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Translational Andrology and Urology Aug 2017Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. In this manuscript, we review our indications, techniques,... (Review)
Review
Scrotal surgery encompasses a wide-variety of surgical techniques for an even wider variety of indications. In this manuscript, we review our indications, techniques, and pit-falls for various reconstructive scrotal surgeries as-well-as surgical tips for placement of testicular prostheses. Penoscrotal webbing (PSW) is an abnormal, often-problematic distal insertion of scrotal skin onto the ventral penile shaft. There are several effective and straightforward techniques used to revise this condition, which include simple scrotoplasty, single- or double-Z-plasty, or the VY-flap scrotoplasty. Reconstruction is also commonly indicated following scrotal skin loss caused by infection, trauma, lymphedema, hidradenitis, and cancer. Although initial management of these conditions often involves scrotal skin removal, repair of expansive scrotal skin loss can be technically difficult and can be accomplished by using one of several skin flaps or skin grafting. Split-thickness skin grafting of scrotal defects can be accomplished easily, and provides durable results.
PubMed: 28904904
DOI: 10.21037/tau.2017.07.06 -
Journal of Clinical Medicine May 2022The goal of this study was to determine the prevalence of the testicular, epididymal, and vasal anomalies (TEVA) in cryptorchid and communicating hydrocele pediatric...
The goal of this study was to determine the prevalence of the testicular, epididymal, and vasal anomalies (TEVA) in cryptorchid and communicating hydrocele pediatric patients. Six hundred and ninety-one prepubertal boys underwent inguinal exploration for 741 undescended (UDT) or hydrocele testes. Two hundred and fifty-five TEVA were detected in 154 UDT boys, compared to 32 defects in 24 hydrocele patients (p < 0.001). The TEVA were more frequent in bilateral UDT (p = 0.009). Multiple defects were observed more frequently in the intra-abdominal testicles (p = 0.028). A correlation was found between the testicular atrophy index (TAI) and the incidence and number of TEVA in the UDT boys (p < 0.001). The smaller the testis (higher TAI), the more the defects that appeared in it and the higher the frequency of their appearance. Another correlation was established between testis position and the incidence and number of TEVA (p < 0.001). The higher the testis position, the more the defects that appeared in it and the higher the frequency of their appearance. A correlation was established between the position and the volume of the affected testis (p < 0.001). The higher the gonad position, the more severe the atrophy observed in it. The TEVA were more frequent in the UDT boys than in the hydrocele patients. We revealed that the risk of abnormal fusion between the testis, epididymis, and vas deferens is connected with the testis position (intra-abdominal testes) and bilateral non-descent.
PubMed: 35683404
DOI: 10.3390/jcm11113015 -
American Family Physician Jan 2022
Topics: Aneurysm; Genital Diseases, Male; Hernia, Inguinal; Humans; Male; Middle Aged; Physical Examination; Scrotum; Spermatic Cord Torsion; Testicular Hydrocele; Testis; Varicocele
PubMed: 35029938
DOI: No ID Found -
Translational Andrology and Urology May 2017Chronic orchialgia is a vexing condition defined as chronic or intermittent scrotal pain lasting at least three months that significantly interferes with daily... (Review)
Review
Chronic orchialgia is a vexing condition defined as chronic or intermittent scrotal pain lasting at least three months that significantly interferes with daily activities. There are currently no guidelines regarding the diagnosis and management of this condition despite it being the cause of 2.5-4.8% of urologic clinic visits. Men often present with chronic orchialgia in their mid to late 30s, although the condition can present at any age. A broad differential diagnosis of chronic orchialgia includes epididymitis, testicular torsion, tumors, obstruction, varicocele, epididymal cysts, hydrocele, iatrogenic injury following vasectomy or hernia repair, and referred pain from a variety of sources including mid-ureteral stone, indirect inguinal hernia, aortic or common iliac artery aneurysms, lower back disorders, interstitial cystitis, and nerve entrapment due to perineural fibrosis; approximately 25-50% of chronic orchialgia is idiopathic in nature. In such cases, it is reasonable to consider psychological and psychosocial factors that may be contributing to chronic pain. Invasive testing is not recommended in the work-up of chronic orchialgia.
PubMed: 28725616
DOI: 10.21037/tau.2017.05.23 -
International Journal of Surgery Case... May 2021Testicular hemangioma is a rare benign testicular tumor. In this case we presented who an infant applied to our clinic with left scrotal swelling. The tests performed...
Testicular hemangioma is a rare benign testicular tumor. In this case we presented who an infant applied to our clinic with left scrotal swelling. The tests performed were found to be compatible with testicular hemangioma and accompanying hydrocele. We performed inguinal exploration due to hydrocele accompanying testicular hemangioma. Pathology of tissue was found to be compatible with testicular cavernous hemangioma. In our investigations, it was seen that it was the first infant cavernous hemangioma in the literature.
PubMed: 33848924
DOI: 10.1016/j.ijscr.2021.105844 -
Journal of Infection in Developing... Mar 2015Filarial hydrocele is the most common chronic manifestation of lymphatic filariasis (LF) and poses a major public health burden to several filarial endemic countries.... (Review)
Review
Filarial hydrocele is the most common chronic manifestation of lymphatic filariasis (LF) and poses a major public health burden to several filarial endemic countries. This review highlights the socio-economic impact of the disease, the role of the immune system in hydrocele development, current diagnostic approaches, and the control and management of filarial hydrocele. In the quest to facilitate the global effort to eliminate filarial hydrocele as a neglected tropical disease, a more comprehensive understanding of the mechanisms underlying the pathogenesis and development of the condition is important. In general, success has been achieved using annual treatment with ivermectin, but much remains to be done, particularly with late-stage infected individuals where surgery remains the only option. Studies have successfully demonstrated that inhibition of embryogenesis in adult female worms occurs after weeks of tetracycline treatment. Even more intriguing was the observation that the Wolbachia endosymbionts potently induce proinflammatory cytokines such as tumor necrosis factors (TNFs) and vascular endothelial growth factors (VEGFs), which are crucial for the development of filarial hydrocele. Furthermore, reports from human studies show that doxycycline treatment significantly ameliorates filarial hydrocele and markedly reverses early-stage filarial hydrocele. However, with the enormous challenges that face LF elimination such as global funding, logistics, civil wars, and drug resistance, a more relentless and collective approach from local governments as well as other stakeholders is needed to accelerate the fight against filarial hydrocele if the goal to eliminate it by 2020 is be to achieved.
Topics: Anti-Bacterial Agents; Doxycycline; Elephantiasis, Filarial; Humans; Male; Neglected Diseases; Testicular Hydrocele; Tropical Climate
PubMed: 25989164
DOI: 10.3855/jidc.5346 -
Translational Andrology and Urology Dec 2016Testicular compartment syndrome (TCS) refers to the impairment of microcirculation in the testicle due to either increased venous resistance or extraluminal compression,... (Review)
Review
Testicular compartment syndrome (TCS) refers to the impairment of microcirculation in the testicle due to either increased venous resistance or extraluminal compression, which leads to hypoxia. TCS releases oxidants through hypoxia and ischemia/reperfusion injury (IRI). The pathophysiology, etiology, evaluation, and management of TCS are reviewed. Based on the properties of TCS, specific causes, e.g., varicocele, hydrocele, orchitis, cryptorchidism, and scrotal hernia, are suggested and categorized. The oxidant-induced stress from TCS may explain the correlations between these causes and infertility. A chief shortcoming of current imaging modalities is that they detect TCS late after it has progressed to impair the macrocirculation of the testicle. We propose frequent sequential periodic power Doppler ultrasonography to monitoring for earlier detection. Intraoperatively, TCS can be diagnosed by the dull purple appearance of a hypoxic testicle and by tissue pressures above 30 mmHg. When compartment pressure is low, the underlying etiology must be promptly treated. During acute presentation, an incision of the resilient tunica albuginea may be necessary. A great challenge of treating TCS is restoring microcirculation while minimizing IRI; concomitant antioxidant therapy secondary to treatment may be effective and harmless at the least. Because testicular oxidant stress is common in infertility and since TCS can cause such a stress, TCS may be a larger factor in infertility than currently suspected.
PubMed: 28078225
DOI: 10.21037/tau.2016.11.05 -
Journal of Ultrasound in Medicine :... Mar 2015Discovery of scrotal swelling in a neonate can be a source of anxiety for parents, clinicians, and sonologists alike. This pictorial essay provides a focused review of... (Review)
Review
Discovery of scrotal swelling in a neonate can be a source of anxiety for parents, clinicians, and sonologists alike. This pictorial essay provides a focused review of commonly encountered scrotal masses and mimics specific to the neonatal setting. Although malignancy is a concern, it is very uncommon, as most neonatal scrotal masses are benign. Key discriminating features and management options are highlighted to improve the radiologist's ability to diagnose neonatal scrotal conditions and guide treatment decisions. Neonatal scrotal processes ranging from common to uncommon will be discussed.
Topics: Diagnosis, Differential; Hernia, Inguinal; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Patient Positioning; Scrotum; Spermatic Cord Torsion; Testicular Hydrocele; Testicular Neoplasms; Ultrasonography
PubMed: 25715370
DOI: 10.7863/ultra.34.3.495 -
PLoS Neglected Tropical Diseases Mar 2020Lymphatic 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...
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.
Topics: Adult; Aged; Aged, 80 and over; Cost-Benefit Analysis; Elephantiasis, Filarial; Humans; Malawi; Male; Middle Aged; Procedures and Techniques Utilization; Surgical Procedures, Operative; Surveys and Questionnaires; Testicular Hydrocele; Young Adult
PubMed: 32210436
DOI: 10.1371/journal.pntd.0008003 -
Ultrasound International Open Nov 2015Ultrasonography(US) of the scrotum has been demonstrated to be useful in the diagnosis of fluid in the scrotal sac. Grayscale US characterizes the lesions as testicular... (Review)
Review
Ultrasonography(US) of the scrotum has been demonstrated to be useful in the diagnosis of fluid in the scrotal sac. Grayscale US characterizes the lesions as testicular or extratesticular and, with color Doppler, power Doppler and pulse Doppler, any perfusion can also be assessed. Cystic or encapsulated fluid collections are relatively common benign lesions that usually present as palpable testicular lumps. Most cysts arise in the epidydimis, but all anatomical structures of the scrotum can be the site of their origin. US may suggest a specific diagnosis for a wide variety of intrascrotal cystic and fluid lesions and appropriately guide therapeutic options. The paper reviews the current knowledge of ultrasound in conditions with fluid in the testis and scrotum. The review presents the applications of ultrasonography in the diagnosis of hydrocele, testicular cysts, epididymal cysts, spermatoceles, tubular ectasia, hernia and hematoceles. The aim of this paper is to provide a pictorial review of the common and uncommon presentation of fluid within the scrotal spaces.
PubMed: 27689151
DOI: 10.1055/s-0035-1555919