ABSTRACT
【Objective】 To report a case of testicular infarction due to polyarteritis nodosa (PAN), and to discuss its clinical diagnosis and treatment based on relevant literatures at home and abroad, so as to have a better understanding of this rare disease. 【Methods】 Clinical data of a case complaining of scrotal pain who was initially diagnosed as testicular torsion and later confirmed to be testicular infarction due to PAN were retrospectively analyzed, and relevant literatures were reviewed. 【Results】 With glucocorticoid, vasodilator and antioxidant treatment, the patient’s testicular blood flow was improved. 【Conclusion】 Testicular infarction due to PAN is a rare disease which is difficult to diagnose timely. The diagnosis depends on biopsy and the standards formulated by American College of Rheumatology (ACR). Good prognosis can be achieved with timely diagnosis and correct treatment.
ABSTRACT
Objective@#To investigate the factors influencing the postoperative resolution of varicocele-associated scrotal pain.@*METHODS@#Using the keywords "varicocele", "testicular pain", "scrotal pain", "painful varicocele", "ligation", and "varicocelectomy", we searched the PubMed, Embase, Cochrane Collaboration's Database, CNKI, Wanfang, and VIP Database up to October 2016 for the studies relating to surgical treatment of varicocele-associated scrotal pain. We assessed the quality of the cohort studies included using the Newcastle-Ottawa Scale and that of the randomized controlled trials included with the Cochrane Collaboration's tool. We conducted a meta-analysis using the RevMan software.@*RESULTS@#Finally 14 studies were included in this meta-analysis, of which, 2 involved the history of disease, 8 involved the nature of pain, 2 involved the intensity of pain, 9 involved the grade of varicocele, 3 involved the side of varicocele, 9 involved surgical approaches, 3 involved surgical techniques, and 4 involved postoperative recurrence. The pain resolution rate was significantly higher after subinguinal ligation than after high or inguinal ligation (RR = 0.82, 95% CI: 0.76－0.89, P <0.01; RR = 0.92, 95% CI: 0.86－0.99, P = 0.02), and so was it after microsurgery than after laparoscopic varicocelectomy (RR = 0.77, 95% CI: 0.60－0.99, P = 0.04).@*CONCLUSIONS@#Subinguinal varicocelectomy and microsurgery are more effective options than laparoscopic and high or trans-inguinal ligation of the spermatic vein for resolution of varicocele-associated scrotal pain, while the history of disease, the nature and intensity of pain, the grade and side of varicocele, or postoperative recurrence cannot be regarded as the influencing factors.
Subject(s)
Adult , Humans , Male , Genital Diseases, Male , Laparoscopy , Ligation , Microsurgery , Pain, Postoperative , Pain, Procedural , Recurrence , Scrotum , Testis , Treatment Outcome , Varicocele , General Surgery , Vascular Surgical Procedures , VeinsABSTRACT
Objective To evaluate the characteristics of the testicular torsion patients with the first symptom of acute abdominal pain.Methods From October 1998 to May 2014, 8 adolescent or boys with testicular torsion presenting acute abdominal pain instead of scrotal pain as their primary symptom were retrospectively reviewed.The average age was 12 (3-16) years.An acute abdominal pain presented firstly in all cases, which accompanied by nausea and vomiting in 4 cases, groin pain in 2 cases, fever in 1 case. In genital examination, the scrotum skin was red and swollen, while the testis was in transverse position and tenderness.The testicular and homolateral abdominal pain got worse when we pulled the involved testis. Doppler ultrasound examination revealed that the blood supply of the involved testis decreased or disappeared.Results In the 8 cases, 5 cases were not examined their testicles or scrotum during the first evaluation, which were found the testicular necrosis during the following exploratory surgery, and orchidectomy was performed. In the other 3 cases, external genital were examined during the first evaluation, and the scrotal and testicular abnormalities were detected.Doppler ultrasonography showed abnormality in testicular blood supply.Testicular torsion was proved during the emergent operation, and the 3 testes were salvaged.The mean duration time from symptom onset to operation was 4 h in the salvaged group, while the average time was 28 h in the orchiectomy group.The mean follow-up time was 18 ( 10-36) months.In the 3 cases whose testis was saved, 1 affected testis was atrophied, and the blood supply of the other two was good.No severe complications occurred in the other 5 cases.Conclusions Testicular torsion should be considered in adolescents and boys with acute lower abdominal pain.The routine external genital examination should be performed when a boy or adolescent complains of abdominal pain.
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PURPOSE: To compare pre-and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches and to identify the factors that affect the outcomes. MATERIALS AND METHODS: A total of 48 patients with left-sided varicocele who had left scrotal pain was included and followed up for more than 3 months. Twenty patients underwent varicocele ligation using modified Palomo, fifteen with laparoscopic approach and thirteen with microscopic subinguinal varicocelectomy respectively. Visual pain scale was used at pre-operation and 3 months later postoperatively. We compared age, grade, a character of pain, operation time, a number of pain killer and pain score. RESULTS: Mean age of patients was 28.9 years (range 15~58 years). 45 patients described their pain as dull ache and 3 as a sharp sensation. There was complete resolution of pain in 35 patients (72.9%), while 7 (14.5%) had partial resolution. 6 (12.5%) had persistent symptoms and varicocele recurred in 3 (6.2%). There was no significant difference in pain resolution according to surgical approaches. Microsurgical approach had a prolonged operation time, but recurrence was not occurred. 3 patients that had a sharp scrotal pain were included in partial resolution or persistent pain. CONCLUSIONS: Surgical approaches were effective in the treatment of painful varicocele in selected patients and there was no significant difference in pain resolution according to surgical approaches. The sharp scrotal pain was related to the outcome of treatment.
Subject(s)
Humans , Ligation , Recurrence , Sensation , VaricoceleABSTRACT
PURPOSE: Acute scrotal pain is one of the most alarming urologic symptoms, concealing testicular inflammation, testicular torsion, torsion of testicular appendix and a variety of miscellaneous diseases. Even with careful physical examination with recently developed diagnostic equipments, a reliable diagnosis may not be achieved in a significant number of patients. In these cases an operation is necessary for exclusion of testicular torsion. MATERIALS AND METHODS: Between 1991 and 1998, we reviewed 17 patients diagnosed as having torsion of testicular appenix, whose ages varied from 3 years to 15 years during recent 8 years. RESULTS: 16 cases out of seventeen patients(94%) were younger 12 years and prevalent age was 11 years(6/17). The average interval that elapsed from onset of symptoms until the patient was seen for the first time on the hospital was 64 hours, with a range varying from three hours to seven days. The most frequently observed symptoms and signs were diffuse scrotal pain, swelling and erythema of the affected scrotum. The explorative scrototomy were performed in 16 cases out of 17 patients who had appendix testis torsion, and the 1 case had conservative treatment after getting confirmative diagnosis by ultrasonography. The scrotal pain disappeared mostly within 1 day after operation, and the complications didn`t happen. CONCLUSIONS: There is controversy as whether the majority of children with torsion of the testicular appendix develop sufficiently grave symptoms to justify the surgical exploration. For this reason, once a diagnosis of torsion of the spermatic cord is ruled out, some investigators prefer conservative treatment. However, differential diagnosis with torsion of the spermatic cord is difficult and acute scrotal pain disappear within 24hours after excision of the twisted appendix. Therefore, we are in favor of surgical treatment.