Large Hydrocele Research Articles

Practice Variation in the Management of Adult Hydroceles: A Multinational Survey

BackgroundAlthough hydrocele is one of the most common urologic pathologies, it is seldom studied, and the major urologic associations have no guidelines for the management of adult hydroceles. ObjectiveTo characterize international practice variation in the treatment of adult hydroceles. Design, setting, and participantsAn international survey was conducted addressing the management of hydroceles among urologists in Belgium, Denmark, Finland, Iceland, Japan, and the Netherlands from September to December 2020. We invited a random sample of 170 urologists from each country (except Iceland). Outcome measurements and statistical analysisUrologists’ treatment options, factors relevant for decision-making, expected patient satisfaction, and outcomes after aspiration versus surgery were assessed. Results and limitationsOf the 864 urologists contacted, 437 (51%) participated. Of the respondents, 202 (53%) performed both hydrocelectomies and aspiration, 147 (39%) performed hydrocelectomies only, and 30 (8%) performed aspiration only. In Belgium (83%), the Netherlands (75%), and Denmark (55%), urologists primarily performed hydrocelectomies only, whereas in Finland (84%), Japan (61%), and Iceland (91%), urologists performed both hydrocelectomies and aspiration. Urologists favored hydrocelectomy for large hydroceles (78.8% vs 37.5% for small), younger patients (66.0% for patients <50 yr vs 41.2% for ≥70 yr), patients with few or no comorbidities (62.3% vs 23.1% with multiple comorbidities), and patients without antithrombotic agents (53.5% vs 36.5% with antithrombotic agents). Most urologists considered patient satisfaction to be highest after hydrocelectomy (53.8% vs 9.9% after aspiration) despite believing that hydrocelectomy is more likely to cause complications (hematoma 77.8% vs 8.8% after aspiration). Estimates varied between countries. ConclusionsWe found a large variation in the treatment of adult hydroceles within and between countries. Optimization of hydrocele management globally will require future studies. Patient summaryOur international survey shows that treatment of adult hydrocele varies considerably within and between countries.

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&amp;gt;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&amp;lt;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.

AUTHOR REPLY

As Dr. Birch correctly notes, benign scrotal pathologies are quality-of-life issues rather than life-threatening issues. In addition, the relative impacts of these conditions are a spectrum that will vary greatly between patients. An elderly patient with limited mobility may be unbothered by his large hydrocele, while a young man may be distraught with the same scrotal appearance. The reverse can also be true. With this range of considerations in mind, the decision to undergo surgery must be an informed one.

An Unusual Inguinal Swelling: LargeHydrocele of Canal of Nuck

The hydrocele of the canal of Nuck is a rare entity. Often referred as ‘female hydrocele’, it results from patent processus vaginalis. Though a preoperative diagnosis is difficult to ascertain, operative evaluation confirms this entity. Surgical excision remains the standard of care. Here, we present a case of 36 year old lady who presented with left inguiolabial swelling and evaluation revealed large Hydrocele of Canal of Nuck.

A rare case of large abdominoscrotal hydrocele in a 7-month old infant: surgical treatment and review of the literature

A rare case of large abdominoscrotal hydrocele in a 7-month old infant: surgical treatment and review of the literature

English

BACKGROUND AND OBJECTIVES: 1. To study various types of clinical presentation of cystic swelling of scrotum. 2. To find out the commonest cause of Cystic swelling of scrotum. 3. Different treatment modalities adopted. 4. Outcome of the Treatment. PATIENTS AND METHODS: Between April 2014 and April 2015 about 60 patients with cystic swelling of scrotum admitted in surgical unit of Tirunelveli Medical College and Govt. Hospital, Tirunelveli were taken up for study, and various surgical techniques like eversion, plication, subtotal/partial excision and eversion of sac was adopted. RESULTS: Primary vaginal hydrocele (70%) is the commonest cause of cystic swelling of scrotum, followed by secondary hydrocele (10%) and epididymal cyst (3%), incidence was more in age group of 21-30years (31%), most of them were coolie by occupation (38%), side wise, Right side the incidence was higher. Haematoma and infection was seen in cases where eversion and partial/subtotal excision of sac was done; In Lords procedure none of them developed haematoma or infection, flattening of testis was seen in 5 cases of primary vaginal hydrocele. CONCLUSION: Lord’s Plication for hydrocele is simple, effective, safe and economical; could be done as a day care surgery. In eversion of sac and partial/subtotal exicision and eversion of sac heamatoma formation and infection is common; but still it is the choice of operation for large hydrocele and in thickened sac.

Congenital pancreatic pseudocyst presenting as neonatal ascites

Abstract Congenital pancreatic pseudocysts are extremely rare in infants and very few cases have been reported in the literature. We are reporting a case of 2-month-old infant with pancreatic pseudocyst. He presented with progressive abdominal distension and large bilateral hydrocele. The diagnosis was based on the operative findings and further confirmed by histopathological examination of the wall of pseudocyst. Later on the patient was operated by laparoscopic assisted transgastric cystogastrostomy technique.

V8-08 MINIMAL INVASIVE HYDROCELECTOMY TECHNIQUE, ONOL (OUTPATIENT NOVEL OUT LEAF) PROCEDURE: 10 YEARS EXPERIENCE

You have accessJournal of UrologyBladder Oncology/Testis/Transplantation/Trauma1 Apr 2016V8-08 MINIMAL INVASIVE HYDROCELECTOMY TECHNIQUE, ONOL (OUTPATIENT NOVEL OUT LEAF) PROCEDURE: 10 YEARS EXPERIENCE Sinasi Yavuz Onol, Fikret Fatih Onol, Ismail Basibuyuk, and Mehmet Remzi Erdem Sinasi Yavuz OnolSinasi Yavuz Onol More articles by this author , Fikret Fatih OnolFikret Fatih Onol More articles by this author , Ismail BasibuyukIsmail Basibuyuk More articles by this author , and Mehmet Remzi ErdemMehmet Remzi Erdem More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.751AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Purpose: Standard surgical procedures for hydrocele may cause postoperative discomfort, temporary limitation of normal activities and complications, such as hematoma, infection, persistent swelling, chronic pain and decreased fertility. Wide and brutal dissection of scrotal structure around hydrocele cause numerous complications, which were mentioned above, in this type of minor surgery. In this study we present our long term results of minimal invasive hydrocelectomy technique with less morbidity. METHODS Between April 2004 and April 2015, 135 patients underwent hydrocelectomy, which was bilateral in 14. Through a 15 mm transverse scrotal incision the tunica vaginalis parietalis was identified and grasped. The sac was dissected bluntly under gentle traction, and delivered out of the incision. The fully mobilized tunica was excised by electrocautery at its base, followed by wound closure. Patients were discharged home within 24 hours after surgery and were controlled at 6-month of operation. RESULTS Mean operative time was 24.3 minutes. Postoperatively hematoma or wound infection was not evident in any case. Mild scrotal edema usually subsided within a few days after the procedure. Two patients with persistent edema and hardening of the scrotum required additional bed rest and anti-inflammatory agents. Patients were able to resume normal daily activity an average of 4 days after surgery (range 1 to 21). Cure was achieved in 130 of the 135 hydrocele cases (96%). CONCLUSIONS Our pull-through technique enables the surgeon to remove large hydrocele sacs through a tiny hole and with minimal dissection under direct vision of the testicular structures with minimal trauma to the surrounding structures, resulting in early recovery, minimal edema, bleeding and lesser complications. This procedure is an option for the surgical management of idiopathic hydrocele as the evidience by the 10 years experiences. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e773 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sinasi Yavuz Onol More articles by this author Fikret Fatih Onol More articles by this author Ismail Basibuyuk More articles by this author Mehmet Remzi Erdem More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Well-differentiated Papillary Mesothelioma of the Tunica Vaginalis

A 39-year-old man presented with painless scrotal swelling for 2 months. He denied any asbestos exposure but worked with wall and ceiling plaster. Physical exam revealed a large right scrotum which transilluminated. Scrotal ultrasonography revealed a large right hydrocele and a polypoidal mass along the anterior wall of the scrotum. Magnetic resonance imaging of the abdomen and computed tomography of the chest showed no metastases. He underwent a right inguinal scrotal exploration and wide excision of tunica vaginalis and a partial epididymectomy. Pathology revealed well-differentiated papillary mesothelioma of the tunica vaginalis. The patient had an uneventful recovery.

Sonological Evaluation of Scrotal Pathology by High Resolution Ultrasound and Color Doppler

Introduction: The development of sonogram with high frequency linear transducer and color doppler is an important mile stone in evaluating scrotal pathologies. Computed tomography exposes testicles to the radiation and MRI is not so easily available. Therefore ultrasound with color Doppler is the best suited modality for the evaluation of scrotal pathologies as it is simple, noninvasive, reproducible, relatively inexpensive and widely available investigation that will not expose the testis to radiation. Aims and Objectives: To classify (etiologically) and to evaluate various scrotal pathologies using ultrasonography and describe the role of High resolution ultrasound and colour doppler in their diagnosis and differentiation. Materials and Methods: The study was done on 60 patients who were referred to the radiology department by the General Surgery and Urology departments for scrotal ultrasound and Doppler study. This study was conducted between May 2012 to September 2014 at Katuri Medical College and Hospital, Chinnakondrupadu, Guntur. Results : Of the 60 patients studied, incidence of various pathologies were as follows -inflammatory pathology in 26%, congenital in 12%, scrotal hernia in 16%, infertility in 8%, torsion in 7%, tumors in 3.3%, trauma in 3%, and others in 26.7%. The imaging features of these conditions with differentiating hallmarks are described. Conclusion: High frequency ultrasonography is invaluable in demonstrating normalcy of testes and epididymis in the presence of large hydroceles. High-frequency ultrasonography enables clear demonstration of the morphological alterations associated with acute scrotal inflammatory diseases. Color doppler sonography is highly sensitive in diagnosing acute scrotal pathology and accurately differentiates testicular ischemia /torsion from acute inflammatory conditions.

Scrotal Swelling as a Complication of Hydrochlorothiazide Induced Acute Pancreatitis.

Background. Scrotal swelling is a rare complication of acute pancreatitis with few reported cases in the literature. In this case report, we present a 59-year-old male with hydrochlorothiazide induced pancreatitis who developed scrotal swelling. Case Presentation. A 59-year-old male presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest. On physical examination, he had abdominal tenderness and distention with hypoactive bowel sounds. Computed tomography (CT) scan of the abdomen showed acute pancreatitis. The patient's condition deteriorated and he was admitted to the intensive care unit (ICU). After he improved and was transferred out of the ICU, the patient developed swelling of the scrotum and penis. Ultrasound (US) of the scrotum showed large hydrocele bilaterally with no varicoceles or testicular masses. Good blood flow was observed for both testicles. The swelling diminished over the next eight days with the addition of Lasix and the patient was discharged home in stable condition. Conclusion. Scrotal swelling is a rare complication of acute pancreatitis. It usually resolves spontaneously with conservative medical management such as diuretics and elevation of the legs.

Ultrasound of the male genital tract in relation to male reproductive health.

Infertility affects ∼7% of all men. Despite much progress, mainly in genetics, its etiology remains obscure in ∼50% of cases. To fill this gap, imaging of the male genital tract (MGT) has progressively expanded, providing useful information in the assessment of MGT abnormalities. A critical, systematic review of the available literature was performed using Medline, with no restrictions regarding date of publication (i.e. from inception date until March 2014), along with analysis of previous reports in color Doppler ultrasound (CDUS) atlas textbooks. Normal anatomy and sonographic characteristics of the MGT have also been summarized. Testicular volume (TV) is tightly associated with both sperm and hormonal parameters. Ultrasound (US) offers a greater accuracy in TV measurement than Prader orchidometer (PO). However US- and PO-derived TV are closely related, making PO-derived TV informative enough in the work-up of the infertile man in everyday clinical practice. US-derived TV might play an independent role in specific clinical conditions (i.e. large hydrocele, inguinal testis, enlarged epididymis). Scrotal US may detect signs of testicular dysgenesis, often related to an impaired spermatogenesis and to a higher risk of malignancy, or testicular lesions suggestive of malignancy. A decreased testis vascularization is characteristic of testicular torsion, whereas hyperemia is often observed in epididymo-orchitis or in some malignant conditions (i.e. lymphoma, leukemia). The impact of varicocele detection and surgical correction on sperm parameters/fatherhood is debated. At present, the clinical management of varicocele is mainly based on physical examination. However, CDUS is useful in assessing venous reflux, when palpation is unreliable and/or in detecting recurrence/persistence after surgery. Epididymis head and/or tail dilation is suggestive of MGT obstruction or inflammation and both are related, along with echo-texture abnormalities, to impaired sperm parameters. Scrotal and transrectal US (TRUS) are useful in detecting congenital uni- or bilateral absence of vas deferens (CBAVD), which may be associated with epididymis, seminal vesicles (SV) or kidney abnormalities/agenesis. TRUS plays a key role in assessing obstructive azoospermia and detecting distal CBAVD or anomalies related to ejaculatory ducts obstruction, such as ejaculatory duct abnormalities, prostate median cysts or SV enlargement/emptying impairment. TRUS findings lead to operational decision-making, such as testicular sperm extraction in the case of CBAVD, cyst aspiration in the case of a large prostatic median cyst, and surgical treatment if ejaculatory duct abnormalities are observed. TRUS may reveal prostate volume reduction (suggestive of hypogonadism) or enlargement, which can be related to aging or even metabolic abnormalities. Finally, TRUS may reveal prostate and SV echo-texture abnormalities suggestive of inflammation or SV stasis. MGT-CDUS is a useful tool in detecting abnormalities related to impaired male reproductive health. However, it suffers from a lack of standardization and often produces subjective/vague diagnoses. To fill this gap, the European Academy of Andrology has promoted an ongoing multicenter study aimed at defining the MGT-CDUS characteristics of healthy, fertile men.

Index of Suspicion in the Nursery

Infant boy B, on initial examination in the newborn nursery, is noted to have a large right hydrocele, which transilluminates. The left testicle is small, indurated, and nontender on palpation. The remainder of the infant's examination is within normal limits. An ultrasound is ordered to evaluate the testes. Infant boy B weighs 3,930 g and was born via normal spontaneous vaginal delivery at 41 weeks’ gestation to a 21-year-old gravida 2 para 1 mother with history of anemia. Maternal prenatal laboratory tests show immunity to rubella and negative serology results for hepatitis B surface antigen, syphilis, and HIV. Group B strep culture is negative within 5 weeks of delivery. First and second trimester sonograms showed no abnormalities. The third trimester sonogram performed at ![Graphic][1] weeks gestational age was notable for a right hydrocele measuring 3.9 × 2.5 cm. No other anomalies noted. Maternal medications included prenatal vitamins. Father and mother of baby are first cousins. Labor was complicated by thick meconium-stained amniotic fluid with rupture of membranes 1 hour. Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. Testicular ultrasound is done and reveals the likely diagnosis. ### Diagnosis Ultrasound revealed a right hydrocele with a right testicle measuring 1.9 × 0.6 × 0.7 cm, with normal intratesticular arterial … [1]: /embed/inline-graphic-1.gif

At what age should an infant with hydrocele be referred for surgery?

Evidence-Based Answer Most hydroceles resolve spontaneously within the first year of life. Surgery referral is usually indicated only if the hydrocele persists beyond 12 to 18 months of age. Indications for earlier referral include large hydroceles causing pain or hydroceles with an associated inguinal hernia (SOR: B, observational studies).

Inguinal hernia containing a kidney with a duplicated system: An exceptionally rare case

An inguinal hernia is a commonly encountered surgical case, with multiple unusual contents being reported. We present an exceptionally rare case of an inguinal hernia. Computed tomography imaging of the 62-year-old male patient showed a large left inguinal hernia extending into the left scrotum that contained a duplicated left kidney. There was an associated large left hydrocele and incidental non-obstructive nephrolithiasis. Left nephropexy, left orchiectomy, and repair of the incarcerated left inguinal hernia with mesh placement via a preperitoneal (retroperitoneal) approach were performed. The patient was discharged to home on post-operative day 5 and the post-operative course was uneventful. We discuss a possible mechanism for this rare event.

USG in evaluation of patients with scrotal pain

Based on physical examination alone it is often difficult to accurately make a clinical diagnosis and decide whether a palpable scrotal pathology arises from the testis itself or from extratesticular elements within the scrotum. Clinical examination of the testis is especially difficult due to pain, tenderness or when obscured by a large hydrocele. The aim of the study was thus undertaken to evaluate the role of ultrasonography (USG) in patients presenting with scrotal pain. 50 patients who presented to the surgical department with scrotal pain were subjected to USG. The commonest cause for scrotal pain was epididymitis with or without orchitis (40 %), followed in descending order by cystic lesions of the epididymis (18 %), varicocele (12 %), trauma (8 %), torsion (4 %) and tumour (2 %). No abnormality was seen on USG in 7 patients ( 14 %). This study concludes that USG is a sensitive and specific examination in patients with scrotal pain. Besides differentiating testicular from extratesticular origin it can also differentiate solid from cystic masses. Colour flow imaging is especially helpful in varicocele and testicular torsion. Torsion of the testis remains the most urgent and important entity dependent on USG for diagnosis. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 18-22 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6821

Thromboses néoplasiques et thromboses cruoriques mécaniques compliquant un cancer du testicule gauche en TEP/TDM au 18FDG

We report the case of a 46-year-old patient with pulmonary embolism complicating thrombosis of the left renal vein and inferior vena cava, which came from a malignant tumor of the left testicle. The case has been elucidated by positron emission tomography with 18FDG coupled to the CT-scan (PET/CT), performed as part of the etiological assessment of this pulmonary embolism, and anatomical and physiological considerations. The examination revealed 18FDG uptake in thrombus of the left kidney vein and the inferior vena cava. In view of the anatomy of the left spermatic vein, this finding led to the left testicle, which shows no nuclide uptake but was bathed in a large hydrocele visible on CT images. If several cases of pulmonary embolism or thrombosis of the inferior vena cava revealing a testicular cancer have been described in the literature, there has been no report including 18FDG PET/CT to the best of our knowledge. This case illustrates the imaging differences between bland and malignant thrombus as a consequence of their pathophysiology. It highlights the contribution of CT images from the PET/CT for the diagnosis.

Persistent Genital Swelling after Hydrocele Ligation in a Patient Receiving Continuous Ambulatory Peritoneal Dialysis

We report a case of genital swelling in a patient receiving continuous ambulatory peritoneal dialysis. A physical examination did not identify any defect. Ultrasonography revealed a large hydrocele, and surgical repair brought resolution of the genital swelling. Two months later, however, the genital swelling had recurred and was not improved until peritoneal dialysis was replaced by hemodialysis 3 months later.

Large tunica albuginea cyst mimicking a large hydrocele with a unique ultrasound feature

A 58-year-old man presented with a large left scrotal swelling suspected to be a large hydrocele, both, clinically and on initial ultrasound. However, at operation, a large tunica albuginea cyst was found arising from the mid anterior wall of the tunica albuginea. It was dissected, excised and edges under run. Further review of the ultrasound scan revealed a unique feature of large tunica albuginea cyst simulating a hydrocele.

Abdominoscrotal hydrocele in infancy with incorporated epididymal tissue

Abdominoscrotal hydrocele is a rare condition where a large hydrocele is connected to a preperitoneal space through the inguinal canal. We present a case of a young male with an abdominoscrotal hydrocele who showed gross absence of an epididymis upon hydrocele removal. Upon pathological examination, epididymal tissue was found to be incorporated into the wall of the hydrocele sac.