Testicular Hydrocele Research Articles

Neonatal lupus erythematosus presenting with effusions: A 13-year retrospective study.

Neonatal systemic lupus erythematosus (NLE) is an acquired autoimmune disease. The presence of effusions, such as pleural effusion and pericardial effusion, is rare. The present study helped investigate the clinical characteristics and progression of children with NLE combined with effusions. Clinical data of patients diagnosed with NLE were retrospectively collected and analyzed from January 1, 2011, to December 31, 2023, at the Children's Hospital of Soochow University and Suzhou Municipal Hospital. Patients with NLE were divided into effusion and non-effusion groups based on the presence of effusion. Moreover, the clinical data of the newborns in both groups were compared and investigated. Eleven (11/45, 24.44%) NLE patients had effusions, such as pleural effusion, testicular hydrocele, peritoneal effusion, pericardial effusion, and hydrocephalus. Other organs involved in effusion patients were cutaneous, gastrointestinal, hematologic, cardiac, and neurological. Among the patients with effusion, five cases of SLE in pregnant mothers, two cases of Sjogren's syndrome, one case of photoallergic symptoms, and three of pregnant mothers with no history of antenatal autoimmune disease. Pregnant mother' autoimmune disease in remission prior to pregnancy, or stable low disease activity. Seven patients were positive for Anti-SSA, five of which were double positive for Anti-SSA and Anti-SSB. Compared with the non-effusion group, the effusion group patients had significantly higher lactate dehydrogenase, creatine kinase, and fibrinogen, significantly lower platelets, total protein, and albumin. These patients were likelier to have thrombocytopenia and coagulation abnormalities. Logistics regression analysis demonstrated that NLE patients with effusions are more likely to have decreased serum total protein levels. All NLE patients with effusion have self-resorption of the effusion. 24.44% of patients had effusions in our study. NLE patients with effusion are more likely to have hematologic involvement and a more inflammatory response. The effusion in NLE patients is usually self-resorption, severe cases can be treated with nonsteroidal anti-inflammatory drugs/steroids. Key Points • NLE patients combined with effusions and were self-limiting, with pleural effusion being the most common. • NLE patients combined with effusions have a more inflammatory response, significant abnormalities in the blood routine and biochemical-related indexes.

Isolated Hydatid Cyst: A Misleading Diagnosis

Cystic hydatid disease is an endemic disease caused by the larval form of Echinococcus granulosis. It is especially evident in the liver, lungs, and kidney. Testicular hydatidosis is extremely rare. A case of a hydatid cyst of the testis is reported that was misdiagnosed clinically as a testicular hydrocele. Echinococcosis should be considered in the differential diagnosis of testicular masses especially in endemic countries. Treatment is mainly surgical and, with proper diagnosis and treatment, the prognosis is good.

Comparison between Microsurgical Varicocelectomy with and without Testicular Delivery for Treatment of Varicocele: An Updated Systematic Review and Meta-Analysis

Dilated testicular gubernacular veins after varicocelectomy were reported to be the cause of varicocele recurrence. The gubernacular veins start at the tail of the testicular and merges into the posterior scrotal veins. The gubernacular veins could be ligated only after testicular delivery (TD) anatomically. TD and ligation of the gubernacular veins during microsurgical varicocelectomy might reduce the varicocele recurrence but this method is still under debate. Therefore, we performed this systematic review and meta-analysis and assessed varicocele recurrence, complications as well as clinical outcomes after microsurgical varicocelectomy with TD. Relevant researches were searched on the PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure databases to perform an updated meta-analysis. Standardized mean differences, relative risks (RRs), and their 95% confidence intervals (CIs) were applied to evaluate result indicators. This updated meta-analysis included 17 publications with 10 randomized controlled trials and 7 cohort studies. A total of 2,254 participants, including 1,024 subjects with TD and 1,230 without TD, were involved. The pooled results demonstrated that microsurgical varicocelectomy with TD might lead to higher incidences of postoperative scrotal edema (RR = 4.20, 95% CI = 2.60–6.81, p < 0.001 ), testicular hydrocele (RR = 6.58, 95% CI = 1.19–36.20, p = 0.030 ), and orchiepididymitis (RR = 6.33, 95% CI = 2.08–19.31, p = 0.001 ) than the group without TD. Similar findings were also found in subgroup analysis of varicocele grade II and III. By contrast, we failed to find significant differences between them in semen parameters, varicocele recurrence, serum testosterone, and natural pregnancy ( p > 0.05 ). Sensitivity analysis revealed the pooled results were stable and no publication bias was detected. TD during microsurgical varicocelectomy may lead to more postoperative complications and may not be beneficial for semen parameters, recurrence of varicocele, and natural pregnancy. Therefore, varicocele patients may not benefit more from TD.

Дослідження вікових морфологічних змін вагінального відростка очеревини в дітей

Statistics state that nosologies resulting from an impaired obliteration of the processus vaginalis of the peritoneum (inguinal hernia, testicular hydrocele, cyst of spermatic cord elements) maintain a high level in the statistics of children's diseases. According to the literature, the above-mentioned diseases and complications in their treatment can cause male infertility which, in turn, will lead to a decrease in the reproductive health of the nation. Purpose - to study changes in morphological structures in the specimen of the vaginal process of the peritoneum based on the age of the child. Materials and methods. Children under the age of 8 years old, of both sexes, with an impaired obliteration of the vaginal process of the peritoneum (inguinal hernias, hydroceles, cysts of the elements of the spermatic cord) were subjected to the study. During the surgical procedure, surgical specimen of the wall of the processus vaginalis of the peritoneum was collected for the purpose of further morphological examination. Results. Muscular, fibrous and fatty elements in different proportions were found in histological specimens. The presence of degenerative pathohistological changes that contribute to the development of hernial defects of the inguinal canal was established. Thus, there is an age-related development of the muscle fibers atrophy of the processes with vacant replacement mainly by adipose tissue. Conclusions. Therefore, by analyzing the histological observations of the vaginal process of the peritoneum in children with an impaired obliteration of the vaginal process of the peritoneum, it is possible to draw a conclusion that the amount of fatty elements in the tissue of the vaginal process directly depends on the age of the child and the muscle elements in the tissue of the vaginal process inversely depend on the age of the child. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

MORPHOMETRIC INDICATORS OF THE MEMBRANES OF THE VAGINAL PROCESS OF THE PERITONEUM IN CHILDREN OF DIFFERENT AGE GROUPS

Background. According to statistics, such diseases as inguinal hernia, testicular hydrocele are the causes of infertility. The anatomical basis for the occurrence of these nosologies is a violation of the process of obliteration of the processus vaginalis of the peritoneum. It was found that the presence of smooth muscle elements in its wall is the morphological basis for the preservation of patency in the processus vaginalis of the peritoneum. Aim. The purpose of the work was to improve scientific data on the etiology of diseases that occur as a result of the violation of the obliteration of the processus vaginalis of the peritoneum, with further use of the obtained knowledge to improve the quality of surgical correction of pathological conditions. Materials and methods. Children with diagnosed inguinal hernias and testicular hydrocele were treated surgically (Duhamel and Ross operations were performed). During the surgical correction, the wall fragments of the processus vaginalis of the peritoneum were selected for further histological examination. The obtained samples of histological preparations were studied in order to evaluate the morphometric criteria. Morphometric analysis criteria: relative area of muscle tissue, relative area of adipose tissue, relative area of fibrous tissue, thickness of muscle fibers, cross-sectional area of muscle fiber. Results. All children were divided into groups by gender and age. In each age group (first year of life, first three years of life, first five years of life and first seven years of life) an increase in both relative and absolute morphometric indicators was observed. The same tendency of the results was observed in both the male and female parts of the studied children. Conclusions. Therefore, the probability of independent obliteration of the processus vaginalis of the peritoneum increases inversely proportionally with the age of the child, that is, the younger the age of the child, the greater the probability of independent obliteration of the processus vaginalis of the peritoneum.

Morphometric indicators of the membranes of the vaginal process of the peritoneum in children of different age groups

Background. According to statistics, such diseases as inguinal hernia, testicular hydrocele are the causes of infertility. The anatomical basis for the occurrence of these nosologies is a violation of the process of obliteration of the processus vaginalis of the peritoneum. It was found that the presence of smooth muscle elements in its wall is the morphological basis for the preservation of patency in the processus vaginalis of the peritoneum. Aim. The purpose of the work was to improve scientific data on the etiology of diseases that occur as a result of the violation of the obliteration of the processus vaginalis of the peritoneum, with further use of the obtained knowledge to improve the quality of surgical correction of pathological conditions. Materials and methods. Children with diagnosed inguinal hernias and testicular hydrocele were treated surgically (Duhamel and Ross operations were performed). During the surgical correction, the wall fragments of the processus vaginalis of the peritoneum were selected for further histological examination. The obtained samples of histological preparations were studied in order to evaluate the morphometric criteria. Morphometric analysis criteria: relative area of muscle tissue, relative area of adipose tissue, relative area of fibrous tissue, thickness of muscle fibers, cross-sectional area of muscle fiber. Results. All children were divided into groups by gender and age. In each age group (first year of life, first three years of life, first five years of life and first seven years of life) an increase in both relative and absolute morphometric indicators was observed. The same tendency of the results was observed in both the male and female parts of the studied children. Conclusions. Therefore, the probability of independent obliteration of the processus vaginalis of the peritoneum increases inversely proportionally with the age of the child, that is, the younger the age of the child, the greater the probability of independent obliteration of the processus vaginalis of the peritoneum.

Review of Dirofilaria spp. infection in humans and animals in Iran

Dirofilariasis is a metazoonoses transmitted by certain mosquito genera (Culicidae: Diptera). Chiefly canids are the reservoirs of Dirofilaria spp. This article analyzed all published records and researches relevant to Dirofilaria in Iran, to provide a basis for future studies in Iran and around the world. All of the important data from human and animal cases that included the pathogen and its reservoir, dispersion, and retrospective studies were investigated and analyzed. Furthermore, the natural history of parasites, pathogenicity, diagnosis, treatment, control, and the final status of the disease in the world was briefly mentioned. Two species of the genus Dirofilaria, Dirofilaria immitis (canine heartworm) and Dirofilaria repens, are detected in Iran. Till now, 13 human cases have been formally reported including seven subcutaneous and three ocular cases of D. repens, a four cases of D. immitis, including a rare case in testicular hydrocele, one ocular and one pre-ocular, a subconjunctival and two pulmonary cases suspected to be D. immitis. Animal and human infections have been recorded in 11 provinces of Iran. Different investigators have reported D. immitis in dogs (with the frequency of 0.95–62.8%), jackals (2.5 57.4%), foxes (5.7–50%), wolves (20–50%), and cats (0.8%) and D. repens in dogs (1.4–60.8%) and jackals (10%) in different areas of the country. The reports on Dirofilaria in Iran are to some extent scattered as regarded to distribution and other features of the disease. More studies should be taken in dirofilariasis in Iran, specifically in regions from where there are no reports.

SAT-088 RETROPERITONEAL FIBROSIS: DIAGNOSTIC AND THERAPEUTIC APPROACH

Retroperitoneal fibrosis (RPF), also named Ormond’s disease, is characterized by a fibrosis reaction that takes place in the retroperitoneal space around the abdominal aorta, compressing the ureters and others structures. It is a rare disease. Its incidence rate goes from 0.7 to 1.3/100000 inhabitants per year. The purpose of our work is to realize a descriptive, epidemiological, clinical, etiological, therapeutic and evolutive study of the RPF. We have conducted a retrospective study in our department between 1985 and 2019. A clear male predominance was noted with 32 men and 7 women. Ten patients were recieving treatments for more than 2 pathologies. The leading medical histories among our patients, which can be a predictive factor of occurrence of RPF, were breast tumor for 1 patient who was in remission at the time of the diagnosis of RPF and abdominal or pelvic surgery in 8 cases. One patient was operated for aortic aneurysm. Three patients were victims of abdominal or lumbar trauma as a result of a road accident. Lymphadenitis tuberculosis was noted in one case. One patient was recieving an antagonist beta adrenergic. Circumstances of discovery were dominated by lumbar pain in 31 cases. Abdominal pain was objectified in 29 patients. Twenty five patients presented a wasting syndrome with anorexia and / or weight loss, and three patients had legs‘ oedema. Acute kideny injury, high blood pressure, biological inflammatory syndrome have been found as a circumstance of discovery, respectively in 23.3 and 16 patients. One case of RPF was discovered following an hepatic cholestasis and another one after an operation for a testicular hydrocele. The abdominal scan confirmed the diagnosis in all the cases. We practiced the biopsy of the RPF for only 8 patients. It had showed an extended fibrosis relative to a chronic pancreatitis (1 case), a non specific inflammatory tissue (1 case). It was not interpretable in 1 case. A metastatic localization of a prostatic carcinoma was found in 1 case. The RPF was idiopahtic in 29 patients. It was due to: abdominal trauma (2 cases), tuberculosis (2 cases), pelvic and abdominal surgery (2 cases), sclerosing pancreatitis (1 case) prostatic tumor (1 case), aortic aneurysm (1 case) and mesenteric panniculitis (1 case). Twenty two patients had an urinary diversion by JJ catheter. No patient required hemodialysis. One patient had been referred to urology for the treatment of a prostatic tumor, 2 patients needed ureterolysis. Left nephrectomy because of pyonephrosis was practiced in one case.A tuberculosis treatment was prescribed for 2 patients. All our patients had a cortecosteroid therapy. We prescribed immunosuppressive therapy for only 7 patients who presented recurrence RPF. The JJ catheter was changed in 14 cases. Twenty patients presented a recurrence of their RPF during the follow up. Nineteen patients never had a recurrece. Eight patients kept a chronic kideny failure. Two patients have died. Because of its insidious nature and the irreversible development towards the chronic renal failure if an early diagnosis was not applied and the treatment did not immediately debuted, FRP requires all attention needed from the clinician. The important relapse rate proposes rethinking the actual therapeutic conduct.

Incidence of filariasis in clinically diagnosed primary vaginal hydrocele

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

Comparison of curative effect of different surgical methods on varicocele

Objective To compare the curative effect of three different surgical methods: peritoneal varicocele ligation, peritoneal single-port laparoscopy and microscopy on varicocele. Methods Retrospective analysis of the case data of 150 patients with varicocele treated in the Affiliated Hospital of Xuzhou Medical University from September 2016 to September 2018. The average age was 24.5 years, and the age range was 22-30 years. The patients were divided into three groups according to different surgical methods: open group, laparoscopy group and microscope group, with 50 cases in each group. Patients in the open group were treated with retroperitoneal spermatic cord ligation. Patients in the laparoscopic group were treated with single-hole laparoscopic laparoscopic surgery. Patients in the microscope group were treated with microscope surgery. Operation time, postoperative hospitalization time, hospitalization cost reserved arteries, surgical complications (such as testicular hydrocele, scrotal edema, epididymitis, testicular atrophy), recurrence, and semen quality improvement were compared between three groups. Measurement data were expressed as mean ± standard deviation(Mean±SD), the two comparisons used the t test, the comparison between the three groups used the analysis of variance, and the comparison between the count data groups using the Chi-square test. Results The operation time of the patients in the microscope group [(52.52 ± 4.29) min] was longer than that of the open group [(36.60±3.69) min] and the laparoscopic group [(39.54±2.87) min]. The difference between the two groups was statistically significant (P<0.05); but the postoperative hospitalization time and hospitalization cost of patients in the microscope group [(2.16±0.95) d, (5 251 ± 300) yuan] were higher than those in the open group [(3.80±0.78) d, (64 75±415) yuan)]and the laparoscopic group [(3.28±1.01)d, (7 379±273) yuan] . The results of pairwise comparison showed that the difference between the microscope group, the open group and the laparoscopic group was statistically significant (P<0.05). Arterial preservation in the microscope group [47(94.0%)] were compared with the open group [35 (70.0%)], and laparoscopic group [30(60.0%)] had obvious advantages. Pairwise comparison results showed that the comparison between the microscope group and the open group and the laparoscopic group was statistically significant (P<0.05). After follow-up for six months, 2 cases were lost to follow-up in the microscope group, 1 cases were lost to the open group, and 5 case was lost to the unilateral laparoscopic group. 2(4.2%) patients had complications in the microscope group, and 14 (28.6%) patients had complications in the open group; 9 (20.0%) patients had complications in the laparoscopic group, and the total incidence of complications showed a pairwise comparison, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05). The recurrence rate in the microscope group was 2.1% (1/48), the recurrence rate in the open group was 18.4% (9/49), and the recurrence rate in the laparoscopic group was 13.3% (6/45); the recurrence rate was compared in pairs, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05) . The improvement rate of semen quality in the microscope group was 68.8% (33/48), the open group was 42.9%(21/49), the laparoscopic group was 55.6%(25/45), pairwise comparison results showed that the microscope group compared with the open group and laparoscopy group, the difference were statistically significant (P<0.05). Conclusions Microscopic surgery has less trauma, faster postoperative recovery, shorter operation cost and hospitalization time. Postoperative complications and recurrence, and improved semen quality are all superior to open spermatic vein ligation and single-hole umbilical laparoscopic surgery, it is a safe and effective way to treat varicocele. Key words: Varicocele; Laparoscopes; Microscopy; High varicocele ligation; Comparative effectiveness research

Individualized minimally invasive treatment for adult testicular hydrocele: A pilot study.

BACKGROUNDHydrocelectomy is the gold standard for the treatment of hydrocele, but it often causes complications after surgery, including hematoma, infection, persistent swelling, hydrocele recurrence, and chronic pain. In recent years, several methods for minimally invasive treatment of hydrocele have been introduced, but they all have limitations. Herein, we introduce a new method of individualized minimally invasive treatment for hydrocele.AIMTo present a new method for the treatment of adult testicular hydrocele.METHODSFifty-two adult patients with idiopathic testicular hydrocele were included. The key point of this procedure was that the scope of the resection of the sheath of the tunica vaginalis was determined according to the maximum diameter (d) of the effusion measured by ultrasound and the maximum diameter of the portion of the sheath pulled out of the scrotum was approximately πd/2. The surgical procedure consisted of a 2-cm incision in the anterior wall of the scrotum, drainage of the effusion, and dissection of part of the sheath of the tunica vaginalis. After the sheath was peeled away to the predetermined target extent, the pulled-out sheath was removed. The intraoperative findings and postoperative complications were analyzed.RESULTSAll patients were successfully treated with a median operation time of 18 min. The median maximum diameter of the effusion on ultrasound was 3.5 cm, and the median maximum diameter of the resected sheath was 5.5 cm. Complications occurred in four (7.7%) patients: two (3.8%) cases of mild scrotal edema, one (1.9%) case of scrotal hematoma, and one (1.9%) case of wound infection. All of the complications were grade I-II. Recurrent hydrocele, chronic scrotal pain, and testicular atrophy were not observed during a median follow-up of 12 mo.CONCLUSIONWe report a new technique for individualized treatment of testicular hydrocele, which is quantitative and minimally invasive and yields good outcomes. Further study is warranted to verify its potential value in clinical practice.

Single-arch laparoscopic combined with self-made spring clip line with arc wire feeding needle and thread needle in the treatment of traffic hydrocele

Objective To investigate the effect of single-arch laparoscopic combined with self-made spring clip line with arc wire feeding needle and thread needle in the treatment of traffic hydrocele. Methods From May 2013 to February 2017, 130 cases of traffic hydrocele were collected, aged between 1 and 8 years, with an average age of 2.3 years. Among them, 25 cases of lateral scabbard (hernia) were combined, and all cases were selected for laparoscopic single-hole method combined with wire needle and pin for the scabbard high ligation, and the therapeutic effect was observed. Results All the 130 cases were successful, with one side operation time (5.0±1.5) min and bilateral operation time (12.0±1.8) min. There was no obvious bleeding in the operation, no blood vessels in the abdominal wall, no vasectomy and vasectomy, no cases of transshipment. There was no obvious pain in the children with 6 h after surgery. No postoperative complications such as scrotal hematoma, iatrogenic cryptorchidism, reactivity of line junction, prodding hernia, and testicular atrophy occured. Postoperative 1-2 d, all patients was discharged and no recurrence was observed for 3-24 months. Conclusions By umbilical single-arch laparoscopic combined with self-made spring clip line with arc wire feeding needle and thread needle in the treatment of traffic hydrocele, the clinical curative effect is significant, and the apparatus is simple and easy to operate, and the trauma is small, the recovery was quick, and no scar, and it can discover and deal with unclosed (hernia) of the scabbard.The method is worthy of clinical popularization and application. Key words: Testicular Hydrocele; Laparoscopy

Simultaneous laparoscopic herniorrhaphy by totally extraperitoneal prosthesis and varicocelectomy for patients with varicocele combined with indirect inguinal hernia

Objective To assess the safety and effectiveness of simultaneous laparoscopic herniorrhaphy by totally extraperitoneal prosthesis (TEP)and simultaneous laparoscopic herniorrhaphy and varicocelectomy by high ligation with the route of TEP. Methods Clinical data of 16 patients who suffered from varicocele combined with indirect inguinal hernia, underwent the simultaneous laparoscopic herniorrhaphy by TEP and varicocelectomy by high ligation with the route of TEP from November 2013 to November 2016 were retrospectively analyzed. Varicocele was detected by color Doppler ultrasounography with the mean diameter of (3.12±0.53)mm.The intraoperative and postoperative clinical parametes including bleeding volume, recovery time of intestinal peristalsis, use of postoperative analgesia, complication, hospital stay and postoperative recovery time were recorded and analyzed. All patients were followed up for a range of 3~24 months. Results The operation was successful in all cases.The operation time was (39.8±7.6) min, the intraoperative blood loss was (6.5±3.2) mL, and recovery time of intestinal peristalsis was (7.8±0.9)h.There was no need for postoperative analgesia. The postoperative hospital stay was (3.6±0.8) d, and it took (4.9±0.8) d for the patients to go back to their normal activities. The normal diameter (1.71±0.32)mm of spermatic veins and and good testicular blood supply were detected by the ultrasounography befor discharge. No operative complications were observed. Varieocele was disappeared in all patients at 3 months postoperatively.All patients were followed up for 3 to 24 months without testicular atrophy and hydrocele. Recurrence of either varicocele or indirect inguinal hernia was not found during follow-up. Conclusions Simultaneous laparoscopic herniorrhaphy by TEP and varicocelectomy by high ligation with the route of TEP are safe and effective for patients with varicocele combined with indirect inguinal hernia with the advantage of less trauma, faster postoperative recovery, and less complication. Key words: Varicocele; Laparoscopes; Hernia, Inguinal

Application of microvascular Doppler ultrasonography in microsurgical varicocelectomy

From January 2015 to June 2016, 107 patients with varicocele underwent microsurgical varicocelectomy in the First Affiliated Hospital of Xiamen University. The clinical outcomes of microsurgical varicocelectomy with (n=56) or without (n=51) microvascular Doppler ultrasonography were compared. All patients were treated successfully by both methods and no postoperative complications such as testicular atrophy and/or hydrocele were found during 12 months postoperative follow-up. For the group without microvascular Doppler, accidental artery ligation occurred in 2 cases and the internal spermatic vessels were unidentifiable in 4 cases, and recurrence occurred in one case. By contrast, no artery injury or ligation occurred during the operation with microvascular Doppler, and no recurrence occurred postoperatively. Microvascular Doppler ultrasonography, which is reliable for discerning arteries and veins, can effectively and safely assist microsurgical varicocelectomy for treatment of varicocele. Key words: Varicocele; Ligation; Microscopy, acoustic

A Testicular Torsion and Contralateral Hydrocele in a Neonate

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

Malignant mesothelioma of the tunica vaginalis testis: A case report and literature review.

Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor without specific clinical manifestations, mainly including hydrocele formation and a painless mass. We herein present the case of a patient with hydrocele of the left testis, without any other complaints. Tunica vaginalis subinvolution was performed, and postoperative pathological examination revealed a malignant mesothelioma arising from the left tunica vaginalis testis. Whole-body positron emission tomography-computed tomography (PET-CT) and subsequent abdominal and pelvic magnetic resonance imaging (MRI) revealed no evidence of local lymphadenopathy. Radical left orchiectomy was performed after the pathological diagnosis. The pathological examination after the second surgery demonstrated that the tumor had invaded the adjacent periorchium and spermatic cord, but there was no evidence of local lymph node metastasis. Pemetrexed and cisplatin were administered at a dose of 900 and 130 mg, respectively, on the first day of a 28-day cycle. After 6 months of therapy, the disease had not progressed on abdominal and pelvic PET-CT and MRI. The patient was still followed up in our urology outpatient clinic at the time of the present report. Although testicular hydrocele is a common and easily diagnosed condition, detailed medical history and physical examination are required. Thus, when clinicians encounter patients with testicular hydrocele, a variety of possible causes must be considered, including testicular or paratesticular tumors, even rare tumors such as mesothelioma of the tunica vaginalis testis.

Anterior abdominal wall extraosseous osteosarcoma, occurring 40 years after para-aortic irradiation

Extraskeletal osteosarcomas (OSs) are highly malignant soft tissue tumours associated with a poor prognosis. Only a few records of these rare aggressive neoplasms have been reported in the literature.We describe...

A Case of Communicating Testicular Hydrocele Immediately after Initiation of Peritoneal Dialysis

A Case of Communicating Testicular Hydrocele Immediately after Initiation of Peritoneal Dialysis

A CASE OF ADENOCARCINOMA OF THE EPIDIDYMIS WITH HYDROCELE.

A 72-year-old man presented with left scrotal swelling. The patient was diagnosed with left testicular hydrocele and underwent the hydrocele aspiration. However, it recurred within a short period. Magnetic resonance imaging (MRI) revealed a tumor in the epididymis and the patient then underwent left high orchiectomy. The histopathological examination revealed an adenocarcinoma of the epididymis. Ten months after the surgery, the patient has been free of disease.

MP86-09 INCIDENTAL FINDINGS ON MULTIPARAMETRIC MAGNETIC RESONANCE IMAGING OF THE PROSTATE: PREVALENCE AND CLINICAL RELEVANCE

INTRODUCTION AND OBJECTIVES: Multiparametric magnetic resonance imaging (mpMRI) is a well established modality for location and staging of prostate cancer. The use of mpMRI for the diagnosis and staging of prostate cancer has increased over the past 5 years. Adequate exam protocol includes evaluation of the whole pelvis to evaluate the presence of lymph nodes and bone metastasis. It is not rare to find extraprostatic additional findings, some of them requiring further medical investigation or medical/operative treatment. Our purpose was to determine the prevalence of relevant and non-relevant extra-prostatic findings in patients submitted to prostate mpMRI. METHODS: We retrospectively reviewed the spectrum and incidence of extraprostatic findings of 1171 patients (mean age 61.5 years-old, range 37-100) who underwent mpMRI on a 3-Tesla scanner without an endorectal coil in the last 18 months. The results were divided into clinical categories and also as significant or not significant findings. The findings categorized as significant were those for which most physicians would agree that further investigation or medical/surgical intervention is needed. RESULTS: 712 patients (60,8%) had extraprostatic findings, including 60 (8,5%) significant lesions. The study discovered 20 cases of unsuspected extraprostatic malignancy (1,7% of all patients and 2,8% of incidental findings). Of those suspicious lesions, there were bladder polyps (4 cases), rectal and sigmoideal lesions (3 cases), testicular nodules (4 cases), osseous lesion (4 cases) and pelvic indeterminate lesions (5 cases). In non oncological urological extraprostatic findings there were: ureteral calculus (3 cases), bladder stone (1 case), renal anatomical variants such as horseshoe kidney (3 cases), testicular hydrocele (39 cases), epididymal cysts (21 cases), other testicular alterations such as ectopy and atrophy (16 cases), penile findings (5 cases, including prosthesis and focal lesions) and renal cysts partially evaluated (23 cases). There were 12 cases of abdominal and iliac arteries aneurysms. Regarding colonic findings there were 2 cases of diverticulitis in a total of 229 diverticulosis, and 6 cases of perianal fistulas. CONCLUSIONS: Although incidental findings in patients submitted to mpMRI of the prostate are common, the vast majority of them have no clinical consequence. However, detection of relevant unsuspected extraprostatic findings may require further clinical evaluation and, therefore, systematic evaluation of extraprostatic structures on mpMRI is mandatory for the radiologist.