cells was observed in significantly more sacs from hydrocele, followed by inguinal hernia and UDT (p < 0.001). The sacs from UDT had a significant presence of striated muscles (p = 0.028). The sacs from inguinal hernia had a significant presence of myofibroblasts, followed by hydrocele and UDT (p < 0.001) and this significantly correlated with the light microscopy and immunohistochemical features. The processus vaginalis sacs from four female patients did not differ statistically from the male inguinal hernia sacs in any of the above parameters.
CONCLUSION
The processus vaginalis sacs in pediatric inguinal hernia, hydrocele and undescended testis differ in the presence, distribution and phenotype of smooth muscles and the presence of myofibroblasts. The clinical presentations in these entities reflect these differences.
Topics: Humans; Male; Testicular Hydrocele; Hernia, Inguinal; Infant; Cryptorchidism; Child, Preschool; Myocytes, Smooth Muscle; Child; Myofibroblasts; Infant, Newborn
PubMed: 38816716
DOI: 10.1186/s12894-024-01449-0 -
Cureus Apr 2024Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare tumor of the testicular sheath. More than 50% of cases initially present as recurrent hydrocele,...
Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare tumor of the testicular sheath. More than 50% of cases initially present as recurrent hydrocele, but there have also been documented cases with hematocele, inguinal hernia, or epididymitis. Due to the non-specific symptoms and signs of the disease, it is almost always diagnosed intra- or postoperatively. The lack of standardized therapy protocols, as well as the lack of evidence supporting systemic chemotherapy, have fueled arguments in favor of the necessity of retroperitoneal lymph node dissection (RPLND) in the treatment of the disease, especially in the case of lymph node metastasis. We present a case of MMTVT achieving prolonged remission after timely and extensive surgical treatment.
PubMed: 38800313
DOI: 10.7759/cureus.59052 -
Medicina (Kaunas, Lithuania) May 2024: Scrotal swelling or hydrocele is a rare complication of acute pancreatitis described in the literature. We present a case of penoscrotal swelling caused by the first...
: Scrotal swelling or hydrocele is a rare complication of acute pancreatitis described in the literature. We present a case of penoscrotal swelling caused by the first attack of acute interstitial edematous alcohol-induced pancreatitis in a young male patient. : A 22-year-old man was admitted to the emergency unit due to diarrhea and vomiting since morning which was followed by severe abdominal pain. Urgent abdominal multislice CT scan showed steatosis, pancreatic swelling and acute peripancreatic fluid collection (interstitial edematous pancreatitis). Also, scan showed fluid between small bowel loops and along the anterior renal fascia, while there was minimal amount of fluid in the Douglas space. There was no sign of penoscrotal swelling. On the second day of admission, the patient developed left scrotal swelling and mild pain without erythema. On the fourth day, a control CT scan showed progression to moderately severe pancreatitis (CT severity index 4). Dilated scrotal veins of the pampiniform venous plexus with an increased caliber of the testicular veins were present on both sides, from the scrotum to the level of the inguinal canal. Penoscrotal swelling was significantly reduced on discharge. : Penoscrotal swelling is a rare complication or manifestation of acute inflammation of the pancreas. It is important to identify scrotal swelling caused by pancreatitis because in severe cases it can be related to possible infertility in the future.
Topics: Humans; Male; Scrotum; Young Adult; Edema; Pancreatitis; Acute Disease; Adult; Tomography, X-Ray Computed
PubMed: 38793003
DOI: 10.3390/medicina60050820 -
Translational Andrology and Urology Apr 2024Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence....
Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. The advantages of the microscopic approach to varicocele repairs are detailed identification and preservation of the vascular structures. In this study, our purpose is to review the outcome of all patients that underwent microscopic subinguinal varicocelectomy with the video telescopic operating microscope (VITOM). Hence, a retrospective review of 23 varicocele patients who underwent microscopic subinguinal varicocelectomy at the center from the year 2019 until 2021 was done. They, ranging between 18 to 58 years of age, comprising one case of right varicocele, fifteen cases of left varicocele, and seven cases of bilateral varicocele, were all having symptoms (pain and swelling) and clinically palpable varicocele. Ultrasounds were done to confirm the diagnosis and measure the testicular size. The surgery was performed by a single surgeon, under spinal anesthesia. The operation was performed using the VITOM telescope system, with an average operative time of one hour. The patients were followed-up at one month postoperatively to review the wound and symptoms. Phone call evaluations of all 23 patients were done to detect any recurrence or complications. All patients were discharged one day after surgery. Post-operative, all of them have a well-formed scar at the previous subinguinal region incision wound during the clinic visits. None of the 23 patients reported with varicocele recurrence, testicular pain, hydrocele formation or sexual dysfunction. The previous testicular pain or discomfort they encountered prior to the surgery was resolved as well. In conclusion, microscopic subinguinal varicocelectomy using the VITOM telescope is feasible and could achieve good outcomes.
PubMed: 38721290
DOI: 10.21037/tau-23-586 -
POCUS Journal 2024Studies have demonstrated the high sensitivity and specificity of pediatric emergency department (PED) point of care ultrasound (POCUS) in the evaluation of testicular...
Studies have demonstrated the high sensitivity and specificity of pediatric emergency department (PED) point of care ultrasound (POCUS) in the evaluation of testicular torsion. Rarely, testicular torsion may present with intact blood flow. Here, we present a case series of four children with testicular torsion confirmed intraoperatively, who had intact blood flow on POCUS. Markers of testicular torsion can include surrounding hydrocele, heterogenous echotexture, absent venous or high resistance arterial flow, or a torsed cord complex. POCUS practitioners should be familiar with these findings, and the presence of any one or more of these findings should prompt urgent urology consultation to avoid missed torsion.
PubMed: 38681172
DOI: 10.24908/pocus.v9i1.17201 -
Frontiers in Oncology 2024Adenocarcinoma of the rete testis (AORT) is an extremely rare and aggressive tumor with a poor prognosis. Its etiology and pathological characteristics have not been...
BACKGROUND
Adenocarcinoma of the rete testis (AORT) is an extremely rare and aggressive tumor with a poor prognosis. Its etiology and pathological characteristics have not been extensively studied, making accurate diagnosis and appropriate management challenging. AORT, an invasive testicular tumor with a mortality rate of 46%, treatment typically involves radical orchiectomy, retroperitoneal pelvic lymph node dissection (RPLND), adjuvant chemotherapy, and/or ongoing monitoring, but the response to conventional radiation and chemotherapy is limited. At present, no effective targeted therapy for AORT has been found.
CASE DESCRIPTION
In this case report, we present the clinical scenario of a 50-year-old male patient initially diagnosed with a right testicular hydrocele, who subsequently underwent eversion of the parietal tunica vaginalis. Postoperative pathological analysis revealed metastatic clear cell renal cell carcinoma (ccRCC). PET/CT demonstrated findings suggestive of left renal upper pole carcinoma with involvement of the right scrotum, para-aortic region, bilateral iliac vessels, bilateral inguinal region, and multiple metastases. Sunitinib, a tyrosine kinase inhibitor, is commonly employed in the treatment of ccRCC. The patient underwent treatment with sunitinib for a duration of 20 months, resulting in the inactivation of multiple metastases. Following this, a radical orchiectomy was performed, and the postoperative pathology confirmed the presence of AORT. This article provides a comprehensive account of the patient's medical history, diagnostic process, treatment modalities, and subsequent follow-up observations.
CONCLUSIONS
This case report highlights the successful use of targeted therapy with sunitinib in a patient with AORT. The patient showed a positive response to targeted therapy. This study not only provides a novel foundation for the treatment of AORT, but also offers valuable insights for future treatment strategies in managing this particular form of testicular cancer.
PubMed: 38651150
DOI: 10.3389/fonc.2024.1358133 -
Frontiers in Oncology 2024Colorectal cancer, with the liver being the most common site of distant metastasis, followed by the lungs and bones. Although reports of metastasis to the testis exist,...
Colorectal cancer, with the liver being the most common site of distant metastasis, followed by the lungs and bones. Although reports of metastasis to the testis exist, paratesticular metastasis is extremely rare. A 37-year-old male presented with scrotal swelling. Ultrasound revealed hydrocele of the tunica vaginalis. The patient underwent routine surgical treatment, and postoperative pathology of the tunica vaginalis indicated adenocarcinoma of gastrointestinal origin. Colonoscopic biopsy confirmed adenocarcinoma of the sigmoid colon. After six months of systemic therapy, tumor reduction surgery was performed in conjunction with tunica vaginalis excision. Postoperative pathology suggested histological similarity in both sites, with immunohistochemistry results supporting the diagnosis of sigmoid colon adenocarcinoma metastasizing to the tunica vaginalis. We conducted a literature review, summarizing and discussing clinical presentations, metastatic pathways, and diagnostic approaches.
PubMed: 38646436
DOI: 10.3389/fonc.2024.1373760 -
Cirugia Pediatrica : Organo Oficial de... Apr 2024Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males. Varicocele diagnosis is important since it can induce... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Varicocele is the abnormal dilatation of the pampiniform plexus. It occurs in 15-20% of pre-adolescent/adult males. Varicocele diagnosis is important since it can induce testicular hypertrophy and fertility issues in adulthood. The objective of this study was to assess whether complications, including varicocele recurrence, depend on the vascular occlusion technique used -clipping + division vs. vascular sealer- in the laparoscopic Palomo technique used in our institution.
MATERIALS AND METHODS
A longitudinal, prospective study was carried out from 2017 to 2021. Two therapeutic groups were created according to the vascular occlusion method used during laparoscopic varicocelectomy -clipping + division vs. vascular sealer. Patients were randomly allocated to the groups in a systematic alternating consecutive manner. Variables -age, varicocele grade according to the Dubin-Amelar classification, postoperative complications, follow-up, and varicocele recurrence- were analyzed according to the method employed.
RESULTS
A total of 37 boys, with a mean age of 12 years (10-15 years) and a mean follow-up of 12 months, were studied. In 20 patients (54.1%), clipping + division was used, and in the remaining 17 (45.9%), the vascular sealer was employed. 24.3% had symptomatic Grade II varicocele and 75.7% had Grade III varicocele. 32.4% of the children had postoperative complications during follow-up. 29.7% of the patients had hydrocele following surgery -8 boys from the sealing group and 3 boys from the clipping group-, with 13.5% requiring re-intervention as a result of this. None of the patients had varicocele recurrence.
CONCLUSIONS
The laparoscopic Palomo technique is safe and effective, with good results in pediatric patients and few postoperative complications, regardless of the vascular occlusion device used. In our study, no statistically significant differences regarding the use of clipping or vascular sealer in this laparoscopic technique were found. However, further studies with a larger sample size are required to find potential differences.
Topics: Male; Adolescent; Humans; Child; Prospective Studies; Varicocele; Retrospective Studies; Laparoscopy; Postoperative Complications; Treatment Outcome
PubMed: 38623800
DOI: 10.54847/cp.2024.02.16 -
Journal of Laparoendoscopic & Advanced... Mar 2024Laparoscopic sac disconnection and peritoneal closure represents an alternative to open pediatric hernia repair. We performed a retrospective review of our data to...
Laparoscopic sac disconnection and peritoneal closure represents an alternative to open pediatric hernia repair. We performed a retrospective review of our data to evaluate this alternative method. With REB approval, a retrospective chart review of all patients who underwent laparoscopic indirect inguinal hernia repair between June 2013 and July 2016 was conducted. Primary outcome was the recurrence rate. Secondary outcomes included length of surgery, postoperative hydrocele, and perioperative complications. Data were extracted from EPIC Hyperspace onto a standardized data extraction form. A total of 243 patients were included, of which 82% were males. Age ranged from 1 month to 17 years of age. A total of 322 defects were repaired. Eighty (32%) had contralateral patent processus vaginalis. Twelve (4%) patients presented with incarceration and three (1.2%) had a direct inguinal hernia defect. Recurrence rate was 0.6% ( = 2). There were no intraoperative complications. Operative time was an average of 40 and 54 minutes for unilateral and bilateral repairs, respectively. No testicular ascents, testicular atrophy, vas deferens injury, postoperative hydroceles, and wound infections were reported. Laparoscopic sac disconnection and peritoneal closure of pediatric inguinal hernia is a safe, feasible method with one of the lowest reported recurrence rate among the other laparoscopic methods.
PubMed: 38526574
DOI: 10.1089/lap.2023.0425 -
Urology Case Reports May 2024We report a case of epididymo-orchitis (EO) in a 12-day-old Saudi boy. The neonate, initially diagnosed with hydrocele post-delivery, presented with left scrotal...
We report a case of epididymo-orchitis (EO) in a 12-day-old Saudi boy. The neonate, initially diagnosed with hydrocele post-delivery, presented with left scrotal swelling. Doppler ultrasound revealed normal testicles but an enlarged, echogenic left epididymis with pyocele. Despite initial therapy with amoxicillin and cefotaxime, a repeated ultrasound indicated compromised testicular vascularity, necessitating emergency surgical exploration. This revealed purulent discharge and inflammation, with as a causative agent. Post-surgery, the patient showed significant improvement and was discharged in good condition after a ten-day of hospitalization. The study emphasizes the significance of including EO in the possible diagnoses for neonatal scrotal swelling.
PubMed: 38516173
DOI: 10.1016/j.eucr.2024.102702