Case Of Testicular Atrophy Research Articles

Микрохирургическая подпаховая варикоцелэктомия в лечении первичного варикоцеле. Опыт университетской клиники урологии РНИМУ им. Н.И. Пирогова.

Introduction. Varicocele is a common condition in men that affects fertility. There are many options for varicocele surgical treatment. Marmar operation shows the best results. Purpose of the study. To study the efficiency of microsurgical varicocelectomy among initially operated patients. Materials and methods. We performed microsurgical treatment in 198 patients with varicocele for 5 years in Pirogov First City Hospital. The mean age of patients was 28 years. 121 patients (61.1%) underwent surgery because of pain syndrome. Infertility was identified in 84 patients (42.4%). Pathospermia was determined in 147 patients (74.2%). Testicular hypotrophy was noted in 68 patients (34,3%). Results. Scrotal pain was relieved in 108 patients (90%). Within 6-36 months after the operation 25 couples (29.8%) had a natural conception. Improvements in sperm parameters were achieved in 104 patients (70.8%). Testicular volume increased at 2.0±0.5 ml in average. Postoperative hydrocele was observed in 5 patients (2.5%). Once wound suppuration was observed. No cases of testicular atrophy were identified. The recurrence rate was 3.5% (n=7). Conclusion. Microsurgical varicocelectomy is the optimal varicocele treatment in terms of efficacy, recurrence rate and complications. Using of microsurgical techniques and instruments makes it possible to identify precisely all venous trunks, including small collaterals, and minimize the risk of intraoperative injury of the testicular artery and lymphatic vessels. Marmar operation is the method of choice in initial treatment of patients with primary diagnosed varicocele.

Ultrasonic Scalpel vs. Polymeric Clip Laparoscopic Varicocelectomy in Adolescents with Symptomatic Varicocele.

Background: The aim of this study was to investigate treatment outcomes in adolescents who underwent laparoscopic surgery with an ultrasonic scalpel for symptomatic varicocele compared with adolescents who underwent surgery with a polymer clip. Methods: A total of 270 adolescents with a median age of 16 (interquartile range, IQR 13-17) years were included in the study. Taking into account the laparoscopic varicocelectomy technique used, the patients were divided into two groups. In the first group (n = 151), a polymer clip was used, while in the second group (n = 119), an ultrasonic scalpel was used to resect the spermatic vessels. The primary outcome measure was the effect of the laparoscopic technique used on treatment outcomes (postoperative complications and recurrence rates). Secondary outcomes were the duration of surgery and anesthesia and the length of hospital stay. Results: The duration of the surgical procedure (12 min (IQR 11, 15) versus 15 min (12, 19), p = 0.029) and anesthesia (21.5 min (16, 29.5) versus 28 min (23, 34), p = 0.003) was shorter in the group of adolescents in whom laparoscopic varicocelectomy was performed with an ultrasonic scalpel than in the group in which a polymer clip was used. No statistically significant difference was found between the groups studied in terms of length of hospital stay, recurrence rate (p >0.999), and complications (p = 0.703). There were no cases of testicular atrophy in either group. In the group of patients who underwent laparoscopic varicocelectomy with an ultrasonic scalpel, a slightly higher incidence of hydroceles was found (n = 4, 3.4%) than in the group in which a polymer clip was used (n = 2, 1.3%) (p = 0.410). At six-month follow-up, it was found that the majority of patients showed moderate or significant improvement in the spermogram after laparoscopic varicocelectomy (n = 85, 89.5%). In addition, the subjective discomfort or pain disappeared in the majority of patients (n = 71, 93.4%). The testicular volume increased significantly in 132 adolescents (89.8%). Conclusions: Laparoscopic varicocelectomy with a polymer clip or ultrasonic scalpel is safe and effective in adolescents with symptomatic varicocele. Treatment outcomes after laparoscopic varicocelectomy are the same regardless of whether a polymer clip or an ultrasonic scalpel is used to resect the spermatic vessels. The use of an ultrasonic scalpel for resection of the spermatic vessels shortens the overall duration of surgery and anesthesia.

A novel technique for the single-port laparoscopic percutaneous extraperitoneal closure (SLPEC) of paediatric isolated giant inguinal hernias using double-modified hernia needles

The objective was to explore the efficacy of single-port laparoscopic percutaneous extraperitoneal closure using double-modified hernia needles with hydrodissection (SLPEC group) and two-port laparoscopic percutaneous extraperitoneal closure (TLPEC group) for the treatment of giant indirect inguinal hernias in children. We performed a retrospective review of all children with giant indirect inguinal hernias (inner ring orifice diameter ≥ 1.5 cm) who underwent laparoscopic high ligation of the hernia sac at FuJian Children’s Hospital from January 2019 to December 2021. We collected data from the medical records of all the children and analysed their clinical characteristics and operation-related and follow-up information. Overall, this study included a cohort of 219 patients with isolated giant inguinal hernias who had complete clinical data and who had undergone laparoscopic high ligation of the hernia sac at our centre. All procedures were successfully performed for the 106 patients who underwent SLPEC and for the 113 patients who underwent TLPEC at our centre. There were no statistically significant differences in patient age, sex, body weight, follow-up time or the side of inguinal hernia between the SLPEC group and the TLPEC group (P = 0.123, 0.613, 0.121, 0.076 and 0.081, respectively). However, there were significant differences in the bleeding volume, visual analogue scale (VAS) score, and postoperative activity time between the two groups (P ≤ 0.001). The operation times in the TLPEC group were significantly longer than those in the SLPEC group (P = 0.048), but there were no significant differences in hospital length of stay or hospitalization costs between the two groups (P = 0.244 and 0.073, respectively). Incision scars were found in 2 patients in the SLPEC group and 9 patients in the TLPEC group, and there was a significant difference between the two groups (P = 0.04). However, the incidence of ipsilateral hernia recurrence, surgical site infection, suture-knot reactions and chronic inguinodynia did not significantly differ between the two groups (P = 0.332, 0.301, 0.332 and 0.599, respectively). Postoperative hydrocele occurred in only 1 male child in the SLPEC group and in no male children in the TLPEC group, and there was no difference between the two groups (P = 0.310). In this study, there were no cases of testicular atrophy or iatrogenic ascent of the testis. Compared with the TLPEC group, the SLPEC group had the advantages of a concealed incision, light scarring, minimal invasiveness, a reduced operation time, minimal bleeding, mild pain and rapid recovery. In conclusion, SLPEC using double-modified hernia needles with hydrodissection and high ligation of the hernia sac is a safe, effective and minimally invasive surgery. The cosmetic results are impressive, and the follow-up results are promising.

Laparoscopic percutaneous closure of patent processus vaginalis without hydrocelectomy for childhood primary hydrocele.

To present our surgical technique and the outcome of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) of patent processus vaginalis (PPV) without hydrocelectomy for childhood primary hydrocele (CPH). A prospective study was conducted on all cases of CPH treated with SILPEC at our center between June 2016 and December 2021. In our SILPEC procedure, PPV was closed extraperitoneally using a percutaneous needle with a wire lasso. No hydrocelectomy or fenestration of the hydrocele was performed. Percutaneous aspiration was performed when the hydrocele fluid could not be pushed back to the peritoneal cavity. 553 patients were enrolled, with a median age of 34months (range from 22months to 13years). Ipsilateral PPV was present in all cases. There were no intraoperative complications and no conversion. At follow-up 6-72months, recurrent hydrocele occurred in 0.36%, and subcutaneous stitch inflammatory reaction was noted in 0.7%. There was no case of testicular atrophy or iatrogenic cryptorchidism. Postoperative cosmesis was excellent as all patients were virtually scarless. Ipsilateral PPV was present in all cases of CPH in our series. Our technique of SILPEC of PPV without hydrocelectomy is feasible and safe, with excellent postoperative cosmesis in the management of CPH.

Standardized single-stage laparoscopic Fowler-Stephens orchiopexy regardless of testis position: Modification of technique eliminates the need for intra-operative decision-making.

It is generally perceived that a primary laparoscopic orchiopexy has superior outcomes due to preservation of the testicular artery, and thus should be the choice when achievable. The two-stage laparoscopic Fowler-Stephens orchiopexy (LFSO) is considered superior regarding success rate compared to the one-stage procedure when the artery must be transected. Outcomes can be jeopardized when a primary orchiopexy is ultimately realized to be the incorrect procedure due to insufficient testicular artery length. It is preferable to decide the approach before initiating dissection, however, in reality, this does not always occur. A single uniform approach to all intraabdominal testes (IAT) that takes into consideration the main challenges encountered when performing laparoscopic orchiopexy can simplify the approach and potentially achieve good outcomes. We present our experience with a standardized approach for IAT regardless of testicular position and describe the surgical modification needed to achieve good results with the one-stage LFSO. Key surgical maneuvers implicated in the modified one-stage LFSO (M-LFSO) include preservation of a wide peritoneal flap between the vessels and the vas deferens, dissecting the vessels as proximal as possible and avoiding manipulation of the epididymis and vessels between the vas and epididymis when transferring the testis to the scrotum. Our cohort included 55 boys (59 testes). Median age and weight at surgery were 13.3 months (interquartile range [IQR] 9.2-32.4) and 10.4 kg (IQR 9.2-12.6). The mean operative time was 70 min (IQR 60-85). The median follow-up was 11 months (IQR 7-12). There was one case of testicular atrophy (2%) and two cases of suboptimal testicular position in the scrotum at 6 months. M-LFSO is a standardized approach for all cases of IAT regardless of testicular position. Preservation of a wide peritoneal flap and proximal dissection of the vessels may contribute to the adequate testicular blood supply. The proposed approach eliminates the need for intra-operative decision-making and for ancillary procedures.

The outcome of laparoscopic assisted orchidopexy in very young children: A single hospital experience

Early orchidopexy has been linked to improved long term outcomes of fertility and reduced malignancy rates. However, the optimal age of intervention has been subject to change over the years. This study aims to study males aged 6 months or less who undergo laparoscopic assisted orchidopexy for intraabdominal testes to establish the safety, efficacy, and benefit in the defined age group. We prospectively assessed 19 boys at or below 6 months of age, who had laparoscopic assisted orchidopexy for intraabdominal undescended testes at Salmaniya Medical Complex in Bahrain between January 2014 and December 2018. We examined: demographics, laterality, testicular locations, testicular volumes, operative time, complications, and durations of hospitalization and follow-up. Ultrasound-derived testicular volumes were assessed before and after orchidopexy. They were calculated using the Hansen formula (Testicular volume=0.52×length [L]×width [W]2 [1]. They were then compared with reference ranges from a Dutch cohort study of 769 healthy boys. Successful outcomes were correct intrascrotal position with minimal complications and normal testicular volumes. A total of 19 males were operated at a mean age of 5.6 months and followed for a mean of 2.35 years. Of these, 7 had left-sided and 12 had right-sided cryptorchidism. Testicular locations were noted intra-operatively; 10 were above the internal ring, 5 near the iliac vessels, and 4 close to the kidney. The mean operative time was 59.58minutes. Only 2 minor complications occurred and no cases of testicular atrophy. None of the patients required hospital-stay beyond 24hours. The success rate was 89.46% in achieving correct scrotal position. Testicular volumes were normal before and after orchidopexy. They significantly increased after orchidopexy (P≤0.05). The testicular growth rate after 24 months was slightly higher than normal. In line with previous studies we were 89.46% successful in re-positioning testes [2]. In contrast to studies intervening at older ages which associated intra-abdominal testes with greater risks of complications, we found few minor complications and no testicular atrophy [3,4]. Testicular volumes in the affected testes were normal, contrary to decreased volumes found by other researchers [5]. Limitations of this study are the small number of patients and short follow-up which limits assessment of long-term outcomes. Early orchiopexy is safe and effective. Laparoscopic assisted orchidopexy at an early age was beneficial and resulted in normal testicular volumes before and after surgery.

Clinical effect of minimally invasive surgery for inguinal cryptorchidism

BackgroundThe purpose of this study was to investigate the clinical effect of minimally invasive surgery for inguinal cryptorchidism.MethodsThe patients were divided into the minimally invasive surgery group (n = 100) and the traditional surgery group (n = 58). In the minimally invasive surgery group, patients with low inguinal cryptorchidism (n = 54) underwent surgery with a transscrotal incision, and patients with high inguinal cryptorchidism (n = 46) underwent laparoscopic surgery.ResultsThere was no difference in the hospital stay duration or cost between the minimally invasive surgery group and the traditional surgery group (P > 0.05). As for the operative time, minimally invasive surgery of low inguinal cryptorchidism was shorter than traditional surgery (P = 0.033), while minimally invasive surgery of high inguinal cryptorchidism was comparable to traditional surgery (P = 0.658). Additionally, there were no cases of testicular atrophy, testicular retraction, inguinal hernia or hydrocele in either group. There was no significant difference in the incidence of poor wound healing between the two groups (P > 0.05). Although there was no significant difference in the incidence of scrotal hematoma between the two groups (P > 0.05), the incidence in the minimally invasive surgery group was higher than that in the traditional surgery group.ConclusionsMinimally invasive surgery including a transscrotal incision for low inguinal cryptorchidism and laparoscopic surgery for high inguinal cryptorchidism is as safe and effective as traditional surgery, and could also provide a good cosmetic effect for children.

Testicular Atrophy Following Inguinal Hernia Repairs

Testicular atrophy is a rare complication of hernia repairs which often results in litigations. While early detection and treatment of ischemic orchitis obviate this grave complication, good communication and adequate counseling are known to minimize the associated litigations. Herein, we report two cases of testicular atrophy following herniorrhaphy. Both patients noticed scrotal pain and swelling within three days after the surgery and were given antibiotics and analgesia by the attending surgeons. They subsequently developed a gradual reduction in testicular volume after two months with severe atrophy of the affected testis. The objectives of this case series are to emphasize the need for immediate evaluation of genital symptoms such as scrotal pain, swelling, and redness after inguinal hernia repairs and the need to counsel patients for possible orchitis, atrophy, and testicular loss before any groin surgery.

Ectopic testis: an experience of a tertiary-level urology center at Upper Egypt

BackgroundTesticular ectopia is defined as a testis which is located away from the normal pathway of testicular descent and outside its ipsilateral hemiscrotum. Controversies have been raised about considering the abdominal and inguinal ectopic testes as undescended ones. Our purpose was to review our center’s experience with the diagnosis and management of testicular ectopia focusing on the inguinal ectopic testis. Retrospectively, we studied the clinical and surgical characteristics of a case series of testicular ectopia which was managed in our center during July 2001–June 2016.ResultsOut of 1132 patients with undescended testes, 44 cases (3.9%) had testicular ectopia. Twenty-three cases (mean age = 5.15 ± 5.79 years) fulfilled the criteria of inguinal ectopic testis. Clinically, testes were relatively mobile and superficial. Surgically, they were located in the superficial inguinal pouch, had relatively long spermatic cords, and commonly had average rather than small sizes. The other ectopic 21 cases (mean age = 10.56 ± 6.92 years) were perineal, anterior abdominal wall, femoral, prepubic, and transverse testes in 7 (33.3%), 4 (19%), 4 (19%), 3 (14.3%), and 3 (14.3%) cases, respectively. Congenital inguinal hernia was the commonest associated anomaly (22.7%). All cases were treated surgically with only 1 case of testicular atrophy (2.3%).ConclusionsTesticular ectopia is rare with relatively delayed presentations. Different anatomical sites have been reported including the superficial inguinal pouch and anterior abdominal wall with variable complexities and controversies. The inguinal ectopic testis is the most controversial, but it might be characterized from other entities based on certain clinical and surgical criteria.

Surgical Management of Undescended Testis in Infants, Single Scrotal Incision Orchiopexy Versus Traditional Inguinal Approach: A Comparative Study

<i>Background</i>: Surgical intervention is mostly needed in many cases of undescended testis to improve fertility; it is still unsure which approach is better than the other in management of undescended testicle in infants; classic inguinal approach or scrotal single incision approach. <i>Aim of the current study</i> was to compare between classic inguinal approach and scrotal single incision approach to perform orchiopexy for management of un-descended testis in infants and to clarify which is better; inguinal orchidopexy or scrotal orchidopexy. <i>Patients and methods</i>: we included forty male patients with undescended testis who were divided into two groups; group A included twenty patients and they were surgically managed with single trans-scrotal orchiopexy and group B included twenty patients and they were surgically managed with classic inguinal approach by two incisions (inguinal and scrotal). We assessed operative time and complications as wound infection, recurrence and testicular atrophy. <i>Results</i>: Operative time in group A was shorter than the operative time of group B which was managed by the inguinal approach (p=0.004). Immediate post-operative complications as; skin site infection, hematoma and edema, in group A were slightly more than the complications in group B (p=0.002). group A showed no recurrence or testicular atrophy after six months while group B showed 2 cases of recurrence and one case of testicular atrophy (p=0.005). At three months after surgery, cosmetic results and patients satisfaction of the incision scar was higher in group A than group B (p<0.001). <i>Conclusions</i>: performing orchiopexy through single scrotal incision approach is better than the approach of inguinal incision regarding operative time, rabid healing time, parents’ satisfaction, fewer long-term complications, less incidence of testicular atrophy and recurrence.

The Technique of Shouldice in the Treatment of the Inguinal Hernias at the Hospital Somin&amp;#233; Dolo of Mopti (Mali) Subject of 675 Cases

The objective was to study epidemiological and therapeutic aspects of the inguinal hernia according to the technique of Shouldice. Methodology: we realized a retrospective study, concerning the patients operated for inguinal hernia according to the technique of Shouldice in the service of general surgery of the hospital Sominé Dolo of Mopti, Mali. All the patients operated during the period of study for inguinal hernia according to the technique of Shouldice were included. The patients operated for hernia by other technique than that of Shouldice were not included. Results: The study has been realized in the service of general surgery of the hospital Sominé Dolo of Mopti (Mali). It was about a retrospective study which concerned 25 years from January, 1987 till December, 2012. 675 patients operated according to the technique of Shouldice were registered. The average age was of 49 years +/−17.7. There were 90.7% (612) men. The sex-ratio is 9.7. The farmers, the housewives and the workers represented 51.1% (115). In 75.2% (508) the patients consulted for inguinal tumefaction. In operating meadow, the hernia was complicated to 246 (36.4%) patients among whom 72 cases were of recurrence. The hernia constriction was the main complication operating meadow 58.5% (48/82). The operating suites in one year were simple at 94.2% (636) of the patients; they were marked by 24 cases of recurrence, 12 cases of neuralgia, 6 cases of testicular atrophy, and 3 cases of keloid. Conclusion: The technique of Shouldice is the technique of choice for the cure of the inguinal hernia in developing countries because of the good result and its little expensive cost with compared with the other techniques using medical devices.

Effect of Microsurgical Subinguinal Varicocele Repair on Chronic Dull Scrotal Pain in Men with Grade II-III Lesions

Introduction: We aimed to evaluate the effectiveness of microsurgical subinguinal varicocele repair in patients with grade II-III lesions and chronic dull scrotal pain. Materials and Methods: A total of 29 patients with grade II-III varicocele and chronic dull scrotal pain that had a microsurgical subinguinal varicocele repair were included in the study. They were followed-up for 6-12 months including pain assessment and scrotal examination. Results: Of the 29 patients, 28 (97%) reported complete resolution of pain with no palpable varicocele on scrotal examination. No cases of testicular atrophy or hydrocele formation were reported. Conclusion: These results indicated that microsurgical varicocele repair should be considered in patients with grade II-III lesions and chronic dull scrotal pain.

Avoiding cord extraction or mobilization during pediatric inguinal hernia repair

Background: Pediatric inguinal hernia (PIH) represents one of the most common congenital defects in infants and children worldwide. Several techniques have been adopted for repair. Conventional open excision of the sac is considered the most popular and most accepted among pediatric surgeons. In the past few years laparoscopic PIH repair has started to gain popularity. Aim: The aim of this study was to minimize the intervention to be near to minimally invasive but at the same time to be conventional in approach, reducing the stretch and manipulation of the vital cord structures. Patients and methods: During the period from April 2013 to May 2015, 200 male infants who presented with PIH were operated upon in our hospital. We excluded patients with complicated inguinal hernias, hernias associated with hydroceles, undescended testis, and female infants. Results: Of the 200 male infants with PIH who were operated upon, 107 had hernias on the right side, 74 had on the left side, and 19 were bilateral. The mean age was 4.5 months. The mean body weight was 5 kg. All infants received general anesthesia. The mean length of the incision was 10 mm. Recurrence was found in only three cases. There were no cases of testicular atrophy. Conclusion: We found our approach to be safe and easy to perform, and the vital structures in the cord did not have to be manipulated. Keywords: pediatric, inguinal hernia, repair

Laparoscopic Interrupted Muscular Arch Repair in Recurrent Unilateral Inguinal Hernia Among Children.

We present a procedure of suturing the transversus abdominis muscular arch to the ileopubic tract laparoscopically in order to repair recurrent unilateral pediatric inguinal hernia (PIH). Twenty-five children with recurrent unilateral PIH were treated during a 5-year period in a tertiary academic center. All cases were subjected to laparoscopic hernia repair and discharged the next morning. Sutures were placed from the muscular arch to the ileopubic tract, avoiding the spermatic vessels and duct, in an interrupted manner using 2/0-3/0 polypropylene (Prolene®; Ethicon, Somerville, NJ) or polyglactin 910 (Vicryl®; Ethicon) sutures. In 4 cases, a rectangular purse-string-like suture was added to narrow the internal ring defect. Operative findings and postoperative results and complications were assessed. The patients were followed up for a period that ranged between 6 and 60 months. There were 23 boys and 2 girls. Operative age ranged between 18 months and 15 years. Three or four sutures were placed in each case. In 4 cases, an additional rectangular purse-string-like suture was added. Operative time ranged between 35 and 70 minutes, and there was no conversion. Mild scrotal edema was reported in 4 cases and port-site infection in 2 cases; all cases were treated conservatively. One case of recurrence among boys was reported, but there was no case of testicular atrophy. Cosmetic outcomes were excellent. Laparoscopic interrupted muscular arch repair is a feasible and safe technique in the reconstruction of the inguinal canal in recurrent unilateral PIH. Larger studies and long-term follow-up are needed to support our encouraging results.

Microsurgical Varicocele Repair on Men with Grade III Lesions and Chronic Dull Scrotal Pain: A Pilot Study

Introduction: The aim of the present study was to evaluate the effectiveness of microsurgical varicocele repair in patients with grade III lesions and chronic dull scrotal pain. Materials and Methods: The study was based on 8 patients with grade III left-sided varicocele and chronic dull scrotal pain for whom a microsurgical subinguinal varicocele repair was performed. The 1-year follow-up included pain assessment and scrotal examination. Results: Of the 8 patients, 7 (88%) reported complete resolution of pain with no palpable varicocele on scrotal examination. No cases of testicular atrophy or hydrocele formation were reported. Conclusion: These results indicated that microsurgical varicocele repair may benefit patients with grade III lesions and chronic dull scrotal pain.

Laparoscopic versus open orchiopexy in the management of peeping testis: A multi-institutional prospective randomized study

ObjectivePeeping testis is an inconsistently palpable/seen undescended testis that migrates back and forth at the internal inguinal ring. Both open and laparoscopic orchiopexy are effective forms of management. The present study aimed to evaluate the efficacy and safety of both approaches. Patients and methodsBetween September 2007 and January 2012, 46 peeping inguinal testes were randomly treated with either open (25 cases) or laparoscopic (21 cases) orchiopexy procedures. Spermatic vessels were preserved for all cases. Operative details, postoperative morbidity and final testicular site and size were recorded. ResultsThe median age of the children was 2.5 years (range 0.5–12.0). The follow-up period ranged from 1.0 to 5.5 years. Of these testes, 20 in the open surgery group and 19 in the laparoscopic group maintained correct intrascrotal position (P = 0.428). Re-do orchiopexy was indicated for two cases in the surgical group (P = 0.493). No cases of testicular atrophy or hernia were encountered. ConclusionOpen and laparoscopic orchiopexy procedures for peeping testes are fairly comparable. However, laparoscopy is relatively more effective, as two re-do orchiopexies were required in the open surgical group.

La pathologie du canal péritonéo-vaginal en pratique urologique

To describe the epidemiological, anatomico-clinical and therapeutic aspects of the patent vaginoperitoneal canal (PVPC) in urological practice and to compare our results with those of pediatric teams. We performed a retrospective descriptive study of PVPC cases operated in a urology unit. The following parameters were studied: medical history, age, method of installation, the anatomo-clinical type, side and the results of the treatment. A total of 163 cases were collected over a period of 5 years. The average age was 7.5 ± 7 years with a range of 2 months and 39 years. Thirty-four patients had less than or equal to age 2 ears and 28 patients were adults. The reason for consultation was an inguinal or scrotal inguinal, painless and intermittent swelling in 72.3% of cases. Installation mode was progressive in 45 patients (27.6%). The PVPC was sitting right in 81 patients (49.7%) and was bilateral in 12 patients (7.3%). The anatomo-clinical types were dominated by the communicating hydrocele (52%). The treatment was carried out in controlled surgery in all patients and the mean duration of hospitalization was 24 hours. The postoperative course was marked by 5 cases of scrotal hematoma and 2 cases of parietal suppuration. Postoperative mortality was zero. After a mean postoperative decrease of 2 years we observed 3 cases of testicular atrophy and two recurrences. Our results in terms of morbidity and mortality although satisfactory were lower than those of pediatric teams. 5.

Hipogonadismo Masculino. Estudio de cinco casos

1. Se hace el estudio clínico-endocrino, de laboratorio y de histología testicular, en cinco pacientes portadores de hipogonadismo masculino. 2. La biopsia testicular es un procedimiento fácil e inocuo, que debería incluírse rutínariamente en todo enfermo con síntomas o siqnos de hipoqonadismo. 3. Esta biopsia testicular nos permite no solo confirmar el diagnóstico clínico hipogonadal, sino hace, al mismo tiempo, el diagnóstico histolóqíco, evalúa el pronóstico y orienta la terapéutica racional. 4. Gracias a este temperamento la biopsia nos ha permitido individualizar dos pacientes con testículo pre-puberal, un síndrome de Del Castillo y un caso de atrofia testicular que probablemente en otras condiciones hubieran sido etiquetados con el término genérico de hipogonadismo. 5. Igualmente consideramos que el estudio de la cromatina sexual debe ser realizado sistemáticamente en todo enfermo con endocrinopatía testicular, teniendo en cuenta los nuevos conceptos genéticos. 6. En nuestros casos la determinacíón de la cromatina sexual mostró concordancia con el fenotipo. 7. La incidencia de esta afección es aparentemente poco frecuente, debido a que buen número de estos enfermos son incluídos en entidades clínicas diferentes (Psiquiatría, Neurocirugía, etc.), ya que las biopsias y los frotisis no se hacen en esos servicios rutinariamente. 8. Nosotros consideramos que esta in frecuencia de hipogonadismo en nuestro medio, deberá modificarse a medida que la exploración biópsica y genética sea un medio de rutina incorporado a la práctica hospitalaria y de consultorio.

Treatment of bilateral varicocele and other scrotal comorbidities using a single scrotal access: our experience on 34 patients.

Introduction. Varicocele is the main cause of infertility in male and the most correctable cause of it too. In this study, we present our experience on 34 patients affected by bilateral varicocele and other scrotal comorbidities treated underwent surgery with a scrotal access. Materials and Methods. 34 patients were enrolled with clinical palpable and infraclinical (ultrasonic doppler scanning) bilateral varicocele and other comorbidities like right hydrocele, left hydrocele, bilateral hydrocele, and epididymal cyst. They all underwent scrotal bilateral varicocelectomy under local anesthesia. Results and Discussion. At 6 months, no other complications were reported. No case of testicular atrophy was observed. None had recurrence of varicocele. All scrotal comorbidities were treated as well. Conclusion. Scrotal access with local anesthesia is a safe and useful technique to treat patients with bilateral varicocele and other scrotal comorbidities.

Transumbilical endoscopic surgery for incarcerated inguinal hernias in infants and children

PurposeTo describe transumbilical laparoscopic herniorrhaphy after unsuccessful attempted manual reduction of incarcerated inguinal hernias in infants and children. MethodsIn our two hospitals, two-trocar transumbilical endoscopic surgery (TUES) is the standard technique used to repair incarcerated inguinal hernias in infants and children. Seventeen patients (aged 8months to 2.5years; median, 15months; 15 boys, 2 girls) with incarcerated inguinal hernias underwent urgent laparoscopy after unsuccessful attempted manual reduction. Two 3- or 5-mm trocars were inserted into the abdomen through two intraumbilical incisions, under laparoscopic guidance. The hernia was reduced by combined external manual pressure and internal pulling with bowel forceps. After inspection of the bowel, a round needle with a 2-0 nonabsorbable suture was introduced into the peritoneal cavity through the anterior abdominal wall near the internal inguinal ring. The hernial orifice was closed with an extraperitoneal purse-string suture around the internal inguinal ring, and tied with an intraperitoneal knot. A similar procedure was performed on the contralateral side if the processus vaginalis was patent. ResultsThe TUES procedure was successful in all patients. No conversions to open surgery were required. The mean operating time was 30min (range, 25–40min). All patients were discharged on the second postoperative day. No complications such as postoperative bleeding, hydrocele, or scrotal edema were observed. The mean follow-up period was 15months. No cases of testicular atrophy, hypotrophy, or hernia recurrence were reported. ConclusionsOur preliminary experience with using TUES for the treatment of incarcerated inguinal hernias in infants and children had satisfactory outcomes. This technique appeared to be safe, effective, and reliable, and had excellent cosmetic results.