Sclerotherapy of hydroceles and spermatoceles with alcohol: results and effects on the semen analysis

PURPOSE: To evaluate the success rates of sclerotherapy of the tunica vaginalis with alcohol for the treatment of hydroceles and/or spermatoceles, as well as, evaluation of pain, formation of hematomas, infection and its effects in spermatogenesis . MATERIALS AND METHODS: A total of 69 patients, with offsprings and diagnosis of hydrocele and/or spermatocele, were treated during the period from April 2003 to June 2007. Semen analysis was obtained from patients who were able to provide us with samples. The sclerotherapy with alcohol at 99.5 percent was undertaken as outpatient procedure. RESULTS: The average volume drained pre-sclerotherapy was 279.82 mL (27 to 1145). The median follow-up was 43 months (9 to 80). A total of 114 procedures were performed on 84 units, with an average of 1.35 procedures / unit and an overall success rate of 97.62 percent. Of the 69 patients, 7 (10.14 percent) reported minor pain immediately after the procedure, 3 (4.35 percent) moderate pain and 2 (2.89 percent) intense pain. Post-Sclerotherapy spermograms revealed reduction of the parameters regarding: concentration, motility and morphology up to 6 months post procedure , with return to normal parameters 12th months after procedure. CONCLUSIONS: Sclerotherapy of hydroceles and spermatoceles with 99.5 percent alcohol is an efficient procedure that can be perormed without difficulties, cost-effectiveness, with few side effects and which may be performed in patients who wish fertility.

Epididymal cyst in von Hippel-Lindau syndrome: clinicopathologic analysis of 3 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathologic features of epididymal cyst in von Hippel-Lindau (VHL) syndrome.</p><p><b>METHODS</b>We reviewed the clinical data of 3 epididymal cyst patients treated by surgery, and detected the expressions of HIF-1alpha, VEGF, alpha-SMA and CD34 in the epididymal tissue samples by the immunohistochemistry SP method.</p><p><b>RESULTS</b>All the 3 patients underwent surgical removal of the epididymal cyst. Immunohistochemistry of the epididymal tissues showed HIF-1alpha, VEGF, alpha-SMA and CD34 to be positive. All the 3 cases were confirmed to be VHL syndrome, 1 right after surgery, and the other 2 within 8 years postoperatively.</p><p><b>CONCLUSION</b>Epididymal cyst is a usual benign disease, which may occur independently of or be complicated by VHL syndrome. If immunohistochemistry of epididymal tissues shows HIF-1alpha, VEGF, alpha-SMA and CD34 to be positive, VHL syndrome should be considered, and further clinical examinations and post-operation follow-up are necessitated.</p>

Sonographic Features of Vasectomy-Related Changes and Abnormalities in the Scrotum

This article presents changes in the testis and epididymis after a vasectomy as well as illustrate the various vasectomy-related abnormalities on sonographic examination. In patients with scrotal pain after a recent vasectomy, the sonographic findings include enlargement of the epididymis with an ill-defined border and hematoma, or a hematocele surrounding the testis and epididymis. Vasectomy-related changes are likely attributable to post-vasectomy obstructive changes and increased intraluminal pressure in the efferent ducts, epididymides, and vas deferens. The typical sonographic changes after a vasectomy primarily include epididymal thickening and epididymal tubular ectasia with diminished blood flow in the epididymis. Spermatoceles display various sonographic findings, from multilocular cysts, to cystic lesions with low-echo levels, to a solid mass. Sperm granulomas appear as well-circumscribed heterogeneous masses on sonography and are commonly found at the epididymis or the ends of the severed vas deferens. The hydrocele, varicocele, epididymal cysts, and testicular cysts can also be associated; however, these findings are nonspecific. When radiologists encounter abnormalities of the scrotum, it would be useful to obtain a history of vasectomy to enable a correct diagnosis. Understanding of sonographic features of vasectomy-related changes and abnormalities is essential for correct diagnosis and proper management.

Results of ultrasound findings in cases of pure cystic scrotal swellings in patients of all ages in ash

To describe the results of ultrasound findings in pure cystic scrotal swellings in patients of all ages in ASH. It was a descriptive case series carriedout from Jan 2003 to Dec 2005 in SOPD and Surgical unit-1, Abbasi Shaheed Hospital and KMDC, Karachi. A total of 100 patients were taken who had pure scrotal swellings which were cystic in nature clinical examinations. These patients were treated in this hospital during this period. All patients [n=100] attending SOPD of Abbasi Shaheed Hospital with presenting complain of pure scrotal swellings were clinically examined with especial attention to get above the swelling, fluctuation and transillumination test and their size of the swelling also noted by an inch tape. An inform consent was taken and ultrasound of scrotum was done in ultrasound department to confirm the cystic swelling of scrotum and also to measure the size of the swelling. These patients were then divided into three groups according to the size of the scrotal swelling in which Group A [n=22] patients had size <5cm in diameter, Group B [n=51] had size 05-10cm in diameter and Group C [n=27] had size >10cm in diameter. All patients were admitted for surgery [exploration of the scrotal swelling]. On exploration of the scrotum [n=100], about 39% [n=39] of patients had < 50 ml of fluid, 32% [n=32] of patients had 50-100 ml of fluid while 29% [n=29] of patients had >100 ml of fluid in the sac. About 77% [n=77] of patients had clear amber coloured fluid, about 13% [n=13] had serous fluid with calcifications, about 07% [n=07] had pussy fluid and only 03% [n=03] had bloody fluid in the sac. Therefore about 90% of the patients had hydrocele [n=90], about 07% had pyocele [n=07] and only 03% of patients had haematocele [n=03]. No malignancy was found in this study. Most of the patients coming in this hospital with pure cystic scrotal swellings had hydroceles [90%], some of the patients had pyoceles [07%] while few had haematoceles [03%]. All most all cystic scrotal swellings were benign in nature and no malignancy was found in this study

Sclerotherapy of idiopathic hydroceles and epididymal cysts: a historical comparison trial of 5% phenol versus tetracycline

Operating time for idiopathic hydroceles and epididymal cysts is scarce as these conditions compete with an increasing caseload of more consequential surgical disease. Therapy is often relegated to repeated aspiration. Sclerotherapy appears to be effective in a majority of published trials, but comparative effectiveness, efficacy and safety of most agents, including phenol versus tetracycline, has not been established A deliberate strategy of re-treatment until cure is not universally practised, with surgery still being offered after single-treatment failures. Two trials, the first consisting of 53 scrotal cysts treated with 5% phenol-in-water and the second, 42 cysts treated with tetracycline, are compared for effectiveness, efficacy and safety of sclerotherapy per se and of re-treatment. Intention-to-treat analysis yields similar cure rates (no re-accumulation three months after last injection) for phenol and tetracycline (83% and 81% respectively, p = 0.8). Per-protocol analysis also yields similar cure rates (100% and 97% respectively, p = 0.26) and mean number of injections to cure (1.34 and 1.12 respectively, p = 0.069), with range 1-4 and 1-3 respectively. Severe pain following tetracycline injection required administration of pre-injection cord block. Other complications occurred equally (25% and 25.7% respectively, p = 0.94) and were trivial except for one case of chronic haematocele treated by orchiectomy in the tetracycline group. Phenol (5%) and tetracycline are equally efficacious sclerosants for idiopathic scrotal cysts, achieving almost 100% cure with re-treatment and matching the efficacy of surgery. Concern about post-treatment fertility applies equally to surgery and demands informed consent for both modalities.

El tiempo de operación para los hidroceles y los quistes epididimales es escaso, ya que estas condiciones triviales compiten con una creciente carga de casos de enfermedades quirúrgicas de mayores consecuencias. La terapia es a menudo relegada a una aspiración repetida. La escleroterapiaparece ser efectiva en la mayoría de los ensayos publicados, pero no se han establecido la seguridad, eficacia y efectividad comparativa de la mayor parte de los agentes, incluyendo el fenol, frente a la tetraciclina. No se practica universalmente una estrategia deliberada de re-tratamiento hasta la cura, ofreciéndose todavía la cirugía, luego de fracasos con tratamientos individuales. Dos ensayos, el primero consistente en 53 quistes escrotales tratados con fenol acuoso al 5%, y el segundo, en 42 quistes tratados con tetraciclina, se comparan en cuanto a efectividad, eficacia y seguridad para laescleroterapia per se y para el re-tratamiento. El análisis de intención de tratamiento produce tasas de curación similares (no hay re-acumulación 3 meses después de la última inyección) para el fenol y la tetraciclina (83% y 81% respectivamente, p = 0.8). El análisis por protocolo también produce tasas de curación similares (100% y 97% respectivamente, p = 0.26) y el número medio de inyecciones paracurar (1.34 y 1.12 respectivamente, p = 0.069), con rangos de 1–4 y 1–3 respectivamente. El dolor severo tras la inyección de tetraciclina requirió hacer un bloqueo espinal de pre-inyec-ción. Asimismo ocurrieron otras complicaciones (25% y 25.7% respectivamente, p = 0.94) y fueron triviales, con excepción de un caso de hematoceles crónicos tratado mediante orquiectomía en el grupo de tetraciclina. El fenol (5%) y la tetraciclina poseen igual eficacia como esclerosantes de los quistes escrotales idiopáticos, ya que logran una curación de casi 100% con el re-tratamiento, e igualan la eficacia de la cirugía...

Tumours and tumour-like conditions of the para-testicular region--a study of morphological features.

Twenty two patients with tumours or tumour-like conditions of the para-testicular region (PTR) were diagnosed over a 5 year period. Of these, 16 (73%) were benign with only one true neoplasm (papillary cystadenoma). The tumour-like conditions were comprised of 6 cases of adenomatous hyperplasia of epididymis, 4 cases of spermatic granuloma, 2 cases each of spermatocele and nodular-fibrous proliferation and one mesothelial cyst. Three patients with spermatic granuloma gave a history of trauma. No case of adenomatoid tumour was encountered. Six malignant neoplasms were diagnosed (27%) all of which were sarcomas. Five were primary to the PTR and one was a metastatic deposit from a primary leiomyoblastoma of the mesentery. Among the 5 primary sarcomas were 2 cases each of rhabdomyosarcoma and leiomyosarcoma, and 1 case of liposarcoma. The patient with leiomyoblastoma presented first with a measenteric mass which was followed a month later by a rapidly growing mass in the scrotum. Immunohistochemical staining (IHC) and Electron microscopy (EM) were done in this case. Intra-cytoplasmic myofilaments as well as desmosomes were observed. The patients ranged from 14 to 65 years of age and most presented with painless mass in the scrotum. Follow-up was not possible due to practical difficulties.

Fifteen Cases of Testicular Microlithiasis / 대한비뇨기과학회지

PURPOSE: This study was made to evaluate the clinical characteristics of testicular microlithiasis which shows small diffuse hyperechoic nonshadowing foci throughout both testes on sonography. MATERIALS AND METHODS: Between July 1995 and May 1997, we had seen 15 Patients with dilateral diffuse microlithiasis of the testes on the sonography. Medical records were reviewed with respect to age at presentation, associated diseases, and sonographic and pathologic characteristics. RESULTS: The age of the patients ranged from 8 to 69 years. The testicular microlithiasis was coincidental to the presence of erectile dysfunction(n=5), epididymitis(n=5), varicocele(n=4), epididymal cyst(n=2), infertility(n=1), testicular teratoma(n=1) and diabetes mellitus(n=1). There were considerable variations in the numbers of echogenic foci on each sonography that examined the entire half of the scrotum(from 15 to more than 60 foci). The histological examinations were done in two patients and sbowed the lumina of seminiferous tubules filled with concentrically lamellated calcified concretions. CONCLUSIONS: The testicular microlithiasis showed a wide range of age at presentation and associated with diabetes mellitus and a variety of urological problems including erectile dysfunction, epididymitis, varicoce18, epididymal cyst, infertility and testicular teratoma. The clinical relevance remains unclear at this time. Further additional cases as well as a long-term follow-up would be necessary to assess the association between testicular microlithiasis and these coincidental conditions.

Clinical Significance of No Appearance of Vasal Fluid on Testicular End of the Vas during Vasovasostomy / 대한비뇨기과학회지

The sperm count in semen analysis after vasovasostomy is significantly higher in men with vasal fluid in the proximal vas during the operation than in those without fluid on one or both sides(P<0.05). On 8(38.1%) of 21 sides in 12 men without vasal efflux during vasovasostomy secondary epididymal obstructions were found on scrotal exploration. Bilateral ductal obstructions were found in 3 of 9 men without vasal efflux on both sides. The cause of obstruction included spermatocele, chronic epididymal inflammation. In epididymal histology the cause of obstruction was the interstitial sperm granulomas resulting from the rupture of the epididymal duct and chronic epididymitis. We concluded that epididymal exploration is necessary in case with no sperm from testicular end of the vas on both sides.

Adult paratesticular tumors: report of two cases

Paratesticular tumors are uncommon tumors, most being found incidentally at autopsy. The most common benign paratesticular tumor is the adenomatoid tumor. A somewhat less frequent benign paratesticular tumor, papillary cystadenoma, accounts for approximately 33 percent of all the primary epididymal tumors and is frequently seen in patients with Von Hippel-Lindau disease. Malignant tumors are rare. Of these, rhabdomyosarcoma is the most frequent. Seen almost exclusively in the pediatric population, paratesticular rhabdomyosarcomas account for 7 percent of childhood rhabdomyosarcomas. We describe two cases of paratesticular tumors in adults: a papillary cystadenoma of the epididymis in a 72-year old male, and an incidental rhabdomyosarcoma in a 49-year old male

Sixty cases of congenital vas agenesis / 대한비뇨기과학회지

Out of 334 patients with obstructive azoospermia between Sep. 1983 and Aug. 1991. scrotal exploration for attempted epididymo-vasostomy showed vas agenesis in 60 of them(17.9%). The anatomical findings were classified into various groups of frequency. In the study of associated structural anomaly of seminal vesicle with transrectal ultrasonography, high incidence of anomalies was detected(8 out of 10). In bilateral vas agenesis, artificial insemination donor and artificial spermatocele were recommended for most of the patients and recently sperm aspiration from the epididymis was tried to unilateral agenesis, epididymo-vasostomies were carried out to ipsilateral (11) and contralateral(3) side. It is desirable to apply various operations with positive attitude. Further study including transrectal ultrasonography is expected to elucidate combined seminal vesicle anomalies.

Experimental Study on Alloplastic Spermatocele / 대한비뇨기과학회지

The "bridge" alloplastic spermatocele, which connected the tails of the both epididymis and collected sperms from both testes, were constructed in 30 male Wistar rats, using Goretex cylinder. The artificial cylinder were aspirated postoperatively every week for 8 weeks, and the animals were then sacrificed and the epididymis connected with spermatoceles were examined histologically. The valid experimental results were not obtained because of the inflammation. However, the surgical procedure was relatively easy and a greater quantity of aspirate was obtained with easy execution of the single puncture. The number of sperms was markedly decreased from the 3rd weeks, and no sperms were survived at the first week in all the experimental rats. Therefore, it is recommended that the basic aspect of the spermatocele should be worked out experimentally before applying it to human patients.

Espermatocele artificial em agenesia dos canais deferentes / Alloplastic spermatocele in agenesis of the vas deferens

Os autores descrevem nova técnica de criaçäo de espermatocele artificial utilizando enxerto vascular tubular de politetrafluoroetileno (Goretex). O procedimento, empregado em quatro pacientes com agenesia-atresia dos canais deferentes, permitiu a obtençäo no pós-operatório de espermatozóides viáveis em três dos quatro pacientes. Embora nenhum caso de gestaçäo da parceira tenha sido observado com a inseminaçäo artificial de material obtido por punçäo das espermatoceles, esta técnica pode representar uma alternativa válida para tratar pacientes com esterilidade decorrente de processos obstrutivos graves das vias seminais

Conventional Ultrasonographic Examination of Scrotal Lesion / 대한비뇨기과학회지

Ultrasound has been shown to be effective in the diagnosis of a variety of scrotal abnormalities. We performed ultrasound of the scrotum in 22 patients with conventional 3.75 MHz real time scanner. There were 6 intratesticular lesions-3 spermatic cord torsion, 1 malignant lymphoma,1 leukemic infiltration and l yolk sac tumor. Extratesticular abnormalities included acute epididymitis, chronic epididymitis, Tb epididymitis, epididymal cyst peritesticular abscess, spermatocele, hematocele and infected hydrocele. Sonography accurately distinguished between testicular and extratesticular masses in all cases and pathologic correlation were obtained for operated scrotal lesions. The results were as follows. l. Out of 22 patients, chief complaints of 9 were acute sctotum and 13 were scrotal mass. 2. Of 9 cases with acute scrotum, ultrasonography detected 5 cases with acute epididymitis, 3 cases with spermatic cord torsion and l case with hematocele. 3. Of 13 cases with scrotal mass, surgical exploration was done in 1O cases. 9 cases were confirmed same as post-operative finding (90% accuracy). One case with hematoma was confirmed to infected hydrocele after operation. 4. Ultrasound characteristics of 22 patients were classified as follows. 13 were hypoechoic, 4 were anechoic, 3 were mixed and 2 were hyperechoic.

Ultrasonographic Examination of Scrotal Masses / 대한비뇨기과학회지

Diagnostic ultrasound was a simple, rapid, harmless, and painless method to visualize ultrascrotal contents, it provided information that was difficult to obtain on clinical examination. We recently tested the effectiveness of diagnostic ultrasound in 41 men with scrotal masses. In general, ultrasound was highly effective in differentiating and characterizing testicular and extratesticular masses. The following results were obtained. 1. The ultrasonic examination revealed 37 extratesticular lesions, 3 testicular lesions and 1 indeterminate lesion. Of the extratesticular lesions 22 were believed to be cystic but represented 18 hydroceles and 4 spermatoceles. 15 lesions were thought to be solid that represented epididymitis. 2. The accuracy rate the scrotal ultrasound, given a complete clinical history, was 97% in this series. 3. The tumor showed decreased echogenicity within the testicle, which was enlarged. The characteristic appearance of hydrocele, spermatocele were sonolucent cystic mass. The epididymis was enlarged in 11 patients with epididymitis, the echogenicity within testicle was decreased in 5 patients with epididymitis.

Creation of Artificial Spermatocele in Aplasia of the Vas Deferens / 대한비뇨기과학회지

Patients with bilateral aplasia of the vas deferens have been considered sterile. In such patients many investigators have tried to create a successful sperm bank with various materials such as saphenous vein, tunica vaginalis, silicone prosthesis, monofilament knitted polypropylene and etc. and to offer hope for fertility. We performed to create an artificial spermatocele in a 32 year old male patient with bilateral vas aplasia by using a segment of great saphenous vein, anastomosed to the globus major to store spermatozoa. Aspirations of the venous cap of the patient at 2.3.4. and 5 months revealed numerous sperm with normal morphology and poor motility. Attempted insemination to his wife with this sperm was unsatisfactory.

A Case of von Hippel-Lindau's Disease

The authors presented a case of von Hippel-Lindau's disease. The patient was a 33-year-old man who visited to our hospital with visual disturbance on the right eye for a month and blind in the left eye for 10 years on the 4th May, 1973. On the eye examination, the left eye revealed ocular hypertension, deep chamber, and vitreous opacity which interfered with the visuality of the fundus. The right eye was normotensive and 0.1 incorrectable in visual acuity. The fundus revealed two angioma associated with large feeding vessels, scattered hemorrhages, and massive exudates along the engorged and tortuous vessels at the temporal retina. On general physical examination, no neurological signs were found, but multiple hard corn sized masses were palpated on the both sides of epididymal head. The masses were confirmed as epididymal cyst on microscopic examination. The x-ray findings were pulmonary tuberculosis far advanced on chest, an extrinsic pressure indentation in the floor of bladder on I.V.P., and abnormal intracranial vascularity, on right carotid angiogram. The blood chemistry showed an abnormal increase of amylase and lipase titers.