Patologias genitais masculinas em cirurgia pediátrica de manejo / Outpatient pediatric surgery of male genital pathologies

Objetivos: Diagnosticar e manejar patologias comuns do trato genital masculino. Métodos: Revisão da literatura do ano de 2011 ao 2017 em base de dados PubMed. Resultados: Hipospádia é a localização anômala do meato uretral. Seu diagnóstico é clínico. As indicações cirúrgicas são anormalidades funcionais e estéticas. Fimose é descrita como impossibilidade de retração do prepcio para exposição da glande peniana, sendo um evento fisiológico quando apresenta resolução espontânea. Nos casos patológicos, o tratamento é primeiramente realizado com corticoide tópico. Se falha, o tratamento é cirúrgico. Hidrocele é o acúmulo de líquido na bolsa escrotal. O diagnóstico é clínico e por transiluminação escrotal. A maioria dos casos regride espontaneamente até os 24-36 meses. A cirurgia é considerada padrão-ouro para hidrocele comunicante na criança. Criptorquidia é a falha na migração do testículo até a bolsa escrotal. Seu diagnóstico é clínico, através da palpação testicular bilateral. Caso os testículos não estejam presentes na bolsa escrotal até os 6 meses de idade, a cirurgia é imprescindível, pelo risco de infertilidade e malignização. Conclusões: É essencial que o médico generalista saiba reconhecer tais condições com o intuito de iniciar prontamente o tratamento adequado, evitando suas complicações.

Aims: Diagnose and manage common pathologies of the male genital tract. Methods: Literary review of the last 6 years in the PubMed database. Results: Hypospadia is an anomalous location of the urethral meatus. The diagnosis is clinical. Surgical indications are functional and aesthetic abnormalities. Fimosis is described as impossibility of retraction of the foreskin to expose the penile glans, it is a physiological event when it presents spontaneous resolution. In pathological cases, treatment is first performed with topical corticosteroids. If it fails, the treatment is surgical. Hydrocele is the accumulation of fluid in the scrotal sac. The diagnosis is clinical and scrotal transillumination. Most cases regress spontaneously up to 24-36 months. Surgery is considered gold standard in cases of communicant hydrocele in children. Cryptorchidism is the failure of the migration of the testis to scrotal sac. The diagnosis is clinical through bilateral testicular palpation. If the testicles are not present in the scrotal sac until 6 months of age, surgery is essential, due to the risk of infertility and malignancy. Conclusions: It is imperative that the general practitioner knows how to recognize such conditions in order to promptly initiate appropriate treatment, avoiding complications.

Do retractile testes have anatomical anomalies?

ABSTRACT Objectives: To assess the incidence of anatomical anomalies in patients with retractile testis. Materials and Methods: We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p <0.05). Results: The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116). Conclusions: Retractile testis is not a normal variant with a significant risk of patent processus vaginalis and epididymal anomalies.

Minimally access versus conventional hydrocelectomy: a randomized trial

ABSTRACTObjective:To compare our previously published new minimally access hydrocelectomy versus Jaboulay's procedure regarding operative outcome and patient's satisfaction.Materials and Methods:A total of 124 adult patients were divided into two groups: A and B. Group A patients were subjected to conventional surgical hydrocelectomy (Jaboulay's procedure) and group B patients were subjected to the new minimal access hydrocelectomy. The primary endpoint of the study was recurrence defined as a clinically detectable characteristic swelling in the scrotum and diagnosed by the two surgeons and confirmed by ultrasound imaging study. The secondary endpoints were postoperative hematoma, wound sepsis and persistent edema and hardening.Results:The mean operative time in group B was 15.1±4.24 minutes and in group A was 32.5±4.76 minutes (P≤0.02). The mean time to return to work was 8.5±2.1 (7–10) days in group B while in group A was 12.5±3.53 (10–15) days (P=0.0001). The overall complication rate in group B was 12.88% and in group A was 37%. The parameters of the study were postoperative hematoma, degree of scrotal edema, wound infection, patients’ satisfaction and recurrence.Conclusion:Hydrocelectomy is considered the gold standard technique for the treatment of hydrocele and the minimally access maneuvers provide the best operative outcomes regarding scrotal edema and hardening and patient's satisfaction when compared to conventional eversion-excision hydrocelectomies.

Minimal Hydrocelectomy with the aid of scrotoscope: a ten-year experience

Background Since hydrocelectomy remains the choice of surgical treatment of hydrocele and standard surgical procedures may cause postoperative discomfort and complications, a new minimal surgery procedure is needed. The scrotoscope was used for the diagnosis and treatment of intrascrotal lesions. The aim of the study is to illustrate a new minimal hydrocelectomy with the aid of scrotoscope, in an effort to decrease complications. Materials and Methods: Between 2002 and 2012, 65 patients underwent hydrocelectomy with the aid of a scrotoscope. Before carrying out hydrocelectomy, the scrotoscopy was first used to examine the intrascrotal contents to exclude any pathological lesions. After determining the condition of testis, epididymis and spermatic cord and excluding any other secondary causes of hydrocele, a 2.0cm scrotal incision was performed. The parietal tunica vaginalis was then grasped out of scrotum, and the mobilized tunica was excised. The scrotoscopy was then performed again to inspect the intrascrotal contents. Results Mean operative time was 35.4 minutes. No major complications occurred during the post-operative follow-up period. Of these 65 patients, 61 underwent scrotoscopy and minimal hydrocelectomy, two patients underwent open hydrocelectomy because thickening of hydrocele wall was identified; two patients with acute inflammation only underwent scrotoscopy. Pathological changes were observed among eight patients. All patients were satisfied with the outcomes. Conclusions Minimal hydrocelectomy shows commendable results and fewer complications. The combination of minimal hydrocelectomy and scrotoscopy seems to be an encouraging technique. This novel surgical procedure proves to be a viable option for the diagnosis and treatment of hydrocele. .

evaluation de la prise en charge des hydroceles a Mbujimayi en Republique Democratique du Congo

Objectif general : evaluer la prise en charge des hydroceles dans les hopitaux de Mbujimayi. Materiel et methodes : la methode utilisee a ete transversale et retrospective. Ce travail a porte sur 76 patients traites et hospitalises pour hydrocele dans les services de chirurgie des structures hospitalieres Bonzola; Dipumba; MIK Geller et Saint Jean Baptiste de janvier 2008 a Decembre 2012. Resultats : La frequence la plus elevee des hydroceles a ete observee dans la tranche d'age de plus de 60 ans suivie de celle comprise entre 0 et 20 ans avec respectivement 38;2 et 31;6. Les hydroceles communicantes ont ete exclusivement observees dans la tranche d'age de 0 a 20 ans (58;3) alors que les hydroceles simples ont ete diagnostiquees dans toutes les tranches d'age. Le retournement de la vaginale a ete le type de traitement le plus frequent pour les hydroceles simples (85;5) alors que les hydroceles simples ont ete diagnostiquees dans toutes les tranches d'age. Le retournement de la vaginale a ete le type de traitement le plus frequent pour les hydroceles simples (85;5) tandis que les hydroceles communicantes ont ete surtout traitees par la ligature du canal peritoneo-vaginal avec resection de la vaginale (92;9). Les complications sont apparues dans 6;6 des cas; les suites operatoires ayant ete simples dans la plupart des cas. L'hematome scrotal a ete la complication la plus frequente dans le retournement de la vaginale.Conclusion : la prise en charge des hydroceles a ete realisee couramment dans les hopitaux de Mbujimayi integres dans l'etude. Elle nous a paru conforme aux normes de bonne pratique rapportees dans la litterature

Lymph scrotum: an unusual urological presentation of lymphatic filariasis: a case series study / Linfoescroto: apresentação rara de filaríase linfática: estudo retrospectivo

Lymphatic filariasis (LF) causes a wide range of clinical signs and symptoms, including urogenital manifestations. Transmission control and disability/morbidity management/control are the two pillars of the overall elimination strategy for LF. Lymph scrotum is an unusual urological clinical presentation of LF with important medical, psychological, social and economic repercussions. A retrospective case series study was conducted on outpatients attended at the National Reference Service for Filariasis, in an endemic area for filariasis (Recife, Brazil), between 2000 and 2007. Over this period, 6,361 patients were attended and seven cases with lymph scrotum were identified. Mean patient age was 45 years (range, 26 to 64 years). Mean disease duration was 8.5 years (range, two to 15 years). All patients had evidence of filarial infection from at least one laboratory test (parasitological, antigen investigation or "filarial dance sign" on ultrasound). Six patients presented histories of urological surgery. The authors highlight the importance of the association between filarial infection and the inadequate surgical and clinical management of hydrocele in an endemic area, as risk factors for lymph scrotum. Thus, filarial infection should be routinely investigated in all individuals presenting urological morbidity within endemic areas, in order to identify likely links in the transmission chain.

A filariose linfática (FL) é responsável por uma grande variedade de sinais e sintomas clínicos incluindo manifestações urogenitais. O controle da transmissão e da incapacitação bem como o manuseio da morbidade são os dois pilares da estratégia global de eliminação da FL. O linfoescroto é uma rara apresentação da FL, tendo importantes repercussões do ponto de vista clínico, psicológico e socioeconômico. Realizou-se um estudo retrospectivo de uma série de casos com diagnóstico de linfoescroto, identificados entre os 6.361 pacientes ambulatoriais atendidos no período de 2000 a 2007 no Serviço de Referência Nacional em Filarioses (Recife, Brasil) área endêmica de filariose. Foram identificados sete casos, com a idade média de 45 anos (com variação de 26 a 64 anos). O tempo médio de evolução da doença foi de 8,5 anos (com variação de 2 a 15 anos). Todos apresentavam evidência de infecção filarial por algum dos exames realizados (parasitológico, pesquisa antigênica ou "sinal da dança da filaria" na ultrasonografia). Seis pacientes relatavam historia prévia de cirurgia urológica. Os autores destacam a importância da associação da infecção filarial e de inadequado manuseio cirúrgico e de acompanhamento de pacientes com hidrocele de uma área endêmica, como fatores de risco para o surgimento de linfoescroto. Assim, a infecção filarial deve ser rotineiramente investigada em todos os indivíduos procedentes de áreas endêmicas apresentando morbidade urológica, para identificar melhor os elementos da cadeia de transmissão.

Cystic lymphangiomatous hamartoma masquerading as massive ascites.

We report a 4-year-old boy presenting with a tense massive ascites and large hydrocele. History and physical examination were unremarkable. Routine laboratory studies were normal. Abdominal ultrasonography revealed massive ascites. Contrast CT was suggestive of a large cyst covering the entire peritoneal cavity. At laparotomy, a large cystic tumor was found extending into the scrotum through the left inguinal ring. Histopathologic examination diagnosed the tumor as a cystic lymphangiomatous hemartoma. Although abdominal lymphangiomas are seen in children, but presenting as massive ascites with hydrocele is very rare.

Hernioplastia y orquidectomía / Hernioplasty and orchidectomy

Estudio prospectivo en pacientes con hernia inguinal irreductible crónica y portadores de patología médica severa, con el propósito de efectuar una intervención con menor riesgo quirúrgico, para lo cual se programó realizar una orquidectomía en forma concomitante con el procedimiento de hernioplastía,. De común acuerdo con cada paciente y debidamente avalado por un consentimiento informado legal específico para patología herniaria, entre Julio de 2000 a Junio de 2005 se operaron 8 pacientes, realizándose 9 orquidectomías. El promedio de edad fue de 66,6 años, con valores extremos de 41 y 85 años. Cinco pacientes tenían patología cardiovascular severa asociada, con un promedio de edad de 76 años, nueve más que en la serie general; dos tenían déficit mental significativo. En tres pacientes se asoció a cirugía herniaria previa; en cuatro un hidrocele de tamaño considerable, con bilateralidad en uno. El saco herniario contenía principalmente ileon y colon; elementos herniarios deslizados: colon derecho en tres, sigmoides en uno y vejiga y uréteres en uno. El tiempo operatorio promedio, fue de 105 minutos, haciendo excepción de dos pacientes. La estadía hospitalaria de fue de 84 horas, a excepción del paciente con sepsis renal. No hubo complicaciones intraoperatorias. La evolución postoperatoria fue satisfactoria en siete pacientes. Las complicaciones quirúrgicas fueron mínimas. No hubo mortalidad en la serie. Conclusión: en pacientes con edad avanzada con patología herniaria irreductible crónica y patología médica severa, el agregar la exéresis testicular a la hernioplastía, disminuye el tiempo quirúrgico, permite una estadía hospitalaria más breve y un escaso compromiso local.

Tunical vaginalis excision: the hydrocelectomy technique not to be forgotten

Background: The technique of excising the hydrocele sac (tunica vaginalis) rather extensively; leaving only 1- 2 cm rim of tissue adjacent to the testis and epididymis in the treatment of hydrocele in adults is to be advocated; as it gives the same result as Jaboulay's technique. The advantage with this technique is that; it reduces the size of the remaining tissue to near normal postoperatively and no risk of strangulating the spermatic cord as it may happen in Jaboulay;s technique.Methods: Adult male patients with different sizes of hydroceles were seen; investigated and operated with this technique in three hospitals- Muhimbili National hospital; Tumaini and MHS- Massana hospitals between January 2004 and June 2006.Results: A total of 25 patients were operated using this technique. The age ranged between 20 - 60years. Most of them had right-sided idiopathic hydrocele; the technique provided excellent results in the treatment of such conditions.Conclusion: The technique of excising the hydrocele sac (tunica vaginalis) needs to be advocated and should not be forgotten hydrocelectomy techniques

Eficacia del tratamiento quirúrgico en la corrección del hidrocele / Effectiveness of surgical treatment for correction of hydrocele

Se revisaron los expedientes de 34 pacientes con 38 hidroceles testiculares, con edades comprendidas entre los 20 y 70 años, que se trataron en el servicio en que trabajan los autores por cirugía abierta y seguimiento durante un periodo promedio de 10 meses. Se produjeron 23.5 por ciento de complicaciones en total, la más frecuente la orquiepididimitis (11.7 por ciento); le siguieron recaídas en 8.8 por ciento y hematomas en 2.9 por ciento

Role of antibiotics in clean wounds.

Two hundred twenty cases with clean surgical wounds were treated without administering any antibiotics. Majority of them (134) were hydroceles and hernias. The study included some major operation also. The infection rate was 3.6% in the present series, which is comparable with the study where antibiotics were used.

Escleroterapia para el hidrocele mediante fenol al 3 por ciento / Sclerotherapy for hydrocele with 3 percent phenol

Se realizó escleroterapia con fenol al 3 por ciento para tratar 15 hidroceles en 14 pacientes adultos, con edad promedio de 47 años. Se practicaron transiluminación y ultrasonido escrotal de hidrocele antes de la escleroterapia con fenol. Se analizaron eficacia del tratamiento, número de sesiones y complicaciones, y se efectuó comparación con un grupo testigo y cuyos enfermos se trataron quirúrgicamente; la eficacia fue de 95 por ciento. En dos casos (13.3 por ciento) el tratamiento consistió en una sesión de escleroterapia; en nueve casos (60 por ciento) en dos sesiones, y otros cuatro casos (26.6 por ciento) en tres sesiones de escleroterapia. esta se realizó en el consultorio. El seguimiento fue de dos meses. No se observaron complicaciones, y se requirieron analgésicos en tres casos (21 por ciento) para el dolor subsecuente al tratamiento. El grupo testigo fue de 10 pacientes, con una eficacia de 100 por ciento; hubo 40 por ciento de complicaciones, con dos casos con edema, uno de hemorragia y uno de hematoma escrotal. El promedio de hospitalización fue de 2.3 días. Se concluyó que la escleroterapia con fenol al 3 por ciento es muy eficaz para los hidroceles, tiene bajo costo económico y evita el tratamiento quirúrgico tradicional

Everted plication--a modified technique in hydrocoele surgery.

In the present article, a new technique of surgery for hydrocoele is described. This technique involves combination of plication and eversion of tunica vaginalis sac. This surgical method was compared with the standard operative procedures-Jabouley's and Lord's (25 patients in each group). Our technique required less suture material (average knots required were 4). The risk of injury to epididymis or testis appeared to be less and time required for surgery was 10 min. Thus the technique appeared to be simple and safe, even when carried out by junior surgeon.

Inguinal hernia in children

Two hundred and seventy one cases of inguinal hernias and hydrocoels in children treated at the University Hospital of the West Indies over a five-year period have been reviewed. The dominance of the boys and the right side is borne out. The younger infant has the highest risk of incarceration which is more common in boys and in right-sided hernias. Females with inguinal hernias were screened for testiculaar feminization and none was found. There were three girls with hydeocoels of the Canal of Nuck. The incidence of metachronous presentations of contralateral hernia occurred only in 6.6 por ciento of cases. When routine explorartion of the contralateral side was undertaken in 5.2 por ciento of cases, a hernia sac was found only in less than half of them. These findings support the present policy of not routinely exploring the opposite side in unilateral inguinal hernias. Herniotomy was adequate for 92.6 por ciento of cases. Herniorrhaphy was seen in only one case. One testicular atrophy occurred following incarceration. Eighty-six per cent of these children were managed as day cases. Inpatient management was required when the hernia was complicated or when there were associated other medical conditions.

Hidrocelectomía por incisión arciforme sobre anillo inguinal superficial / Hydrocelectomy by arc-shaped incision over the superficial inginal ring

Se practicó hidrocelectomía en treinta pacientes con o sin intervención previa en el sitio del hidroceles. Se realizó una incisión arciforme de concavidad cefálica de ñ 4 cm de longitud sobre el anillo inguinal superficial hasta el tejido celular subcutáneo. Los resultados fueron excelentes ya que no se presentó ninguna complicación. Se analiza el procedimiento

Hérnia inguinal e hidrocele no recém-nascido e criança maior / Inguinal hernia and hydrocele in newborn and child

Os autores revisaram 726 prontuários junto ao Serviço de Cirurgia Pediátrica do Ambulatório Médico Central da Faculdade de Medicina de Caxias do Sul, num período entre novembro de 1989 e novembro de 1992. O objetivo básico foi estudar o comportamento da hérnia inguinal quanto ao sexo, idade, técnica cirúrgica, bilateralidade, encarceramento e prematuridade, além de estudar os casos de hidrocele quanto à idade e bilateralidade. Os resultados obtidos foram cruzados com os obtidos da literatura mundial mostrando equivalência nas conclusoes.

Patologia do conduto peritônico-vaginal hérnia inguinal e hidrocele

Após as consideraçöes iniciais quanto aos aspectos embriológicos, anatômicos e patológicos, é apresentada a classificaçäo dos defeitos de fechamento do conduto peritônio-vaginal (CPV), seguindo-se o estudo da incidência e do diagnóstico dhérnia inguinal redutível (näo complicada) e irredutível (complicada), bem como da hidrocele. É considerado, também, o problema da hérnia inguinal contralateral, com a apresentaçäo dos vários métodos que podem ser aplicados para evidenciá-la. Com relacäo ao tratamento, é abordada a idade ideal para a indicaçäo do tratamento cirrugico, os tempos operatórios e as complicaçöes pós-operatórias. A apresentaçäo do tema está baseada na experiência adquirida com o tratamento da hérnia inguinal e da hidrocele no Hospital Infantil de Florianópolis-SC nos últimos 20 anos, em cujo Serviço de Cirurgia Pediátrica säo operadas cerca de 500 crianças por ano com estes problemas, a maioria absoluta em regime ambulatorial

Hidroceles e cistos de cordäo na criança / Hydrocele and cysts of the cord in children

Os autores apresentam um artigo de revisäo sobre hidroceles e cistos de cordäo na criança. Apresentam uma classificaçäo baseada na comunicaçäo ou näo com a cavidade abdominal, associaçäo com hérnia inguinal e morfologia sacular. Mostram esquematicamente a tendência evolutiva dessas patologias, discutem o tratamento e as técnicas cirúrgicas mais adequadas. Apresentam uma discussäo sobre vascularizaçäo do testículo, o aparecimento de atrofia testicular pós-operatória e sobre as causas de reacúmulo pós-operatório de líquido no saco da hidrocele