Hydrocele Sac Research Articles

Neonatal pyocele originating from a urinary tract infection: a case report

BackgroundThe origins of pyocele are primarily idiopathic, with reports suggesting the spread from intraperitoneal or hematogenous infection. However, we found no information in the literature regarding the pathogen’s spread from the urinary tract.Case presentationWe report here a case of a 23-day-old term Iranian boy (Fars ethnicity) with complaints of new-onset fever, irritability, poor feeding, right hemiscrotal erythema, and edema. Moreover, the physical examination revealed an enlarged, erythematous, tender right hemiscrotum and edematous scrotal walls. Along with leukocytosis and elevated C-reactive protein levels, the urine culture indicated an infection with Escherichia coli. However, as the color Doppler ultrasonographic examination was inconclusive, he underwent surgical exploration on which a hydrocele sac with reddish cloudy pus fluid was noted, with its culture indicating growth with the same mentioned pathogen. Therefore, an appropriate antibiotic regimen was administered, and the patient was discharged a few days later after achieving full recovery and demonstrating no urinary tract structural abnormalities.ConclusionIn neonatal pyocele, the spectrum of evaluating the source of the infection should also be extended to the urinary tract. Moreover, administering suitable antibiotics would produce favorable results in cases with no structural abnormalities.

Abdominoscrotal Hydrocele - Considerations.

The aim of the study was to highlight the pathology, clinical spectrum, and approach considerations in abdominoscrotal hydrocele (ASH). Our study included eight children with ASH from 2015 to 2022. The demographics, clinical presentation, investigations, operative details, and postoperative outcome were collected retrospectively from case files. The age of presentation ranged from 11 months to 2½ years. Six lesions were on the right side and two were on the left side. One child presented with an acute scrotum and underwent emergency inguinal exploration, revealing hemorrhagic fluid after trauma. Others presented with tense inguinoscrotal swelling, which was fully reducible but refilled promptly after emptying. Preoperative ultrasound showed the abdominal component in 50%, while others were detected intraoperatively. All of them were approached inguinally, and the hydrocele sac was traced proximally to the abdominal component through the internal ring. This was drained and a partial excision of the extraperitoneal sac was done. An additional patent processus vaginalis (PPV) was identified in 87%, dissected up to the deep ring, and ligated. On follow-up, there was no recurrence. ASH is an uncommon condition that should be identified and dealt with appropriately. Physical examination and ultrasonography are usually sufficient for diagnosis. The inguinal approach is a safe, simple method and an extension of the standard operation for the hydrocele. One must keep in mind to explore for an additional narrow PPV to prevent the recurrence of hydrocele.

A Case of Encysted Hydrocele of Spermatic Cord Mimicking Incarcerated Inguinal Hernia in an Adult Male

Encysted hydrocele of the spermatic cord occurs due to the persistence of the Cranford section, which is a segment of the patent processus vaginalis. This results in localised fluid collection, causing an encysted hydrocele. The present case reports a rare cause of groin swelling that mimics an incarcerated inguinal hernia. A 55-year-old male presented with complaints of swelling over his right groin for the past 6 months and dull-aching pain for the past 1 week. Clinically diagnosed as a case of a right incarcerated inguinal hernia. High-frequency ultrasound revealed an anechoic cystic lesion of size 8×3.8 cm in the subcutaneous plane of the right inguinal region with no bowel or omentum as content. Intraoperatively, a 9×7 cm ovoid encysted hydrocele of the cord was identified. No intraoperative findings were suggestive of an inguinal hernia. The hydrocele sac was carefully excised from cord contents. Prompt anticipation and surgical management are required for the diagnosis and management of an encysted hydrocele.

Eggshell calcified hydrocele sac: a case report

IntroductionHydrocele, an abnormal fluid collection between parietal and visceral layers of the tunica vaginalis, is the commonest cause of scrotal swelling, and it affects all age groups. Calcification of hydrocele sac/wall is a rare clinical entity. The etiology of calcification of hydrocele sac is not clear, but most literature proposes that calcification is secondary to chronic irritation. Trauma and infectious diseases including Schistosoma haematobium, filariasis, and tuberculosis can also cause calcification of the hydrocele sac.Case presentationA 74-year-old Ethiopian male patient presented with left side scrotal swelling of 3 years duration, which was initially small but progressively increased. He had no history of trauma, and he had no history of swelling on the contralateral side. Scrotal ultrasound (US) showed a large echodebrinous left-side scrotal collection with calcifications, bilateral testis appear normal in size, echogenicity, and color Doppler flow with the index of likely chronic hematocele. Therefore, with a diagnosis of left-sided calcified hydrocele, the patient was operated on and the calcified sac was excised and sent for histopathology. Finally, the patient was discharged improved after 2 days of hospital stay.ConclusionCalcification of the tunica vaginalis is very rare and is probably due to chronic irritation of the wall from the coexisting hydrocele. Surgical excision of calcified hydrocele sac is the treatment of choice.

Can the Hydrocele Sac Dissection Technique Affect the Surgical and Cosmetic Satisfaction Results of Conventional Hydrocelectomy?

Aim: In this study, we applied the classical technique and modified open pull-through procedure (OPtP) for hydrocele sac dissection in excisional Winkelmann hydrocelectomy procedure (WHP) to retrospectively compare the surgical and cosmetic satisfaction results of the two techniques. Material and Methods: Sixty-two patients underwent excisional WHP from 2017 to 2020. The modified OPtP and classical technique groups included 30 and 32 patients, respectively. The intraoperative and postoperative parameters of the patients in both groups were evaluated statistically until the postoperative second month. Cosmetic satisfaction was evaluated statistically at the postoperative sixth month. Results: Postoperative infection and recurrence were not observed in either group. The patients in both groups had large hydrocele sacs. There was no statistically significant difference between the groups in terms of the hydrocele sac volume, operation time, length of hospitalization, postoperative scrotal edema, and postoperative scrotal pain scores (p>0.05). The postoperative hematoma rate was 15.6% in the classical technique group. The statistical difference in incision length and cosmetic satisfaction was significant in favor of the modified OPtP group (p<0.05). Conclusion: Excisional WHP was determined to be safe in the treatment of large hydroceles. In the modified OPtP group, shorter scrotal incision length and low risk of postoperative scrotal hematoma were achieved, and cosmetic satisfaction was also increased.

V04-12 SINGLE PENILE INCISION FOR CONCOMITANT CIRCUMCISION AND INGUINAL SURGERY

You have accessJournal of UrologyCME1 Apr 2023V04-12 SINGLE PENILE INCISION FOR CONCOMITANT CIRCUMCISION AND INGUINAL SURGERY Andrew Carey, Arighnno Das, Madison Wi, Fardod O'kelly, Shannon Cannon, Vinaya Bhatia, and Walid Farhat Andrew CareyAndrew Carey More articles by this author , Arighnno DasArighnno Das More articles by this author , Madison WiMadison Wi More articles by this author , Fardod O'kellyFardod O'kelly More articles by this author , Shannon CannonShannon Cannon More articles by this author , Vinaya BhatiaVinaya Bhatia More articles by this author , and Walid FarhatWalid Farhat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003252.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients undergoing circumcisions with concomitant inguinal pathologies currently require both a penile and inguinal incision. We have previously described performing inguinal procedures through a penile incision. Herein we extend on this minimally invasive approach by performing a hydrocelectomy through a circumcision incision. METHODS: Once the preputial skin is excised, the penopubic junction is bluntly dissected. An S-shaped retractor is placed on the pubic bone and retracted towards the ipsilateral shoulder. With the pubic bone as a key landmark, the cord structures are carefully identified and the hydrocele sac is dissected off. The circumcision is then completed in the usual fashion. RESULTS: To date, we have offered this approach to all children undergoing circumcision and who also have undescended testis (UDT), hydroceles, or hernias. We have found that this approach is best for children who are under 5 years of age. Notably, this approach does not affect the appearance of the circumcision in any way. CONCLUSIONS: Children with inguinal pathologies, such as UDT, hernias or hydroceles, who are also undergoing circumcision or any penile procedure are currently offered this approach. A single penile incision for circumcision and correction of inguinal pathology is feasible, safe, and provides similar surgical outcomes with shorter overall operative time. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e341 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrew Carey More articles by this author Arighnno Das More articles by this author Madison Wi More articles by this author Fardod O'kelly More articles by this author Shannon Cannon More articles by this author Vinaya Bhatia More articles by this author Walid Farhat More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcomes after eversion of sac and subtotal excision of sac in cases of primary hydrocele

Background/Aim: Hydrocele is a common disease worldwide, and an effective treatment for it is surgery. The commonly performed procedures for its treatment are a) excisional technique — subtotal excision of the sac and b) Jaboulay’s procedure — eversion of the hydrocele sac. This study aimed to evaluate the merits and demerits of eversion of the sac versus subtotal excision in terms of complications, postoperative hospital stays, and recurrence rate. Methods: This prospective study was conducted at a large surgical center. Patients who presented with scrotal swelling and were diagnosed as primary hydrocele cases constituted the study population (100 in all). Subtotal excisions or eversions of the sac were performed depending on the type of hydrocele encountered preoperatively. Follow-up was done at 1week, 1 month, 3 months, and 6 months postoperatively. Results: Eversion of the sac was done in 70 cases, and subtotal excision was done in 30 cases. Incidence of edema, intense pain, and hematoma formation was higher in the group undergoing excision of the sac compared to those undergoing eversion of the sac. The average postoperative hospital stay was 3–5 days in the eversion group. The average postoperative hospital stay was 7–9 days in the subtotal excision group. No recurrence was noted in either of the study groups during the stays study period. Conclusion: Eversion of the sac was associated with fewer postoperative complications, minimal tissue handling, and good hemostatic control compared to subtotal excision of the sac. Patients who underwent eversion of the sac received earlier discharge than those undergoing a subtotal excision of the sac for primary vaginal hydrocele.

Abdominoscrotal hydrocele: excision of sac may not be necessary

Abdominoscrotal hydroceles (ASH) are uncommon occurrences in boys and usually treated similarly to a hernia with the assumption that there is an associated patent processus vaginalis. Treatment in this manner may be challenging due to sac size, extension and adherence to the spermatic cord. Due to the rarity of ASH, the literature is mostly limited to small, single-institution case studies. Our goal was to evaluate two techniques in large number. We hypothesized a simplified scrotal technique with eversion, Jaboulay procedure, would demonstrate less complications and equivalent efficacy to standard excision. We retrospectively reviewed medical records at three tertiary children's hospitals to identify boys who underwent surgical repair of ASH between 1998 and 2018. Group 1 had excision and/or ligation of the hydrocele sac. Group 2 had a scrotal incision with limited excision and then eversion of the hydrocele sac (Jaboulay procedure). Variables that were analyzed included preoperative imaging, surgical technique, surgical findings, length of follow up, complications and recurrence of swelling. We identified 61 boys, who had 77 abdominoscrotal hydroceles. Group 1 included 38 patients with 48 hydroceles. Group 2 included 23 patients with 29 hydroceles. Complications were more common in Group 1 patients (18% vs 0%) but complication rate and operative time were not statistically associated with surgery type or age. No patient in either group had recurrence of hydrocele. Although this is a large study for this rare condition, the analysis is limited by number and its retrospective nature. For the rare and difficult to treat abdominoscrotal hydrocele, we were unable to prove with statistical significance that a simplified technique of eversion via the scrotum is safer. However, this large series did demonstrate that the simplified procedure provides equal efficacy as excision.

Laparoscopic suture-less herniotomy using tissue-sealing device for paediatric hydrocele.

Introduction:Laparoscopic herniotomy (LH) for hydrocele is an accepted procedure and provides advantages of contralateral diagnosis and repair with the same incisions. The suturing of patent processus vaginalis is associated with various complications. We describe suture-less herniotomy using tissue-sealing device for LH of hydrocele in children.Materials and Methods:The study was carried out on a prospective group of 21 children presenting with hydrocele after 1 year age over a period of 2 years. All infants with hydrocele and complicated hydroceles were excluded. The technique involved peritoneal incision and sealing of hydrocele sac with tissue-sealing device.Results:A total of 21 patients (28 hydroceles) were operated. The age ranged from 1 year to 14 years (mean age, 4 years). Ten right, 4 left and 7 bilateral hydroceles (2 diagnosed on laparoscopy) were operated. Operative time ranged from 15 to 32 min, with a mean time of 18 min. All patients were discharged after a hospital stay of 12 h. No recurrences were observed during the follow-up period. One patient had persistent hydrocele for 4 months which resolved spontaneously.Conclusion:The laparoscopic suture-less herniotomy for paediatric hydrocele is a safe, secure and easy procedure which can reduce suture and suturing-related complications following LH in hydroceles.

Hydrocelectomy through Inguinal Approach in Adults

Background: hydrocele is the most common cause of painless scrotal swelling. The incidence in adult males is approximately 1%, although prevalence varies according to country. Objective: to compare between the two groups? as regards the volume of the hydrocele sac, operative time, postoperative morbidity, length of hospital stay, and time of return to daily life. Patients and Methods: this prospective study was conducted on 40 patients with a diagnosis of unilateral (idiopathic) primary vaginal hydrocele during the period from October 2010 to October 2011. All patients were admitted to the Department of General Surgery, El-Hussein University Hospital, and underwent hydrocelectomy. Results: the age of the patients in the inguinal approach group ranged from 17 to 52 years (mean 30.75±10.67), whereas the patients included in the scrotal approach group had an age range of 16–48 years (mean 29.35±8.93). The difference in mean age between the two groups was statistically insignificant. The mean volume of the hydrocele sac was 196± 30.28 ml (range, 155–250 ml) in the inguinal approach group and 197.75±26.72 ml (range, 150–260 ml) in the scrotal approach group. The difference in mean volume of hydrocele between the two groups was statistically not significant. Conclusion: hydrocelectomy using the inguinal approach in adults is associated with low or no postoperative morbidity, no discomfort, short hospital stay, and early return to normal life. It is easily applied and allows management of any associated lesions in the inguinal canal.

Hydrocelectomy through Inguinal Approach in Adults

Background: hydrocele is the most common cause of painless scrotal swelling. The incidence in adult males is approximately 1%, although prevalence varies according to country. Objective: to compare between the two groups? as regards the volume of the hydrocele sac, operative time, postoperative morbidity, length of hospital stay, and time of return to daily life. Patients and Methods: this prospective study was conducted on 40 patients with a diagnosis of unilateral (idiopathic) primary vaginal hydrocele during the period from October 2010 to October 2011. All patients were admitted to the Department of General Surgery, El-Hussein University Hospital, and underwent hydrocelectomy. Results: the age of the patients in the inguinal approach group ranged from 17 to 52 years (mean 30.75±10.67), whereas the patients included in the scrotal approach group had an age range of 16–48 years (mean 29.35±8.93). The difference in mean age between the two groups was statistically insignificant. The mean volume of the hydrocele sac was 196± 30.28 ml (range, 155–250 ml) in the inguinal approach group and 197.75±26.72 ml (range, 150–260 ml) in the scrotal approach group. The difference in mean volume of hydrocele between the two groups was statistically not significant. Conclusion: hydrocelectomy using the inguinal approach in adults is associated with low or no postoperative morbidity, no discomfort, short hospital stay, and early return to normal life. It is easily applied and allows management of any associated lesions in the inguinal canal.

Effectiveness of Laparoscopy in the Treatment of Pediatric Hydrocele: A Systematic Review

Objective: To conduct a systematic review of the published studies concerning laparoscopic pediatric hydrocele (PH) repair and summarize the surgical details and operative outcomes of this procedure. Materials and Methods: A PubMed search was performed for all studies concerning laparoscopic repair of hydrocele in children. The search strategy was as follows: (laparoscop* OR coelioscop* OR peritoneoscop* OR laparoendoscop* OR minilaparoscop*) AND hydrocele* AND (child* OR pediatric*). Inclusion criteria included (1) children with hydrocele as the study participant; (2) laparoscopic PH repair as the main surgical procedure; and (3) operation time and complications as the outcomes of interest. Reviews, studies with insufficient information or reporting the outcomes of abdominoscrotal hydrocele, and duplicate patient series were excluded. Results: Overall, 20 studies fulfilled the inclusion criteria of this review and 15 studies were included in the final analysis. These studies comprised at least 2920 patients undergoing laparoscopic repair for various PH subtypes, of which most were conducted in Asia. Most authors repaired PH laparoscopically through an extraperitoneal approach, while only a few studies applied a laparoscopic intraperitoneal method. The majority of the studies used nonabsorbable sutures to ligate hydrocele sac, while very few studies used absorbable materials. Hydrocele sac was resected or transected in only five studies, but left alone in the majority. Mean operation time was between 15.6 and 43.2 minutes for unilateral laparoscopic PH repair and between 16.9 and 53.2 minutes for bilateral surgery. Operative complications were not very common, with a highest recurrence/persistence incidence of 1.4%. Subgroup analysis showed that hydrocele subtype, surgical approach, suture material, and management of hydrocele sac did not significantly influence the operative complications. Conclusions: laparoscopic PH repair seems to be a safe and effective procedure. Given the limitations of this review, our conclusion needs to be confirmed by more well-designed studies.

Comparative study of inguinal versus scrotal approach in idiopathic vaginal hydrocele.

Background: Hydrocele is a common cause of painless scrotal swelling worldwide.Methods: Hydrocele is a common cause of painless scrotal swelling worldwide. This prospective study was carried out at AVBRH, Sawangi Wardha, Maharashtra, India with the aim of comparing scrotal and inguinal approaches of hydrocelectomy. 100 patients were enrolled between September 2015 and September 2017 and were randomly selected for inguinal and scrotal approaches (n=50 each). They were compared on the basis of volume of hydrocele sac, operative time, post-operative hospital stay, post-operative complications, number of doses of injectable analgesia required and time of return to daily life activity.Results: The patients’ age ranged from 23 to 65 years (42.80±9.73 years) in the inguinal approach group and 22 to 65 years (41.30±11.21 years) in the scrotal approach group. Operative time in the scrotal approach group was less and was associated with more post-operative complications (pain and scrotal edema being frequent), longer hospital stay, increased requirement of injectable analgesia dosage. On the other hand, inguinal approach group had a marginally longer operative time and was associated with less post-operative pain, none to minimal complications, less hospital stay and early return to daily life activities. Conclusions: Thus, hydrocelectomy by inguinal approach is an effective alternative method for the treatment of idiopathic hydrocele.

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 Western snip, stitch, and tug hydrocelectomy: How I do it.

Adult idiopathic hydrocele is a common benign disorder that merits surgical correction when symptomatic. The most popular techniques for repair are plication (Lord's procedure) or excision and eversion of the tunica vaginalis (Jaboulay procedure). Established complications from these traditional repairs include hematoma, recurrence, and infection. These procedures are performed through a scrotal incision. We describe a novel technique of hydrocele repair with gubernaculum preservation through a subinguinal incision. The novel technique is described in detail. A retrospective review was performed of those patients treated by a single surgeon with the subinguinal technique. Demographic information, indication for treatment, success rate, and details regarding complications were collected. We term the technique the "Snip, Stitch & Tug" repair. Through a small subinguinal incision, the tunica is everted posterior to the spermatic cord and testis without resection of the hydrocele sac or division of the gubernaculum. Twelve patients with postoperative followup were identified. Eleven patients (92%) treated with the novel technique were cured. There was only one complication (superficial wound infection) recorded after this technique. Idiopathic hydrocele repair with gubernaculum preservation can be easily and safely performed through a small subinguinal incision.

A Rare Case of Well Differentiated Papillary Mesothelioma of the Tunica Vaginalis

Well Differentiated Papillary Mesothelioma (WDPM) is an uncommon neoplasm of the paratesticular area usually presents as hydrocele. Here we report a rare case of benign papillary mesothelioma of the tunica vaginalis presented as hydrocele with singly polypoidal grossly papillary lesion with multiple foci in the hydrocele sac. Histologically tumor shows branching papillary structures with fibro vascular core and cytologically bland nuclei without any mitosis, necrosis or area of invasion. In addition histochemistry is done to differentiate it with other papillary neoplasm. WDPM must be distinguished from the aggressive lesion to avoid unnecessary treatment.

Hydrocele of Femoral Hernial Sac-an Extremely Rare Case.

A previously healthy 40-year-old woman presented with a right groin swelling for the last 2years. Diagnosed preoperatively as uncomplicated, irreducible epiplocele of right femoral hernia, later per-operatively was diagnosed as hydrocele of femoral hernial sac also known as "femorocele"; ultrasound abdomen and groin demonstrated as a cystic mass right groin with no precise origin. All other basic line investigations within normal limits, except anemia 7gm %, corrected to 10gm %, by preoperative transfusions of 2units of complete fresh blood. After low approach incision, excision of hydrocele sac, and feormal hernia repair were done with approximation of iliopectineal ligament to inguinal ligament, patient was discharged on 5th postoperative day with satisfactory wound healing and uneventful hospitalization.

Application of a Laparoscopic, Single-port, Double-needle Technique for Pediatric Hydroceles With Multiple Peritoneal Folds: A Trial From a Single-center 5-Year Experience

To report our 5-year experience with a modified single-port, double-needle, minilaparoscopic technique for patent processus vaginalis with multiple peritoneal folds in the hydrocele sac orifice. A total of 125 consecutive cases of boys with unilateral pediatric hydrocele underwent minilaparoscopic repair between June 2008 and June 2013. The patients were divided into 2 groups. Group 1 consisted of 65 patients who underwent a 2-port laparoscopic procedure, during which a 3-mm grasping forceps was used to grasp the folds around the internal inguinal ring. Group 2 included 60 patients who received a modified single-port, double-needle, minilaparoscopic surgery. An Endo Close needle was used to spread the peritoneal folds and facilitate circular extraperitoneal suturing in group 2. The principal outcome factors were assessed between the groups. A total of 151 minilaparoscopic procedures were performed in 125 patients (age range, 12-68 months; median, 21.5 months). In total, 26 extra procedures were performed for simultaneous repair of a potential contralateral patent processus vaginalis. No significant difference in operation time was noted between group 1 and group 2 (25.9 ± 6.4 vs 27.1 ± 5.5 minutes). The procedures were performed successfully without serious preoperative complications. During a median follow-up period of 18 months (range, 6-36 months), no postoperative hydrocele recurrence was encountered. Our limited experience suggests that the modified single-port, double-needle, minilaparoscopic technique could be safe, effective, and more cosmetically appealing for the management of complicated pediatric hydroceles.

Microsurgical Hydrocelectomy: Rationale and Technique

IntroductionHydrocelectomy may be complicated by hematoma, infection, testicular atrophy, epididymal injury and recurrence. Microsurgical hydrocelectomy allows for better visualization of epididymal tubules and testicular vasculature. We investigated the clinical outcomes of microsurgical hydrocelectomy. MethodsWe retrospectively reviewed the charts of all men who underwent microsurgical hydrocelectomy from 1999 to 2013. All operations were performed through a scrotal incision. The spermatic vessels, vas deferens and epididymis were identified under an operating microscope at 6× to 25× magnification. The hydrocele sac was excised under the microscope. Assessment of operative outcomes included postoperative physical examination, need for subsequent fertility treatment and recurrence. Pathology reports were reviewed and descriptive analysis was performed. ResultsMean ± SD patient age was 44.4 ± 17.4 years. Mean hydrocele volume was 275.5 ± 260 ml. The etiology was prior inguinal hernia repair in 21% of patients, nonmicrosurgical varicocelectomy in 16%, recurrent hydroceles in 14%, epididymitis or orchitis in 7%, trauma or scrotal surgery in 7% and an idiopathic cause in 35%. Surgery was performed on 70 units (12 bilateral) in a total of 58 men. There was a 12% postoperative complication rate and all complications were Clavien grade I. No recurrence developed during a mean followup of 68.8 months. At hydrocelectomy concomitant surgical procedures were done in 60% of cases, of which 50% were spermatocelectomy. In 69 hydrocele sac pathology specimens no epididymal tubules were identified. In an older man in whom fertility was not an issue part of the epididymis was intentionally transected with the sac. ConclusionsMicrosurgical hydrocelectomy minimizes the risk of injury to the epididymis, vas deferens or testicular blood supply as well as the risk of infection or hematoma.