Hydrocele Fluid Research Articles

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.

Injection Sclerotherapy in Encysted Hydrocele in Paediatric Population

Objective: To determine the role of Sclerotherapy for treating encysted hydrocele in the paediatric population. Study Design: Prospective Study Place and Duration of Study: Department of Paediatric Surgery, Children Hospital Pakistan Institute of Medical Sciences, Islamabad for six months (1st November,2021 to 30th April,2022) Patients and Methods: This study on the captioned topic involved 39 patients aging 2 to 12 years who attended the outpatient department with the complaints of scrotal swelling. In order to rule out non-communicationg hydroceles, these patients were examined clinically and scrotal ultrasound was advised to all the patients which was carried out by them accordingly. In this study, the single team performed the above said procedure on Operation theatre days regularly. The incidence of complications was also monitored with each follow up visits on 1st, 3rd and 6th weeks after the procedure. Results: Study was conducted on 39 children having mean age 4.77 ± 2.860. Pre and post volumes of hydrocele fluid were satistically significant (p≤0.05) with average of 9.00 and 3.269 respectively. Complication rates were decreasing at every follow-up and these were not statisticaly significant (p≥0.05), recurrence complication was significant (p≤0.05). Conclusion: Sclerotherapy has been found to be a positive alternate approach, which is simpler to perform, less time consuming and involving lower complication rate. Keywords: Encysted Hydrocele, Paediatric Population, Sclerotherapy

On the cultivation of dental spirochetes

The method of cultivation of most spirochaetes is not yet generally available to every bacteriological laboratory; cultivation is associated with considerable, sometimes even insurmountable difficulties, both in relations to preparation of nutrient media and cultivation technique itself, and especially in terms of obtaining pure cultures. For preparation of nutrient media one usually needs blood serum of human, horse, rabbit, ram or guinea pig, or ascitic fluid or hydrocele fluid.

English

Lymphatic filariasis, commonly termed as elephantiasis has been recorded since ancient Indian, Chinese, Egyptian and Persian writings.1 It is caused by a slender thread like nematode called Wuchereria bancrofti belonging to super family filaroidea.2 It exists in two morphological forms: Adult form and larvae. The adult form has a predilection for intrascrotal lymphatic vessels in hosts; thus hydrocele is one of the most common manifestations of bancroftian filariasis.3 Individuals having circulating microfilaria are outwardly healthy but have the ability to transmit infection to others through mosquito bites (Culex quinquefasciatus) 1 In developing countries like India, occurrence of genital filarial hydrocele is more common in people living in bancroftian endemic areas or in people who were previously operated for eversion of sac. We hereby report a case of hydrocele fluid with microfilaria- an incidental finding on microscopy. Wuchereria bancroti a filarial nematode inhabiting the lymphatics and transmitted through vector - culex mosquito. We hereby present a case of recurrence of genital filariasis. The patient presented with swelling of the left scrotal region with pain of dragging type. On evaluation, eosinophilia was not seen. He had a history of right hydrocele 28 years back. The aspirated hydrocele on direct microscopic examination showed presence of actively motile microfilaria which was confirmed on Giemsa staining. Recurrence is more common in bancroftian filarial endemic areas.

Presence of VGKC complex: CASPR2/LGI1 antibodies in hydrocele fluid in Morvan’s syndrome (1117)

Presence of VGKC complex: CASPR2/LGI1 antibodies in hydrocele fluid in Morvan’s syndrome (1117)

Incidence of filariasis in clinically diagnosed primary vaginal hydrocele

Background: Lymphatic filariasis is caused by a mosquito-borne parasite affecting roughly 100 million people round the world. There is consensus that hydrocele is the most frequent clinical manifestation of bancroftian filariasis. In endemic areas, about 40% of men are suffering from testicular hydrocele. With this background, the present study was aimed to find the incidence of filariasis in clinically diagnosed primary vaginal hydrocele.Methods: A hospital based prospective, cross-sectional study was conducted with 60 patients diagnosed clinically as primary vaginal hydrocele coming to the department of surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, to assess the incidence of filariasis.Results: Anti-filarial antibody and circulating filarial antigen in serum were detected in 5 (8.3%). Out of 60 patients and anti-filarial antibody was detected in hydrocele fluid of 2 (3.3%) patients. 2 patients out of these 5 showed microfilaria in peripheral blood smear and eosinophilic infiltrates in histopathological examination of sac.Conclusions: In 5 out of 60 cases both anti-filarial antibody and circulating filarial antigen in serum are positive thus proving that incidence of filarial hydrocele is 8% in clinically diagnosed primary vaginal hydrocele which is supposed to be idiopathic. Even though these cases have presented as clinically primary vaginal hydrocele, they are found to be filarial hydrocele after analysis of serum and hydrocele fluid. So, it is advised that all cases of clinically diagnosed primary vaginal hydroceles should be investigated for filariasis and if not, may lead to recurrence in these cases.

Isolated Testicular Tuberculosis in a 9-Year-Old Boy: An Incidental Finding

Isolated testicular Tuberculosis (TB) is a rare clinical condition. A 9-year old boy presented to the paediatric surgical clinic with a 3-month history of a painless mass in the right testis and 1-month history of low- grade continuous fever. The boy had normal anthropometry, no abnormal respiratory signs, there was a right hemiscrotal swelling with a solid hard, non- tender mass felt on the upper pole of the right testis. The chest radiograph was normal, histopatholgic results of the mass showed tuberculotic granuloma with caseous necrosis, FBC revealed WBC of 9.7×10³/MM³, HCT-33% Platelets-357×10³/MM³, Neutrophil-24, Lymphocyte-34, Eosinophils-1O, Monocyte-30, Basophils-2, ESR-26mm/hr, Mantoux-0mm², Cytology smear revealed a mixed inflammation consisting mainly neutrophils and plasma cells with an eosinophilic background. Hydrocele fluid aspirate for M/C/S showed no significant bacterial growth. To date, no clinical method has been defined for the definitive diagnosis of such cases and the definitive diagnosis is only achieved by surgical exploration and histopathological examination. Testicular tuberculosis (TB), a rare form of (EP-TB), may present with diagnostic challenge.

Mini Hydrocelectomy – Outcome of A Short Term Study And Comparison With Conventional Jaboulays Technique

Background: Hydrocele is among the commonest benign conditions of scrotum. Its incidence is around 1% in adult male population with a predilection for males above 40 years of age. Conventional surgical procedures like Jaboulays Eversion of Sac (EOS) and Lords plication of redundant tunica vaginalis remain the most commonly used procedures used in the treatment of idiopathic adult hydrocele. Both procedures are invasive and are associated with durable success and low incidence of recurrence. These procedures are however associated with many post-operative complications like pain, hematoma, infection, persistent swelling and induration of scrotal skin, wound related complications, chronic pain and reduced fertility. All these translate into high morbidity, loss of work hours and increased surgical expenses. To avoid / minimize these complications associated with plication or excision of the redundant hydrocele sac fenestration has been proposed as a minimal access procedure. Fenestration exposes the secretory surface of the tunica vaginalis sac to the lymphatic-rich subcutaneous tissues, from where the hydrocele fluid is cleared off the scrotal cavity. Methods: The present study was carried out in the Department of General Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard during the time period of June 2014 - December 2015. 120 patients of primary vaginal type hydrocele with ASA grade 1 were randomly allocated into two groups of 60 patients each – one group for the Mini-Hydroceletomy MiH-(Group A) and the other group for routine Jaboulays EOS (Group B). All the patients were followed up for a period ranging from 6-18 months. Results: Mean age of patients was 42 years for jabouleys and 45 for mini hydrocelectomy group. Mean hydrocele volume for Group A was 240 ml and for group B was 252 ml. Average time for the procedure in group A was 10-12 min (mean 11min) and for group B was 25 -30min (mean 27min). In Group A, Average incision length was 2.1 cm whereas in Group B it was 5.4 cm. Conclusions: We hereby present our experience that mini-hydrocelectomy (MiH) technique to be the procedure of choice for medium sized uncomplicated hydroceles.

Methylene blue dye for identification of processus vaginalis during hydrocele repair: experience in a teaching hospital.

The aim of this study is to investigate the use of methylene blue in perioperative identification of the patent processus vaginalis in a group of boys presenting with congenital or recurrent hydrocele where surgery was performed by junior surgeons in training. We retrospectively reviewed the notes of 22 boys with hydrocele, of which two recurrences, who were operated via a standard inguinal approach, by trainees. Methylene blue 0.3-0.5 mL was injected into the hydrocele fluid through the scrotal wall. A processus vaginalis was identified as a blue line. Methylene blue injection clearly identified a patent processus vaginalis in 91% of patients. In 9% (N.=2), of which one recurrence, methylene blue injection demonstrated a hydrocele with an obliterated processus vaginalis. There were no intraoperative complications. No testicular atrophy was recorded. Injection of methylene blue into the hydrocele sac may be considered a useful aid for a clearer identification of a difficult patent processus vaginalis. In the present series, there were no complications, and thus we believe that this technique might be suitable and especially helpful, in cases of recurrent hydrocele, and for junior surgeons in training.

The role of transforming growth factor beta 1 in communicating and non-communicating hydrocele

Repair of inguinal hernia and hydrocele are one of the most common operations performed by surgeons. However, the exact biological mechanism responsible for the closure of processus vaginalis (PV) is not completely understood. Transforming growth factor beta 1 (TGF-β1) is a potent fibrogenic agent and probably stimulate fibrosis and disappearing of PV. From September 2012 to December 2014, all boys from 1 to 5 years who were referred for surgery of hydrocele were divided into two groups of communicating (HC) or non-communicating hydrocele (HNC). During surgery, the fluid in the sac was aspirated and sent for biochemical evaluation including calcium, phosphorus, total protein, and TGF-β1. Finally, a biopsy of the sac was sent to the pathology. The results obtained were considered statistically significant (P<0.05). The patients were categorized into two groups of non-communicating hydrocele, including 43 patients and communicating, including 33. The patients studied were aged 1-5years (mean 33.6months). Biochemical tests on hydrocele fluid showed no significant difference in the levels of calcium, phosphorus, total protein, and bilirubin between two groups. However, mean TGF-β1 in NHC was found to be 53.45-114.28pg/ml in HC group. A statistically significant difference (P=0.04) was obtained. Furthermore, the study showed higher amounts of muscles in NHC (P<0.001). The amount of TGF-β1 was higher in HC fluid than in non-communicating. To investigate the role of cytokine in the closure of PV, further studies will be required.

MicroRNA miR-371a-3p - A Novel Serum Biomarker of Testicular Germ Cell Tumors: Evidence for Specificity from Measurements in Testicular Vein Blood and in Neoplastic Hydrocele Fluid

Background: microRNAs (miRs)-371-3 are suggested to be novel biomarkers of germ cell tumors (GCTs), but their specificity is unresolved. We aimed at clarifying the origin of miR 371a-3p by measuring this miR in peripheral vein blood, and in fluids present in the vicinity of GCTs. Methods: miR-371a-3p levels were measured by quantitative PCR in 9 tumor surrounding hydroceles and in cubital vein blood (CVB) and testicular vein blood (TVB) of 64 GCT patients, 51 with clinical stage (CS) 1, 13 with CS2-3. Thirty three CS1 cases had also postoperative CVB measurement. TVB miR levels were compared with those of CVB. Associations with clinical factors were analyzed statistically. Results: TVB miR levels were 294-fold, 80-fold and 4.6-fold higher than those in CVB of CS1 patients, CS2-3 patients and controls, respectively. Neoplastic hydrocele fluid comprised of very high miR levels. In CS1, miR levels dropped to normal postoperatively. Statistically, CVB miR levels are significantly associated with tumor size (p = 0.0211) and testis length (p = 0.0493). TVB miR levels are associated with testis length (p = 0.0129). Conclusions: This study provides evidence for the origin of circulating miR 371a-3p molecules from GCT cells. miR-371a-3p represents a specific serum biomarker for germ cell cancer.

"Scrotal pearl" or calculus in hydrocele

Scrotal pearl or calculus in the hydrocele fluid is found incidentally during an operation, ultrasound or clinical, if large in size. The exact etiopathogenesis of the disease is not clear but is linked to inflammation, injury, necrosis, and infections by parasites. It is a benign asymptomatic condition and a rare complication of hydrocele. A stone in hydrocele does not change the management or prognosis; however, if the stone is adherent to the tunica albuginea and does not change position on ultrasonography the possibility of a tumor has to be borne in mind.

Overexpression of aquaporin 1 in the tunica vaginalis may contribute to adult-onset primary hydrocele testis.

To investigate the cause of the adult-onset primary noncommunicating hydrocele testis, protein expressions of water channel aquaporins (AQPs) 1 and 3 in the tunica vaginalis were assessed. Frozen tunica vaginalis specimens from patients with adult-onset primary hydrocele testis and control male nonhydrocele patients were subjected to Western blot analysis for the detection of AQP1 and AQP3 proteins. Paraffin-embedded sections of tunica vaginalis specimens were histochemically stained with anti-AQP1 and anti-AQP3 antibodies as well as an anti-podoplanin antibody to stain lymphatic endothelia. Hydrocele fluid was subjected to biochemical analysis. AQP1 protein expression in the tunica vaginalis was significantly higher in patients with adult-onset hydrocele testis than in the controls. The AQP3 protein was not detected in the tunica vaginalis. Histochemically, AQP1 expression in the tunica vaginalis was localized in vascular endothelial and smooth muscle cells. The densities of AQP1-expressing capillaries and lymphatic vessels were similar between the tunica vaginalis of the controls and those of hydrocele patients. Sodium levels were higher in the hydrocele fluid than in the serum. In conclusion, overexpression of the AQP1 protein in individual capillary endothelial cells of the tunica vaginalis may contribute to the development of adult-onset primary noncommunicating hydrocele testis as another aquaporin-related disease.

Historic View of Hemorrhage Management

LEEDING IS A highly visible manifestation of injury. Methods for hemorrhage control, including direct pressure, ligature, and suture to close injuries, were described in the Edwin Smith surgical papyrus from Egypt in 1600 BCE. 1 Cautery and the binding of wounds also were known to the ancients, with a classic Greek plate showing Achilles binding the wounded arm of Patroclus in a scene from the Trojan War. 2 Styptics, such as sulfur, and procoagulants, such as spider webs, were known and used in both folk and formal medicine. With the Renaissance, knowledge of anatomy and of the circulation of the blood led to the use of tourniquets and increasingly sophisticated amputation for the control of hemorrhage from extremity injuries. 3,4 Napoleon’s surgeon, Dominique Larrey, performed 200 amputations, including 11 at the shoulder, in the 24 hours after the battle of Borodino. 5 Blundell, who described the first successful human-tohuman transfusions in 1828, wrote that “States of the body really requiring the infusion of blood into the veins are probably rare; yet sometimes we meet with such cases in which the patient must die unless the procedure can be performed, …”. 6 Despite its obvious lifesaving potential, transfusion remained risky throughout the 19th century because of primitive and unsterile equipment and the lack of anticoagulants or knowledge of blood types. Nevertheless, modern understanding of coagulation started in the 19th century with the recognition that fibrin formed in standing rabbit blood, and that the fresh serum thus formed would clot hydrocele fluid. 7 This meant that the precursor of the fibrin—what now is called fibrinogen—was present in the hydrocele fluid, and the “fibrin ferment”—what is now called thrombin—was activated in the fresh serum and must exist in the blood in an inactive form that was activated when the blood was removed from the body or exposed to tissue other than the blood vessel. Late in the century, achromatic microscopes allowed the further recognition that platelets adhered to the walls of damaged blood vessels. 8 Advances in clinical chemistry allowed the identification of the salts in human blood and the development of blood volume replacement solutions such as Ringer’s solution. Early in the 20th century, Roger Lee confirmed the fibrinogen and thrombin model for human coagulation, identified citrate as an anticoagulant, and developed the Lee-White clotting time, the first coagulation test. 9 While serving in the Harvard Medical Unit in World War I, Lee arranged for his former student, Oswald Robertson, to collect “universal donor” whole blood in citrate in bottles, build the world’s first blood bank for the treatment of seriously injured battle casualties, and demonstrate the lifesaving capability of transfusion as an adjunct to surgical care. 10 In the same unit, Walter Cannon,

Role of persistent processus vaginalis in hydroceles found in a tropical population

Lymphatic obstruction by Wuchereria bancrofti is thought to be the mechanism for development of tropical hydrocele in men and for elephantiasis, mostly in women. Hydrocele prevalence is used to determine the effectiveness of para site eradication programs. We maintained a prospective log of operations performed at 1 Canadian Field Hospital during its relief mission to Léogâne, Haiti. Information regarding duration of symptoms, type of previous surgery (if any), surgical approach, associated inguinal hernia and volume and appearance of hydrocele fluid in patients with tropical hydroceles were recorded. From January to March 2010, 4922 patients were seen, none of whom had elephantiasis. Of the 64 patients who collectively underwent 69 inguino-scrotal procedures, 5 patients had inguinal hernia repair several years after hydrocele excision via the scrotum, 19 patients with bilateral hydroceles underwent a scrotum-only approach, and 45 patients had an inguinal approach (33 unilateral and 12 bilateral) to repair 57 hydroceles. A patent processus vaginalis was present in 50 of 57 (88%) hydroceles where the groin was explored. Hydroceles remain common in Léogâne despite successful eradication of filariasis with mass drug administration using diethylcarbamazine-fortified cooking salt. Persistent patent processus vaginalis is a more likely cause than persistent filariasis. There is probably little difference between hydrocele in developed countries and tropical hydrocele other than neglect. Hydrocele prevalence is not a measure of the effectiveness of parasite eradication programs.

Using methylene blue for perioperative localization of the hydrocele sac in boys

Ligation of a patent processus vaginalis via the inguinal approach is the standard operative technique for the treatment of hydroceles in infants and children. Although a simple technique, identification of the processus vaginalis can be difficult even for the experienced surgeon. To investigate the use of methylene blue in the perioperative identification of the patent processus vaginalis in a group of children presenting with hydrocele. Twenty consecutive patients with hydrocele between the ages of 1 and 9 years were recruited for the study. Methylene blue 0.3-0.5 ml was injected slowly into the hydrocele fluid through the scrotal wall after aspiration, followed by routine ligation of the hydrocele track. The track of the processus vaginalis was clearly visualized in 17 (85%) of the patients, while in 3 (15%) patients no track could be seen, the hydrocele being localized to the tunica vaginalis. There were no cases of inadvertent testicular injury and there was no intraoperative complication. No patient reacted in any abnormal way to the methylene blue. The technique helps in the identification of a patent processus vaginalis when it is present. It may be useful in cases where difficulty in identification of the hydrocele tract is anticipated in a child.

A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair

BackgroundChronic hydrocele is the most common manifestation of bancroftian filariasis, an endemic disease in 80 countries. In a prospective study, we evaluated the occurrence of intrascrotal lymphangiectasia, gross appearance/consistency of the testis, and the efficacy of complete excision of hydrocele sac in patients living in a bancroftian filariasis endemic area who underwent hydrocelectomy at the Center for Teaching, Research and Tertiary Referral for Bancroftian Filariasis (NEPAF).Methodology/Principal FindingsA total of 968 patients with uni- or bilateral filarial hydrocele (Group-1) and a Comparison Group (CG) of 218 patients from the same area who already had undergone hydrocele-sac-sparing hydrocelectomy elsewhere were enrolled at NEPAF. Twenty-eight patients from the Comparison Group with hydrocele recurrence were re-operated on at NEPAF and constitute Group-2. In Group-1 a total of 1,128 hydrocelectomies were performed (mean patient age of 30.3yr and mean follow-up of 8.6yr [range 5.3–12]). The hydrocele recurrence rates in Group-1 and in the Comparison Group (mean age of 31.5 yr) were 0.3%, and 19.3%, respectively (p<0,001). There was no hydrocele recurrence in Group-2 (mean patient age of 25.1yr and mean follow-up of 6yr [range 5–6.9]). Per surgically leaking or leak-prone dilated lymphatic vessels were seen in the inner or outer surface of the hydrocele sac wall or in surrounding tissue, particularly in the retrotesticular area, in 30.9% and in 46.3% of patients in Group-1 and Group-2, respectively (p = 0.081). The testicles were abnormal in shape, volume, and consistency in 203/1,128 (18%) and 10/28 (35.7%) of patients from Group-1 and Group-2, respectively (p = 0,025).Conclusions/SignificanceLymph fluid from ruptured dilated lymphatic vessels is an important component of chronic filarial hydrocele fluid that threatens the integrity of the testis in an adult population living in bancroftian filariasis endemic areas. To avoid hydrocele recurrence the authors advise complete excision of hydrocele sac and when identified, leaking or leak-prone dilated lymphatic vessels should be sutured or excised.

Calculi in Hydrocele: Incidence and Results of Infrared Spectroscopy Analysis

Trauma, inflammation, or necrosis in the scrotal cavity may lead to depositing of organic material in hydrocele fluid with consecutive calcification if the fluid is oversaturated. During a period of 25 years, 2 scrotal calculi (calculous material in hydrocele fluid) in 2 of 42 patients (4.8%) were found during surgery on symptomatic hydroceles by the first author. In these symptomatic cases, infrared spectroscopy revealed carbonate apatite as the causative mineral. The appearance of scrotal calculi in hydrocele does not change the treatment or prognosis of hydroceles. However, if the calculous material is attached to the visceral or parietal part of the tunica vaginalis and does not change position during sonography with different postures, tumor growth may be a problem. An inguinal approach for operation should be chosen in such situations. Infrared spectroscopy can be used to determine the mineralogy of scrotal calculi. Carbonate apatite, the predominantly found mineral in scrotal calculi, can precipitate in an alkaline milieu.

CIRCULATING FILARIAL ANTIGEN IN SERUM AND HYDROCELE FLUID FROM INDIVIDUALS LIVING IN AN ENDEMIC AREA FOR BANCROFTIAN FILARIASIS

This study examined circulating filarial antigen by monoclonal antibody Og4C3-enzyme-linked immunosorbent assay (ELISA) from 114 men with hydrocele, living in an endemic area. Nocturnal blood and hydrocele fluid were collected and examined for microfilaria. ELISA was performed on serum and hydrocele fluid for detection of antigen. Amongst 114 cases, 5(4.4%) showed microfilaria in blood but none in fluid. ELISA was positive in 13(11.40%) serum and 5 (4.4%) fluid samples. All five fluid antigen positive cases were positive for antibodies and showed microfilaria in blood. These findings emphasize the use of circulating filarial antigen detection and alternative usage of hydrocele fluid for diagnosis of filariasis.

Circulating filarial antigen in serum and hydrocele fluid from individuals living in an endemic area for bancroftian filariasis

This study examined circulating filarial antigen by monoclonal antibody Og4C3-enzyme-linked immunosorbent assay (ELISA) from 114 men with hydrocele, living in an endemic area. Nocturnal blood and hydrocele fluid were collected and examined for microfilaria. ELISA was performed on serum and hydrocele fluid for detection of antigen. Amongst 114 cases, 5(4.4%) showed microfilaria in blood but none in fluid. ELISA was positive in 13(11.40%) serum and 5 (4.4%) fluid samples. All five fluid antigen positive cases were positive for antibodies and showed microfilaria in blood. These findings emphasize the use of circulating filarial antigen detection and alternative usage of hydrocele fluid for diagnosis of filariasis.