Contralateral Hydrocele Research Articles

Metachronous Contralateral Occurrence of Hydrocele After Unilateral Hydrocelectomy in Children Younger Than 8 Years.

Hydrocele on the contralateral side after surgical repair is an uncommon condition compared to surgical site recurrence. Although there has been much research on metachronous contralateral inguinal hernia in children, metachronous contralateral hydrocele, which share a common pathology with inguinal hernias, has not yet been investigated. We have investigated the incidence and risk factors for metachronous contralateral occurrence of communicating and noncommunicating hydroceles in children younger than 8 years. From January 2017 to June 2020, 302 children younger than 8 who were diagnosed with unilateral hydroceles were treated in our hospital without surgical exploration of contralateral hydrocele. The disease was classified into communicating and noncommunicating hydroceles. We divided patients into two groups according to the presence of metachronous contralateral hydrocele and analyzed the differences between the two groups. Among 302 patients, the mean age was 36.4 ± 20.9 months. Metachronous contralateral hydrocele occurred in 15 (4.9%) patients as communicating hydroceles. Comparison between the two groups showed statistically significant differences in type of hydrocele (P = 0.047) at first diagnosis. Clinically evident risk of metachronous contralateral hydrocele after unilateral hydrocelectomy was 4.9%. Despite the relatively low incidence rate, the risk of metachronous contralateral occurrence should always be consulted with parents before surgical treatment of hydroceles.

Comparison of the Detection and Ligation of Patent Processus Vaginalis Between Laparoscopy-Assisted Transscrotal Orchiopexy and Single Scrotal Incision Orchiopexy.

This study aimed to compare the detection and ligation of patent processus vaginalis (PPV) between laparoscopy-assisted transscrotal orchidopexy (LATO) and single scrotal incision orchiopexy (SSIO) for low palpable undescended testis (UDT). We performed a retrospective medical record review of transscrotal orchidopexies performed for low palpable UDT at our institution from 2017 to 2019; 33 and 39 boys underwent LATO and SSIO, respectively. Data collection included patient demographics, incidence of PPV, operative time, and clinical outcomes. All 95 testes were delivered into the scrotum. There was no significant difference between the two groups with respect to patients' age, side, and mean operative time. The incidence of PPV in the LATO group was significantly higher than that in the SSIO group (56.52 vs. 34.69%, P = 0.04). The incidence of contralateral PPV in the LATO group was 45%. One patient in the SSIO group underwent unilateral PV ligation and laparoscopic exploration revealed bilateral PPV owing to metachronous contralateral hydrocele. One patient in the LATO group demonstrated obliterated PV in the initial transscrotal procedure, but an ipsilateral PPV was found in the latter laparoscopic procedure. In conclusion, LATO has a higher detection rate and higher ligation of the PPV than SSIO, suggesting that, LATO may help reduce recurrent PPV-related issues. However, long-term follow-up results are needed to evaluate the advantages and disadvantages in a larger case series.

Prenatal Diagnosis of Right Sided Inguinoscrotal Hernia Associated with Severe Growth Restriction in a Fetus with Trisomy 18: A Case Report

AbstractFetal inguinoscrotal hernia is an uncommon occurence in the prenatal life, and published literature on it is scarce. This is a type of indirect hernia that results from abnormal migration of the small bowel into the scrotum via the patent processus vaginalis. We present a case of prenatal diagnosis of right sided fetal inguinoscrotal hernia, with contralateral hydrocele and severe fetal growth restriction confirmed as Trisomy 18 in subsequently performed chromosomal analysis. The index case presented at 35+2 weeks of gestation with a right sided solid scrotal mass with a regular contour, mixed echogenic texture with a few echo-free areas, a distinctive arterial supply and characteristic peristaltic movements. Fetal demise was noted one week later. The diagnosis was confirmed by postnatal examination. Prenatal diagnosis of fetal inguinoscrotal hernia should be followed up with detailed anatomical assessment and chromosomal analysis if indicated by the presence of additional abnormalities. Isolated cases require surgical repair in the neonatal period to avoid sequelae and complications.

Laparoscopic inguinal hernia repair by modified peritoneal leaflet closure: Description and initial results in children

Inguinal hernias are common in infants and children. While the gold standard for hernia repair in the pediatric period has been via an open inguinal incision with dissection and high ligation of the hernia sac, over the past two decades laparoscopic herniorrhaphy has increased in popularity. The advantages of laparoscopy include decreased post-operative pain, improved cosmetic results, ability to easily assess the contralateral side for an open internal inguinal ring, and decreased risk of metachronous hernias. Herein, we describe a modified laparoscopic herniorrhaphy using a peritoneal leaflet closure and report our operative experience with intermediate-term results. We retrospectively reviewed our IRB-approved registry for all children who underwent initial laparoscopic herniorrhaphy at our tertiary care center over a 2.5-year period. All surgeries were performed by a single surgeon using a technique we have termed the peritoneal leaflet closure. This technique involves incising the peritoneum circumferentially around the open internal ring and developing peritoneal leaflets which are then closed together over the ring with a running non-absorbable barbed stitch (Figure). Intraoperative findings and complications, operative times, and post-operative complications were reviewed for all children. A total of 50 initial laparoscopic hernia repairs (4 bilateral, 42 unilateral) were performed in 46 children (43 boys, 3 girls) at a median age of 5.9 years (range 0.5-16.7). Median operative time was 73min (range 48-138) for unilateral and 106min (range 104-135) for bilateral herniorrhaphy. No patient had an intraoperative complication. Two children (4%) had contralateral open rings discovered at time of surgery and underwent unplanned bilateral laparoscopic hernia repair. All patients went home on the same day as the procedure and three children (6%) had minor post-operative complaints (umbilical bulge, thigh pain, and urine holding) that all self-resolved. Thirty-nine children had follow-up data available. Intermediate-term complications occurred in two children (5%): one boy developed a contralateral hydrocele (despite a closed ring at surgery) and one boy had a hernia recurrence that required open repair. Overall, operative success with the modified peritoneal leaflet closure technique was therefore 97% (38 of 39 children with follow-up). All 37 boys who followed up had bilateral descended testes of normal size and consistency. Laparoscopic herniorrhaphy using a peritoneal leaflet closure technique is safe and effective when used in infants and children to close an indirect hernia (i.e. patent processus vaginalis). No intraoperative complications occurred in this cohort and success rate was 97%.

A Testicular Torsion and Contralateral Hydrocele in a Neonate

Background: A testicular torsion is an acute surgical emergency which needs a prompt work up. Neonatal testicular torsion is an uncommon event. Aim of the work: This article aim to describe a case report of a neonate presented with testicular torsion and contralateral hydrocele. Results: Clinical and radiological management were discussed. Conclusion: The casedemonstrated that the possibility of uncommon presentation of acute scrotum such as testicular torsion with contralateral hydrocele can occur.

Hydrocele of the canal of Nuck

Abstract Hydrocele of the canal of Nuck is a rare condition in female children caused by a failure of complete obliteration of the canal of Nuck. The canal of Nuck is an abnormal patent pouch of the peritoneum extending anterior to the round ligament of the uterus into the labia majora. Incomplete obliteration of this canal (patent processus vaginalis) can result in either an inguinal hernia or a hydrocele. Here, we report two cases of hydrocele of the canal of Nuck presented within a two-month period. In the first case, incarcerated right-sided inguinal hernia was suspected while the second case was clinically diagnosed as encysted hydrocele of canal of Nuck. Both patients underwent surgical exploration. Hydrocelectomy with high ligation was also performed. One month after the surgery, the first patient showed signs of hydrocele on contralateral side, while the other patient showed no sign of contralateral hydrocele or hernia.

Treatment of contralateral hydrocele in neonatal testicular torsion: Is less more?

Treatment of neonatal testicular torsion has two objectives: salvage of the involved testicle (which is rarely achieved) and preservation of the contralateral gonad. The second goal universally involves contralateral testicular scrotal fixation to prevent the future occurrence of contralateral torsion. However, there is controversy with regards to management of a synchronous contralateral hydrocele. It has been our policy not to address the contralateral hydrocele through an inguinal incision to minimize potential injury to the spermatic cord. Our objective in this study was to determine whether the decision to manage a contralateral hydrocele in cases of neonatal testicular torsion solely through a scrotal approach is safe and effective. We reviewed all cases of neonatal testicular torsion occurring at our institution between the years 1999 and 2006. Age at presentation, physical examination, ultrasonographic and intraoperative findings were recorded. Patients were followed after initial surgical intervention to determine the likelihood of developing a subsequent hydrocele or hernia. Thirty-seven patients were identified as presenting with neonatal torsion. Age of presentation averaged 3.5 days (range 1-14 days). Left-sided pathology was seen more commonly than the right, with a 25:12 distribution. All torsed testicles were nonviable. Twenty-two patients were noted to have a contralateral hydrocele at presentation. All hydroceles were opened through a scrotal approach at the time of contralateral scrotal fixation. No patient underwent an inguinal exploration to examine for a patent process vaginalis. None of the patients who presented with a hydrocele have developed a clinical hydrocele or hernia after an average 7.5 years (range 4.3-11.2) follow-up. We have demonstrated that approaching a contralateral hydrocele in cases of neonatal testicular torsion solely through a scrotal incision is safe and effective. Inguinal exploration was not performed in our study and our long-term results demonstrate that such an approach would have brought no additional benefit. In avoiding an inguinal approach we did not subject our patients to unnecessary risk of testicular or vasal injury. Contralateral hydrocele is commonly seen in cases of neonatal testicular torsion. In our experience this is a condition of minimal clinical significance and does not warrant formal inguinal exploration for treatment. This conservative management strategy minimizes the potential of contralateral spermatic cord injury in the neonate. The aims of the study were met.

소아의 일측 음낭수종 교정술 후 반대측 발생의 치험 1례

Abstract A Case Study of Contralateral Occurrence after Unilateral Repair of Hydrocele inChildren Kim Eun Jin ․ Min Sang Yeon ․ Kim Jang Hyun Department of Pediatrics, College of Oriental Medicine, Dongguk University Objectives Hydrocele is a common disease found in pediatrics and is usually treated by hydrocelectomy, and even after the unilateral repair of hydrocele, it has been reported that the contralateral hydrocele still occurs in 5.4-12.5%. Therefore, the purpose of this study is to conduct a case study of contralateral hydrocele treated by Oryeong-san and Bangkeehwangkee-tang (五苓散 合 防己黃芪湯). Methods A patient diagnosed with San Syndrome (Su-San) (水疝) was administered Oryeong-san and Bangkeehwangkee- tang (五苓散 合 防己黃芪湯). Results The sizes of hydrocele and symptoms were reduced. Conclusions In the case of contralateral occurrence after unilateral repair of hydrocele in children, it is better to select a safer treatment than operation considering other possible complications. In this report, we have proven that Oryeong-san and Bangkeehwangkee-tang (五苓散 合 防己黃芪湯) can be very effective in reducing the size of hydrocele, improving symptoms and preventing recurrence.

Ultrasound Prenatal Diagnosis of Inguinal Scrotal Hernia and Contralateral Hydrocele

Fetal inguinal scrotal hernia is a rare condition resulting in an abnormal embryonic process of the tunica vaginalis. We report a case of ultrasound prenatal diagnosis of inguinal scrotal hernia associated with contralateral hydrocele in a woman at 37 weeks of gestation, referred to our clinic for a scrotal mass. Differential diagnosis includes hydrocele, teratoma, hemangiomas, solid tumours of testis, bowel herniation, and testicular torsion. Bowel peristalsis is an important ultrasound sign and it allowed us to make diagnosis of inguinal scrotal hernia. Diagnosis was confirmed at birth and a laparoscopic hernia repair was performed without complications on day 10. During surgery, a bilateral defect of canal inguinal was seen and considered as the cause of scrotal inguinal hernia and contralateral hydrocele observed in utero.

An Unusual Presentation of Crossed Testicular Ectopia as an Incarcerated Inguinal Hernia

Crossed testicular ectopia (CTE) is generally defined as both testes located in the same hemiscrotum and contralateral hydrocele with the absence of a testis. However, the initial presentation of CTE in an infant as an incarcerated inguinal hernia is extremely rare. We report on a 10-month-old infant with CTE, who visited the emergency room presenting with a left incarcerated inguinal hernia. After manual reduction for an incarcerated hernia and left inguinal herniorraphy, the left testis was fixed into the left hemiscrotum and right transseptal orchiopexy was performed.

Nodular periorchitis masquerading as a malignant parafunicular tumor in an adolescent

We report on a case of nodular periorchitis, an uncommon perifunicular mass in a 13-year-old adolescent accompanied by contralateral hydrocele. Nodular periorchitis is a rare, fibroproliferative, benign mesenchymal neoplasm of the paratesticular tissues of the scrotum with a low risk for recurrence. Testis-preserving surgery is the treatment of choice.

Follow-up after inguinal herniotomy or surgery for hydrocele in boys.

A retrospective review of 556 boys who had undergone inguinal herniotomy or surgery for hydrocele was carried out to assess the value of early routine postoperative follow-up. Of 386 children given an appointment, 319 (82.6 per cent) attended. The testis was no longer palpable in the normal scrotal position in 12 boys; eight were normal on further review and four required orchidopexy. Six hydroceles, all of which resolved, and four contralateral hernias were detected. Nineteen boys (4.9 per cent) were referred later with recurrent hernia (two patients), ipsilateral high testis (two), or contralateral hernia or hydrocele (15). Of 170 children not given a routine appointment, ten (5.9 per cent) were subsequently referred back with a transient hydrocele (two) or a contralateral hernia (eight). After a total of 440 appointments, eight boys (1.8 per cent) were found to have a significant abnormality. The rate of referral back to hospital was similar in both groups. Early discharge would make more efficient use of outpatient resources without significantly affecting overall outcome.

Prenatal testicular torsion: diagnosis and natural course. An ultrasonographic study

The aim of this study was to demonstrate the ultrasonographic features of prenatal torsion of the testis at presentation and during follow-up, with histological correlation post-orchidectomy. Between January 1985 and December 1999, 13 neonates with antenatal torsion of the testis were examined postnatally, at presentation and during follow-up, with high-resolution ultrasonography, including colour Doppler ultrasonography. Bilateral testis volume was evaluated [lengthxwidthxdepthx(pi/6)]. Ultrasonographic findings were correlated with histological findings (n=8) and findings at surgery. Moreover, in 1 patient the affected testis was postoperatively examined with ultrasonography in vitro. These findings were correlated with preoperative ultrasonography and corresponding histological slices. All patients (n=13) presented with a painless congenital scrotal mass. On the affected side no flow was found with colour Doppler ultrasonography. Testis volume on the affected and normal side showed mean values of 2.1 and 0.5 cc, respectively. On ultrasonography all patients showed scrotal swelling and a heterogeneous testis with hypoechoic central areas (necrosis). The tunica albuginea was thickened in all patients, with focal (n=2) or rim-like (n=11) hyperechoic reflections (calcifications) at the transitional zone between testis and tunica albuginea. In 9 patients follow-up ultrasonography showed progressive testis atrophy on the affected side. In 10 patients a contralateral hydrocele was found. Prenatal torsion shows a characteristic ultrasonographic pattern. In newborns with a scrotal mass, these ultrasonographic findings should suggest this diagnosis and delay in immediate surgery and/or oncological work-up may be appropriate.

RISK OF CONTRALATERAL HYDROCELE OR HERNIA AFTER UNILATERAL HYDROCELE REPAIR IN CHILDREN

Purpose Recent laparoscopic studies indicate a high incidence of a contralateral open internal ring in children undergoing unilateral hydrocele or hernia repair, raising the question of whether routine contralateral exploration should be done. Data on the long-term risk of clinical contralateral hernia or hydrocele after unilateral hydrocele repair are limited. To address this question we performed long-term followup in patients who underwent unilateral hydrocele repair. Materials and Methods We followed patients who previously underwent unilateral hydrocele repair performed by one of us before 1997. Patients were interviewed by telephone and encouraged to return to one of us or their pediatrician for evaluation. Results Of the 101 patients who fulfilled study inclusion criteria 85 who were 5 to 107 months old (median age 37) at the original surgery were successfully contacted, including 45 examined by one of us or a pediatrician and 40 followed by telephone interview only. Contralateral hydrocele or hernia developed in 6 of the 89 patients (7%) 6 to 15 months (median 12) postoperatively. The remaining 79 patients have been recurrence-free for 6 to 153 months (mean 44, median 37). Of the patients 5 of 32 are (15%) and 1 of 53 (2%) who underwent left and right hydrocele repair, respectively, had contralateral recurrence. Conclusions The risk of a clinically evident contralateral hydrocele or hernia after unilateral hydrocele repair is approximately 7%. We do not recommend routine contralateral exploration in children undergoing unilateral hydrocele repair.

Preoperative sonography of the inguinal canal prevents unnecessary contralateral exploration

The need for contralateral inguinal exploration in children during unilateral inguinal hernia repair remains controversial. We questioned whether an elective preoperative sonographic examination of the contralateral inguinal canal was accurate enough to prevent unnecessary exploration of the asymptotic side. Sonography (US) of the groins was performed randomly in 200 out of 600 patients awaiting unilateral hernia repair over a 1.5-year period during 1990-1991. The patients and their medical records were reviewed in 1994, 3-4 years following surgery. Four hundred infants and children underwent unilateral inguinal hernia repair without preoperative US, based on the clinical diagnosis (group I). Of the remaining 200, 160 (group II)_ had the clinical diagnosis confirmed by US. Forty patients with US evidence of a contralateral hernia or hydrocele (group III) were excluded from the study. At follow-up after 3-4 years, 26 patients in group I presented with a hernia in the opposite groin 2 weeks to 2 years following surgery. The incidence of a subsequent contralateral hernia in patients under 1 year, 1-2 years, and older than 2 years was 7.3%, 9.6%, and 4.5%, respectively. None of the patients in group II presented with a clinically evident hernia during the follow-up period. These findings suggest that US is a readily available, non-invasive, and accurate method of preoperative evaluation of the groins. Our policy of contralateral exploration based on the US findings was shown to be reliable in preventing unnecessary surgical exploration of the unaffected inguinal canal.

Sexual function after bilateral retroperitoneal lymph node dissection for nonseminomatous testicular cancer.

This study concerns the sexual functions of 101 patients who had undergone bilateral retroperitoneal lymph node dissection for stage I or II nonseminomatous testicular cancer between 1969 and 1982. All patients were without evidence of disease after at least 4 years of follow-up. Antegrade ejaculation was present in 12 patients, while 89 patients experienced "dry ejaculation." Urine collected after intercourse or masturbation from 75 patients with dry ejaculation showed retrograde ejaculation in 55 and lack of ejaculatory emission into the urethra in 20 patients. Regarding other sexual functions, 17 patients had a diminished sexual desire (especially those patients who had received radiotherapy), 12 experienced difficulty reaching organism, and 6 complained of erectile dysfunction. The incidence of a contralateral hydrocele developing after retroperitoneal lymph node dissection seems to correlate with ligation of the contralateral spermatic vessels and their lymphatics. A review of the literature is presented comparing the types of dissection with the incidence of sexual disorders after retroperitoneal lymph node dissection. Since preserving normal ejaculation and fertility is important, a modified or unilateral retroperitoneal lymph node dissection, when required, is advocated. In patients, with stage I disease the therapy may be limited to an orchiectomy without lymph node dissection. In patients with retroperitoneal lymph node metastases combination chemotherapy with cisplatin and tumor excision gives good results. Patients with true retrograde ejaculation can be treated with alpha-sympathomimetic drugs such as imipramine HCl, and thus be offered the chance of fatherhood by coitus.

Hydrocele formation after sandwich irradiation therapy for testicular tumor

Contralateral hydrocele formation secondary to irradiation, radical retroperitoneal lymphadenectomy, or both, in the treatment of tumor of the testis has, to our knowledge, never before been reported. Our experience with 8 patients in whom hydrocele occurred after the combined modalities of therapy prompted this report. Because these benign hydroceles cannot be differentiated from a second testicular neoplasm on the basis of symptom complex, duration, or time interval after therapy, high inguinal expliration is mandatory in every case.