Scrotal Contents Research Articles

Editorial Comment

No AccessJournal of UrologyAdult Urology1 Jun 2016Editorial Comment Phil Vu Bach and Marc Goldstein Phil Vu BachPhil Vu Bach More articles by this author and Marc GoldsteinMarc Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.11.098AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 195(6), p. 1847 References 1 : Microsurgical denervation of the spermatic cord for chronic orchialgia: long-term results from a single center. J Urol2008; 180: 949. Link, Google Scholar 2 : Microsurgical spermatic cord denervation as a treatment for chronic scrotal content pain: a multi-center open label trial. J Urol2015; 194: 1323. Link, Google Scholar 3 : Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. BJU Int2012; 110: 1536. Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 195Issue 6June 2016Page: 1847 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.MetricsAuthor Information Phil Vu Bach More articles by this author Marc Goldstein More articles by this author Expand All Advertisement PDF downloadLoading ...

Chronic orchialgia: Review of treatments old and new.

Introduction:Chronic orchialgia is historically and currently a challenging disease to treat. It is a diagnostic and therapeutic challenge for physicians. Conservative therapy has served as the first line of treatment. For those who fail conservative therapy, surgical intervention may be required. We aim to provide a review of currently available surgical options and novel surgical treatment options.Methods:A review of current literature was performed using PubMed. Literature discussing treatment options for chronic orchialgia were identified. The following search terms were used to identify literature that was relevant to this review: Chronic orchialgia, testicular pain, scrotal content pain, and microsurgical denervation of the spermatic cord (MDSC).Results:The incidence of chronic orchialgia has been increasing over time. In the USA, it affects up to 100,000 men per year due to varying etiologies. The etiology of chronic orchialgia can be a confounding problem. Conservative therapy should be viewed as the first line therapy. Studies have reported poor success rates. Current surgical options for those who fail conservative options include varicocelectomy, MDSC, epididymectomy, and orchiectomy. Novel treatment options include microcryoablation of the peri-spermatic cord, botox injection, and amniofix injection.Conclusion:Chronic orchialgia has been and will continue to be a challenging disease to treat due to its multiple etiologies and variable treatment outcomes. Further studies are needed to better understand the problem. Treatment options for patients with chronic orchialgia are improving. Additional studies are warranted to better understand the long-term durability of this treatment options.

Scrotal doppler ultrasound evaluation in Zaria, Nigeria

Introduction: The superficial location of the scrotal contents makes them ideally suited for sonographic examination. The development of high-frequency, real-time greyscale scanners along with Doppler facility has enhanced the diagnostic accuracy of scrotal sonographic examinations. Objectives: To determine the pattern and utility of Doppler ultrasound in the assessment of patients with scrotal pathologies in Zaria, Nigeria. Methodology: This retrospective study was carried out over a period of 36 months (February 2012 to January 2015) at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, on patients who presented for scrotal sonography on account of scrotal pathology. After a brief examination, colour Doppler ultrasound scan (CDUS) was performed. The clinical diagnosis and final ultrasound diagnosis were compared to determine the sensitivity and specificity of the later. Results: A total of 115 patients were scanned. Nearly 55.6% presented on account of primary infertility. Varicocele (45), hydrocele (31), epididymo-orchitis (8), epididymal cyst (6), microlithiasis (6) and others (6) were frequent Doppler findings. Only 12 cases were normal scan. Overall sensitivity of CDUS in diagnosing varicocele and hydrocele was 100% each, respectively. Conclusion: Doppler ultrasonography is an excellent, safe and reliable method for evaluating patients with scrotal diseases. It is especially important in conditions such as varicocele and hydrocele where accurate diagnosis is required in the management of infertility.

An overview of the management of post-vasectomy pain syndrome.

Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them. The etiology of post-vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis. Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options.

Symptomatic male with subclinical varicocele found on ultrasound evaluation.

Subclinical varicocele is a common incidental ultrasound finding detected during evaluation of men with infertility or presenting with chronic scrotal content pain. Studies regarding this disease entity mainly investigated the value of its management in infertile men rather than for pain relief. Current guidelines do not indicate varicocelectomy for subclinical varicocele. Coming across such a diagnosis in the context of chronic orchialgia, the clinician should be careful in ruling out other potentially treatable etiologies. Conservative measures are initially recommended. However, if pain persists, spermatic cord denervation may be an option provided that a favorable response to spermatic cord block has been achieved.

Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label Trial

We prospectively evaluated the results of microsurgical spermatic corddenervation in a series of patients with chronic scrotal content painin amulticenter study, including 1 center in Germany and 3 centers in Chile. A total of 50 patients with chronic scrotal content pain more than 3 months in duration were prospectively selected for standardized operative microsurgical spermatic cord denervation as pain treatment. In all patients preoperative management included a positive response to a spermatic cord block test with local anesthesia. Pain severity was assessed using an analog visual pain scale (range 0 to 10) for 30 consecutive days. A total of 52 testicular units were operated on using a subinguinal approach. In all cases a surgical microscope was used to identify the arteria testicularis. No intraoperative complications were observed and no testicular units were lost. Two reoperations were performed, including 1 for hematocele and 1 for hydrocele. Six months after surgery 40 patients (80%) were completely pain-free. In 6 patients (12%) intermittent testicular discomfort persisted, which could be managed by acetaminophen on demand. Four patients (8%) had no change in pain severity after surgery. After proper selection of patients microsurgical spermatic cord denervation seems to be a safe and efficient procedure to treat chronic scrotal content pain. Considering the limitations of the study, a randomized, controlled trial with longer followup is highly warranted.

Evaluation and management of chronic scrotal content pain.

Chronic scrotal content pain (CSCP) is a common patient complaint which virtually all urologists will encounter in practice. While our understanding of the pathophysiology and management has increased in recent years, CSCP remains a frustrating process for both the patient and physician given that there currently is no standardized protocol for treatment or evaluation. The following article is a literature review regarding the pathophysiology and current medical and surgical options for CSCP. We also provide an updated evaluation and treatment algorithm.

Comparison between Open Epididymal Cystectomy and Minimal Resection of Epididymal Cysts Using a Scrotoscope: A Clinical Trial for the Evaluation of a New Surgical Technique

To provide a new surgical technique for epididymal cyst (EC) treatment and to assess its safety and efficiency. Forty-eight patients with symptomatic EC were randomized into 2 groups. One group (n = 23) received traditional open epididymal cystectomy (OEC) and the other group (n = 25) underwent minimal epididymal cystectomy with scrotoscope (MECS), which provided a clear vision of scrotal contents. Demographic information and perioperative and postoperative outcomes data were obtained and analyzed during a 2- to 6-month follow-up. No significant differences between the OEC and MECS groups were found in demographic information. Compared with OEC group, the MECS group had a shorter operating time (18.6 ± 2.9 vs 54.5 ± 7.0 minutes; P <.05), shorter incision length (1.1 ± 0.2 vs 4.8 ± 0.6 cm; P <.05), and less blood loss (4.6 ± 1.6 vs 17.0 ± 3.1 g; P <.05). Except for the 8.0% rate (2 of 25) of scrotal edema after MECS and 17.4% rate (4 of 23) of scrotal hematoma after OEC, both groups resulted in 0% incidence of testis or epididymis injury, wound infection, and cyst recurrence based on postoperative outcome data. Significant differences were observed after MECS compared with those after OEC based on the rates of symptom relief (95.2% vs 61.1%; P <.05) and days of wound pain (12.1 ± 2.6 vs 17.7 ± 4.1 days; P <.05). For the first time, our study applied scrotoscope as a new alternative technique for EC treatment. Scrotoscope provides a clear field of vision and makes tissues harvested available for pathologic examination when performing decortications of EC. The results suggest MECS may be a safe, effective, and encouraging new technique.

PD45-09 SCROTOX: SALVAGE PERI-SPERMATIC CORD BOTULINUM-A TOXIN INJECTIONS FOR PATIENTS WITH REFRACTORY CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD.

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Medical and Non-Surgical Therapy II1 Apr 2015PD45-09 SCROTOX: SALVAGE PERI-SPERMATIC CORD BOTULINUM-A TOXIN INJECTIONS FOR PATIENTS WITH REFRACTORY CHRONIC SCROTAL CONTENT PAIN AFTER MICROSURGICAL DENERVATION OF THE SPERMATIC CORD. Bayo Tojuola, Ibrahim Kartal, Jamin Brahmbhatt, and Sijo Parekattil Bayo TojuolaBayo Tojuola More articles by this author , Ibrahim KartalIbrahim Kartal More articles by this author , Jamin BrahmbhattJamin Brahmbhatt More articles by this author , and Sijo ParekattilSijo Parekattil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2581AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Botulinum-A toxin (Botox) has been shown to modulate the release of neuropeptides leading to inhibition of neurogenic inflammation and chronic pain. This provides an antinociceptive effect. Chronic scrotal content pain is a difficult condition to treat. Microsurgical denervation of the spermatic cord (MDSC) is one surgical treatment option with success rates published in the 60-85% range. However, patients who fail MDSC have limited options. Our goal was to assess the use of peri-spermatic cord Botox injections (Scrotox) to provide prolonged pain relief in men with refractory chronic scrotal content pain after MDSC. METHODS Retrospective review of 25 patients who underwent Scrotox (29 procedures: 4 bilateral, 10 right side, 11 left side) from July 2013 to July 2014. All patients had failed prior MDSC. 100 units of Botox diluted in 10cc of saline was injected medial and lateral to the spermatic cord at the level of the external inguinal ring to ablate branches of the genitofemoral, ilioinguinal and inferior hypogastric nerves. The primary outcome measure was the level of pain. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ-6, QualityMetric Inc., Lincoln, RI). RESULTS Median age was 43 years. Median duration of pain prior to the procedure was 10 years. Median operative duration was 15 minutes. Median follow up post procedure was 8 months. Subjective VAS patient pain outcomes: 70% significant reduction in pain (14% complete resolution, 56% reported a greater than 50% reduction in pain). Objective PIQ-6 outcomes: significant reduction in pain in 40% of patients at 6 months and 20% at 1 year post-op. There were no complications in our small cohort. CONCLUSIONS Scrotox is a potentially safe and viable treatment option for the salvage management of persistent chronic scrotal content pain in patients who have failed MDSC. Further studies are warranted to better understand the long-term durability of this treatment modality. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e905 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bayo Tojuola More articles by this author Ibrahim Kartal More articles by this author Jamin Brahmbhatt More articles by this author Sijo Parekattil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD40-03 TARGETED ROBOTIC ASSISTED MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR THE TREATMENT OF CHRONIC SCROTAL CONTENT PAIN: SINGLE CENTER, LARGE SERIES REVIEW.

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy II1 Apr 2015PD40-03 TARGETED ROBOTIC ASSISTED MICROSURGICAL DENERVATION OF THE SPERMATIC CORD FOR THE TREATMENT OF CHRONIC SCROTAL CONTENT PAIN: SINGLE CENTER, LARGE SERIES REVIEW. Bayo Tojuola, Ibrahim Kartal, Jamin Brahmbhatt, and Sijo Parekattil Bayo TojuolaBayo Tojuola More articles by this author , Ibrahim KartalIbrahim Kartal More articles by this author , Jamin BrahmbhattJamin Brahmbhatt More articles by this author , and Sijo ParekattilSijo Parekattil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2437AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical denervation of the spermatic cord (MDSC) is a treatment option for chronic scrotal content pain that is unresponsive to conservative treatments. A recent study has shown specific nerve fiber abnormalities (Wallerian degeneration) in the cord as a potential cause for this pain. Our goal was to assess outcomes of a more targeted technique in ablating only these abnormal nerves when performing MDSC: targeted robotic assisted microsurgical denervation of the spermatic cord (RMDSC). METHODS Retrospective review of 620 patients who underwent RMDSC by two fellowship trained microsurgeons from October 2008 to July 2014. Selection criteria was as follows: chronic testicular pain (>3 months), failed standard pain management treatments and negative urologic workup. Targeted ligation of tissues containing the trifecta location of nerves with Wallerian degeneration was performed: the cremasteric muscle fibers, the peri-vasal sheath and the posterior spermatic cord lipomatous tissues. A robotic microsurgical platform was utilized (DaVinci S, HD with magnification, Intuitive Surgical, Sunnyvale, CA). The primary outcome measure was level of pain. Pain was assessed preoperatively and postoperatively using two assessment tools: a) the subjective visual analog scale (VAS) and b) an objective standardized externally validated pain assessment tool (PIQ-6, QualityMetric Inc., Lincoln, RI). RESULTS Median operative duration (robot console time) was 20 minutes (15-80). Subjective VAS patient pain outcomes: 85% significant reduction in pain (63% complete resolution ¡V 385 patients, 22% reported a greater than 50% reduction in pain ¡V 135 patients). Objective PIQ-6 outcomes: significant reduction in pain in 71% of patients at 6 months and 72% at 1 year post-op. The 4th robotic arm allowed the surgeon to control one additional instrument leading to less reliance on the microsurgical assistant. CONCLUSIONS Targeted robotic assisted microsurgical denervation of the spermatic cord is a safe and viable treatment option for patients with chronic scrotal content pain refractory to conservative measures. Further studies are warranted. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byFurr J and Bowen A (2018) Editorial CommentaryUrology Practice, VOL. 5, NO. 4, (277-277), Online publication date: 1-Jul-2018. Volume 193Issue 4SApril 2015Page: e836 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bayo Tojuola More articles by this author Ibrahim Kartal More articles by this author Jamin Brahmbhatt More articles by this author Sijo Parekattil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Spermatocele in a South African Boerboel Dog

A 2-year-old intact male South African Boerboel presented for semen cryopreservation and was discovered to be azoospermic. The dog had excellent libido and had sired litters within 6 months, so a further investigation of why his collection lacked sperm was warranted. On further examination of his scrotal contents, his right epididymis had an enlarged area with a hard texture. Ultrasonography revealed that the enlarged area of the right epididymis was fluid filled. A sample of the fluid was aspirated for aerobic culture. No bacteria showed growth. Although the culture was negative, it was suspected that this dog had an epididymitis or epididymal abscess, and treatment with enrofloxacin at 10mg/kg orally was initiated for 4 weeks. The abnormal texture and fluid-filled cavity in the right epididymis persisted, despite antibiotic therapy. Cytology of a repeat aspiration of the fluid-filled area after antibiotic therapy revealed a mixture of red blood cells and sperm. Owing to the potential for blood-testis barrier disruption, a unilateral orchiectomy of the right testicle was performed, as an attempt to protect future sperm production of the remaining testicle. A spermatocele was confirmed on histopathology. After another month, an excellent-quality semen sample was collected, with 90% progressive motility, good concentration, and few morphologic abnormalities. A subsequent collection was acquired and was successfully cryopreserved for future breeding. In dogs with spermatoceles, semen quality can be preserved with aggressive treatment to remove the affected testicle. The disruption of the blood-testis barrier in spermatoceles may result in antisperm antibody production and eventual infertility; however, cryopreservation can result in long-term options for owners seeking to continue using an animal in their breeding program.

Pattern of scrotal examination by physicians in the Eastern Province of Saudi Arabia

Introduction: A wide variety of pathological lesions affect the scrotal contents. They include both benign and malignant lesions. Missed or delayed diagnosis of such lesions can lead to compromised fertility, cosmetic deformities, testicular loss or even death. Early diagnosis of scrotal lesions can prevent the possible development of such complications. Objectives: The pattern of scrotal examination by physicians in the Eastern Province of Saudi Arabia was evaluated in this study to assess the extent of efficacy for early diagnosis. Materials and methods: In this cross-sectional study of scrotal pathology, self-administered questionnaires regarding scrotal evaluation were answered by physicians of different disciplines, including emergency care, internal medicine, paediatric surgery, family medicine and general practitioners. The questionnaires included direct questions on clinical examination of the scrotum as well as clinical scenario quizzes. Collected data were analysed with SPSS (Statistical Product and Service Solutions) version 17 (SPSS Inc., Chicago, IL, USA). The chi-squared test was used to analysis categorical variables, while the t -test was used for continuous variables. Factors affecting scrotal evaluation were assessed by logistic regression. Results: 257 questionnaires were analysed. Routine evaluation of the scrotum was performed by only 14% of respondents. Among the physicians who did not perform routine scrotal examination, 64.2% restricted it to cases with scrotal complaints and 16% considered the conservative cultural nature of their patients a hindering factor. Forty-five per cent did not perform scrotal examination in the standing position. Only 27.8% advised patients with high risk of testicular cancer to perform routine self-examination of their testicles. Conclusions: This study revealed a significant deficiency of early detection of scrotal disease by physicians in the Eastern Province of Saudi Arabia with a high probability of development of complications. We recommend that all physicians be advised to follow a well-structured protocol for scrotal examination during routine practice.

Single Incision Vasectomy Reversal

Objectives: With the goal of reducing morbidity and expediting recovery following vasectomy reversal (VR), this video highlights the single incision vasectomy reversal (SIVR). The SIVR offers an innovative approach to VR by which the entire procedure is performed through a single midline mini-incision in the scrotum. Materials and Methods: A SIVR may be considered in the absence of significant vasal gaps, sperm granulomas, and/or limited mobility of the scrotal contents. As in the no-scalpel vasectomy (NSV), the SIVR begins by stabilizing the vas directly under the scrotal skin at the midline raphe. The NSV ring clamp is used to capture the vas in the midline at the vasectomy occlusion site. A small (<1 cm) opening in the scrotal skin is created and vas is gently exposed and delivered through the midline incision. The mobile and compliant scrotal skin allows the midline incision to be shifted and brought to the vas, as opposed to the vas being mobilized to the anatomical midline. Once both the testicular and abdominal ends of the vas have been mobilized and delivered through the midline incision, each end is stabilized using a vas approximator. The surgical microscope is used to complete the anastomosis according to the surgeon's preference. The contralateral vas is approached through the same skin incision, but through separate opening in the dartos muscle. This fosters a tension-free anastomosis bilaterally with each vas remaining in its respective hemiscrotal space. The small opening in the skin is closed with a single dissolvable suture. The single midline mini-incision consistently measures <1 cm. If the single midline incision does not allow for the necessary exposure to comfortably complete the VR or a vasoepididymostomy is indicated, the midline incision can simply be extended or a second incision can be performed where appropriate. Results: Of 145 consecutive primary bilateral vasovasostomy VRs performed by a single fellowship-trained reproductive microsurgeon (E.D.G.), a SIVR approach was successfully completed in 35 (24%) patients with a mean age of 39 years (range: 29–48 years) and mean vasal obstructive interval of 5.3 years (range: 3 months–11 years). In one patient, a SIVR was attempted but subsequently converted to a bilateral mini-incision VR due to concern regarding excess tension on the anastomosis. Postoperative semen parameters and/or a confirmed pregnancy were available in 23 men. Among them, postoperative patency with motile sperm returning to the ejaculate was established in all patients. Mean postoperative sperm concentrations and percent motile sperm were 35 million/mL and 49%, respectively. The operative time was reduced due to efficiency of wound closure. In one patient, a superficial hematoma was identified and resolved with conservative management. Conclusions: A SIVR is technically feasible in approximately 20% of men undergoing vasovasostomy and does not appear to compromise patency outcomes or semen parameters compared with more traditional approaches to VR. Minimizing the number and size of the incisions, as well as the degree of dissection of the spermatic cord and testis, may result in less postoperative discomfort and quicker functional recovery. In appropriately selected patients, urologists who perform VR can easily adopt this innovative technique. The authors have no commercial or financial associations that might create a conflict of interest in connection with this manuscript submission. Running time: 7 mins, 56 secs

Editorial Comment

The use of ultrasonography in urologic practice is now well established. Urologists have become proficient in the use of sonography to evaluate the prostate, scrotal contents, pelvis, and abdomen. Renal ultrasonography is widely used as a screening tool for patients suspected of urinary tract stone disease or renal masses. Determining the Efficacy of Ultrasonography for the Detection of Ureteral StoneUrologyVol. 84Issue 3PreviewTo assess the efficacy of ultrasonography (US) for the detection of ureteral stone using non–contrast-enhanced computed tomography (NCCT) as a standard reference. Full-Text PDF

Presumed testicular rupture during a college baseball game: a case report and review of the literature for on-field recognition and management.

Scrotal rupture during athletic competition is considered a rare occurrence; however, blunt trauma to the scrotum is relatively common. Protective athletic cups are strongly recommended for both children and adults engaging in contact sports as they likely limit the amount of serious injury to the scrotal contents. Nonetheless, should the on-field assessment by the athletic trainer, coach, or team physician indicate that the athlete has increased pain, ecchymosis, swelling, and tenderness to palpation after blunt trauma, testicular rupture should be suspected and prompt ultrasound and urologic assessment should be undertaken, as early operative intervention is necessary for testicular preservation. This report reviews testicular trauma during athletic competition.

PD20-08 MICROSURGICAL SPERMATIC CORD DENERVATION FOR CHRONIC SCROTAL CONTENT PAIN: RESULTS OF A MULTICENTER PROSPECTIVE STUDY

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy1 Apr 2014PD20-08 MICROSURGICAL SPERMATIC CORD DENERVATION FOR CHRONIC SCROTAL CONTENT PAIN: RESULTS OF A MULTICENTER PROSPECTIVE STUDY Marcelo Marconi, Cristian Palma, Mauricio Olea, Thorsten Diemer, and Wolfgang Weidner Marcelo MarconiMarcelo Marconi More articles by this author , Cristian PalmaCristian Palma More articles by this author , Mauricio OleaMauricio Olea More articles by this author , Thorsten DiemerThorsten Diemer More articles by this author , and Wolfgang WeidnerWolfgang Weidner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1698AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Microsurgical Spermatic Cord Denervation (MSCD) has become a consented procedure for the treatment of Chronic Scrotal Content Pain (CSCP). Previous reports success rates range from 71% to 100%. Surgical approach can be either performed using a microscope or surgical loupes. Objective: To evaluate in a multicenter (1 Center in Germany, 3 in Chile) prospective series of 40 patients with CSCP, the results of MSCD, using either a loupe assisted approach (magnification 3.5x) or a surgical microscope (magnification 20x) Methods Forty patients with CTP were prospectively enrolled in the study. In order to be a candidate to MSCD all patients meet criteria for CSCP definition and had a positive response to a spermatic cord block test with bupivacaine and no response to a placebo injection (saline solution). Pain severity was measured using an Analog Visual Pain (AVS) scale for the last 30 days (Range 0 -10). The surgery was performed in an ambulatory basis, 13 patients were operated using surgical loupes and 27 using a microscope. Patients were controlled one week, three and six months after surgery with a color doppler ultrasound of the testis. Results A total of 43 testicular units were operated. The mean duration of surgery was 65 minutes (Range 50 – 95 minutes). No intraoperative complications were observed and all patients were operated in an ambulatory basis. No testicular units were lost and the color doppler ultrasound was normal in all cases. Three and six months after surgery 32 patients (80%) were pain free with no need of further oral analgesia. Eight patients (20%) persisted with intermittent testicular discomfort, six could be managed with on demand paracetamol, and two had no change in pain severity. No statistically significant differences were observed between patients operated using loupes or microscope regarding operation time and success rate. Conclusions Microsurgical spermatic cord denervation is a safe procedure with high success rate. The loupe assisted approach is comparable to the classical microscopic approach. © 2014FiguresReferencesRelatedDetailsCited byMarconi M, Palma C, Troncoso P, Dell Oro A, Diemer T and Weidner W (2018) Microsurgical Spermatic Cord Denervation as a Treatment for Chronic Scrotal Content Pain: A Multicenter Open Label TrialJournal of Urology, VOL. 194, NO. 5, (1323-1327), Online publication date: 1-Nov-2015. Volume 191Issue 4SApril 2014Page: e614 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Marcelo Marconi More articles by this author Cristian Palma More articles by this author Mauricio Olea More articles by this author Thorsten Diemer More articles by this author Wolfgang Weidner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V8-05 SINGLE INCISION VASECTOMY REVERSAL (SIVR)

You have accessJournal of UrologyMale Voiding/Infection/Infertility/Testis1 Apr 2014V8-05 SINGLE INCISION VASECTOMY REVERSAL (SIVR) Ethan D. Grober, Mary Samplaski, and Shaun Mehta Ethan D. GroberEthan D. Grober More articles by this author , Mary SamplaskiMary Samplaski More articles by this author , and Shaun MehtaShaun Mehta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2152AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the goal to reduce surgical morbidity following vasectomy reversal (VR), the current video highlights the Single Incision Vasectomy Reversal (SIVR) - An innovative approach to VR by which the entire procedure is performed through a single midline mini-incision. METHODS A SIVR was considered in the absence of significant vasal gaps, large sperm granulomas, and/or limited mobility of the scrotal contents. As in the no-scalpel vasectomy (NSV), the SIVR begins by stabilizing the vas directly under the scrotal skin at the midline raphae. The NSV ring clamp is used to capture the vas in the midline at the vasectomy occlusion site. A single small (<1cm) opening in the scrotal skin is created and vas is gently exposed and delivered through the midline incision. The mobile and compliant the scrotal skin allows the midline incision to be shifted and brought to the vas, as opposed to the vas being mobilized to the anatomical midline. Once both ends of the vas have been delivered and stabilized in a vas approximator, the surgical microscope is used to complete the anastamosis according to surgeon preference. The contra-lateral vas is approached via the same incision but through separate opening in the dartos muscle. This fosters a tension-free anastamosis with each vas remaining in its respective hemi-scrotal space separated by the dartos muscle in the midline. If necessary, the small opening in the skin closed with a single dissolvable suture. RESULTS Of 104 consecutive vasovasostomy VR, a SIVR was attempted in 24 patients (23%). Mean patient age was 39 years (range: 29-48) with a mean vasal obstructive interval of 5.2 years (range: 3 months-11 years). Post-operative semen parameters and/or a confirmed pregnancy was available in 15 men. Patency (motile sperm) was established in all patients. Mean sperm concentrations and % motile sperm were 27 million/ml and 56%, respectively. Operative time is reduced due to efficiency of wound closure. In one patient, a superficial hematoma was identified that resolved with conservative management. CONCLUSIONS A SIVR is feasible in well-selected men undergoing vasovasostomy without compromising patency rates or semen parameters. Minimizing the number and size of the incisions and the degree of surgical dissection involving the spermatic cord and testis may translate into less postoperative discomfort and quicker functional recovery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e786 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ethan D. Grober More articles by this author Mary Samplaski More articles by this author Shaun Mehta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Triorchidism: a rare genital abnormality

1However, the most of patients are asymptomatic and usually diagnosed incidentally. Some may present as inguinal hernia (30%), maldescended testis (15% to 30%), testicular torsion (13%) and hydrocele (9%), varicocele (1%), hypospadias (<1%), anomalous urogenital union (<1%), and malignancy (<1%). 2 Management of polyorchidism is still controversial. Important factors of polyorchidism management are testis location, size and anatomical organization of the testicular drainage system and the age of the patient. A 28-year-old single Turkish man presented to our clinic with 12 years history of a small palpable lump in the left hemi-scrotum. There were no other urological and general medical symptoms or significant past medical history. Physical examination was normal with no palpable mass on abdomen wall and no palpable inguinal herniae. Scrotal examination revealed a normal right testis and scrotal content, but on the left-side there were palpated two mass in similar size. It was difficult to make a distinction between the normal testis and the mass because of their similar consistency and size. They were separate testis and had two epididymis and two vas deferens. In laboratory findings such as human chorionic gonadotropin and α-fetoprotein and lactate dehidrogenase were in normal range. Scrotal ultrasound identified a left-side duplicated testis with normal echo-texture and blood flow. Scrotal magnetic resonance imaging (MRI) scan was performed for confirming the diagnosis and anatomical evaluations. MRI showed single right testicle and a left-side double testis having their own epididymis and vas deferences (Figure 1). Blasius recorded the first case of triorchidism at a routine autopsy in 1670. 1 The first histologically documented case of polyorchidism was reported by Lane in 1895. Most patients with polyorchidism has been identified especially early adulthood period and the majority of supernumerary testes are located in the scrotal region (66%) followed by inguinal (23%) and abdominal (9%) positions. The most common type of polyorchidism is triorchidism with the supernumerary testis detected to the left-side as our case. 3

Giant inguinoscrotal hernia: An emergency presentation with life-threatening sepsis

A 74-year-old male was brought by ambulance to the emergency department with a 12-hour history of an acutely painful scrotum with associated rapidly progressing discoloration of the overlying scrotal skin. This was on a background of a giant inguinoscrotal hernia present for approximately 12 years for which he had previously declined operative intervention. Other than well controlled hypertension, his past medical was unremarkable. Upon arrival in the emergency department, he was noted as being markedly hypotensive and displaying clinical signs consistent with septic shock. His scrotum was noted as being grossly enlarged with a black discoloration (Figure 1). Several fluids filled bullae were noted on the scrotal skin (Figure 2). On physical examination his abdomen was soft and non-tender. Initial resuscitation was provided in accordance with ATLS and sepsis guidelines. Anesthetic input was sought and the patient was transferred to the intensive care unit for continued resuscitation in the form of central venous pressure monitoring and inotropic support prior to emergency operative intervention. The patient’s condition was deemed too unstable for transfer to the radiology department for preoperative imaging.In theatre, initial incision of the scrotum and examination of the scrotal contents revealed necrotic loops of small and large bowel. Mesenteric thickening was noted at the neck of the hernia sac. In light of this, a midline laparotomy incision was made and the necrotic hernial contents were reduced into the abdominal cavity

Contemporary diagnostic work-up of testicular germ cell tumours

Diagnostic work-up of testicular masses should begin with a complete patient history and palpation of the testes with both hands. First-line imaging of the scrotum should be performed using multiparametric ultrasonography, that is the sequential use of grey-scale ultrasonography, colour Doppler ultrasonography (CDUS), and, if available, contrast-enhanced ultrasonography (CEUS) and real-time elastography (RTE). Increased vascularization--a characteristic of malignancy and inflammation--is visualized on CDUS and CEUS. RTE provides additional information for distinguishing between benign and malignant tissue by measuring tissue elasticity of lesions. MRI is another powerful modality, typically used for second-line imaging of intrascrotal disorders. MRI can provide images with a broad field of view of the scrotal contents. Cancerous lesions are identified on MRI by their signal enhancement after injection of contrast agent. Testicular germ cell tumours require treatment by inguinal orchiectomy. Testis-sparing surgery is advocated for benign tumours and in solitary testicles provided the tumour is <3 cm and the preoperative serum testosterone level is normal. For intraoperative decision-making with regard to testis-sparing surgery, frozen section histological examination can be used, which has a false-negative rate of <10%.