Hidrocele en niños: diagnóstico y tratamiento / Hydrocele in children: diagnosis and treatment

Hidrocele es una colección benigna anormal de líquido seroso entre las capas parietal y visceral de la túnica vaginal. Puede ser congénito o adquirido y comunicante o no comunicante. Objetivo:revisar los conceptos actuales en el diagnóstico y manejo del hidrocele en niños, basados en literatura reciente. Material y Métodos: la información se obtuvo a través de una búsqueda en las bases: PubMed/Medline, Hinari, SciELO, LILACS, Redalyc y Google Académico; también se consultaron libros de textos en inglés y español, utilizando los descriptores: hidrocele, niños. Seleccionando 23 artículos y 5 capítulos de libros. El diagnóstico se realiza mediante anamnesis y el examen físico. La transiluminación del escroto y la ecografía son importantes para la confirmación del diagnóstico. Las opciones de tratamiento son; cirugía abierta y cirugía endoscópica. La reparación quirúrgica del hidrocele es una de las operaciones comunes realizadas en la práctica de cirugía pediátrica. Conclusión:la mayor parte de los niños con hidrocele, presentan la forma comunicante que se resuelve espontáneamente, sin embargo, se deben diagnosticar las variedades que requieren manejo quirúrgico para tratarlas oportunamente...(AU)

Hidrocele traumático: a propósito de un caso / Traumatic hydrocele: a case report

Resumen:La colección anormal de líquido seroso entre las capas visceral y parietal de la túnica vagina del testículo se llama hidrocele. Es considerada la causa más común de inflamación escrotal no dolorosa. El fluido peritoneal pasa al espacio escrotal a través de una comunicación que queda con el proceso vaginal, esto en el caso de los que son de origen congénito ya que desde el nacimiento el conducto peritoneovaginal no se oblitera adecuadamente.Los hidroceles adquiridos normalmente son de origen idiopático, pero también se puede dar en infecciones, varicocectomía, cirugía inguinal y trauma. En el presente artículo se expondrá la revisión de un caso de hidrocele de origen traumático.

Abstract:The abnormal collection of serous fluid between the visceral and parietal layers of the vaginal tunic of the testicle is called a hydrocele. It is considered the most common cause of painless scrotal swelling. The peritoneal fluid passes the scrotal space through a communication that keeps the vaginal process, that in the case of those who are congenital because from birth through the peritoneovaginal not properly obliterated. Hydroceles acquired are usually idiopathic, but can also result in infections, varicocectomía, inguinal surgery and trauma. In this article a review of a case of traumatic hydrocele isexposed.

Primary vaginal hydrocele; different surgical procedures: a comparative study

A hydrocele is a fluid - filled sac surrounding a testis that results in the swelling of scrotum. They can develop due to inflammation or injury within the scrotum. This study aimed to evaluate the efficacy and adaptation of different surgical procedures in the repair of hydrocele.Comparative, Retrospective study .The study was conducted at Fauji Foundation Hospital Karachi, Al-Tibri Medical College, Karachi and Civil Hospital Karachi from January, 2000 to December, 2013. Patients with primary vaginal hydrocele registered during the period of thirteen years in the out patient department of surgery were selected. A total of 300 patients were assessed clinically, diagnostically and radiologically about the status of hydrocele before the surgical procedures and anesthetic opinion. The different surgical technique were carried out in different group of patients asJaboulay's technique in 70 patients, Lord's procedure in 70 patients, Aspiration and Sclerotherapy in 05 patients, Window operation technique in 05 patients and the Hydrocelectomy by supra pubic procedure were carried out in 150 patients out of total 300 registered patients. The data collected and analyzed statistically in SPSS version 19.00. The different procedures have been adopted surgically in patients with primary vaginal hydrocele. The results showed that among the different operative techniques adopted, the best procedure regarding hydrocelectomy is the supra pubic approach line of treatment. It showed better result and recovery with very minimum complications and side effects as compared to other surgical procedure. The data thus concluded that hydrocelectomy done via supra pubic approach in number of patients proved to be the best procedure because of having very little complications

Understanding the processus vaginalis: the abdomino scrotal hydrocoele / Entendiendo el proceso vaginal: el hidrocele abdomino-escrotal

A knowledge of the embryology and descent of the testes is essential for all clinicians. Congenital hydrocoele, though an embryologic anomaly can present in adulthood. A abdomino scrotal hydrocole must be considered when a mass in the lower abdomen co exists with a scrotal hydrocoele.

El conocimiento de la embriología y el descenso de los testículos es esencial para todos los clínicos. El hidrocele congénito, aunque es una anomalía embriológica se puede presentar en la edad adulta. Un hidrocele abdomino-escrotal debe ser considerado cuando una masa en la parte inferior del abdomen co existe con un hidrocele testicular.

Gray scale and doppler ultra-sound in the diagnosis of painless scrotal masses

To determine the role of gray scale and Doppler Ultrasound in the diagnosis of painless scrotal masses. It was a descriptive study conducted at Department of radiology, Dow University of Health Science [DUHS] and Civil Hospital Karachi [CHK] from June 2006 to June 2007. Adult patients with painless scrotal mass referred for ultrasound examination, were included in the study. All subjects were scanned with 11 MHz linear transducer on NEMIO 17 scanner in supine position and erect posture as and when needed. Gray scale ultrasound was first conducted to determine the size, location and echogenecity of the lesion. Doppler ultrasound was done to assess and document the blood flow, spectrum, and velocity of flow and indices in the epididymis, as well as in the lesion. Accuracy of Doppler scan was determined against histopathology of the respected specimen in case of tumors and against surgical findings in the benign lesions. The average age of the patients was 38.51 +/- 9.4 years. The most common scrotal mass was hydrocele [n=24, 34.29%] followed by varicocele [n=13, 18. 57%], testicular tumors [n= 12, 17.14%], spermatocele [n 11, 15.71%] and epididymal cyst [n=10, 14.29%]. Out of 12 testicular tumors, there were 05 cases of seminoma [41.7%], 02 of cases of embryonal cell carcinomas [16.7%], two epidermoid cysts [16.7%] and 01 [8.3%] each of teratoma, choriocarcinoma with metastasis and testicular lymphoma Sensitivity and positive predictive value of the ultrasound were 66.7% and 100%. Gray scale ultrasound in combination with Doppler ultra sound is a good imaging technique in patients presenting with painless scrotal masses. Benign masses are more accurately diagnosed than tumors that require histopathology for exact tissue characterization

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.

Paratesticular myxoid liposarcoma: a case report.

Liposarcoma of the paratesticular region is a rare malignant soft tissue neoplasm. Out of all the possible sites of liposarcoma, the incidence in spermatic cord is rare, accounting for only 5% of these neoplasms. Among the various subtypes of liposarcoma described in the paratesticular region, myxoid variant of liposarcoma is seen very rarely. One such case is we ported here for its rarity and also to draw attention to the fact that, early diagnosis and complete excision carry better prognostic value.

Sonographic evaluation of the intrascrotal disease.

PURPOSE: To determine the causes of intrascrotal disease in patients who were sent for scrotal sonography at King Chulalongkorn Memorial Hospital and whether the imaging findings can help differentiate the tumor from infection of the testis. MATERIAL AND METHOD: Retrospective review was performed in 72 cases of extratesticular lesions and 48 cases of the intratesticular lesions to find out the causes of intrascrotal disease. The sonographic findings in the cases with final diagnosis of intratesticular infection and testicular tumor were analyzed according to the following criteria including the size of the testis, number, echogenicity, and margin of the mass, diffuse abnormal echogenicity of the testis, presence of fluid in the scrotal sac, epididymal lesion, scrotal skin thickening and calcification. RESULTS: Hydrocele was the most common extratesticular lesion (29.87%) and epididymitis was the second most common (14.28%). Infection was the most common intratesticular pathology (54.17%) and tumor was the second most common (31.25%). Most testicular tumors appeared as a focal mass while testicular infection usually caused diffuse abnormal echogenicity throughout the testis (p = 0.008). Epididymal lesions and skin thickening were usually detected together with intratesticular infection while they were not present in the cases of tumor (p = 0.000061 and 0.017). The number, echogenicity, margin of the mass, presence of testicular enlargement, fluid in the scrotal sac and calcification did not differ between testicular infection and tumor CONCLUSION: Hydrocele was the most common cause of extratesticular disease, followed by epididymitis. Most of the extratesticular pathology was benign entities. For intratesticular disease, the most common cause was infection, followed by intratesticular tumor Findings of a solitary intratesticular mass without epididymal lesion or skin thickening prefered malignant entity, while diffuse abnormal echogenicity of the testis with epididymal lesion and skin thickening prefered infectious process.

Acute appendicitis presenting as acute hemiscrotum in a boy.

A 6-year-old boy presented with diffuse abdominal pain, nausea and vomiting followed by features of acute scrotum. Laboratory and radiological evaluation suggested presence of infective pathology in the inguinoscrotal region. Surgical exploration revealed patent right processus vaginalis with purulent collection resulting from the presence of perforated tip of appendix in the hernial sac. Appendectomy with drainage of scrotal collection and ligation of hernial sac resulted in satisfactory recovery.

Microlitiasis testicular / Testicular microlithiasis. a case report and review of the literature

Introducción. La microlitiasis testicular consiste en depósitos de calcio dentro de los túbulos seminíferos. Se diagnostica como hallazgo realizando ultrasonidos con transductores de alta frecuencia en pacientes con síntomas testiculares diversos. Se describen casos uni o bilaterales, en algunos reportes el diagnóstico se basa sólo en hallazgos histológicos. Se ha observado en pacientes con criptorquidia, varicocele, orquialgia, hidrocele, hernia inguinal, calcificaciones del sistema nervioso simpático y cerebro, microlitiasis pulmonar, fibrosis quística entre otros. Reportes recientes demuestran su asociación con malignidad testicular. Caso clínico. Masculino de 4 años, que acude al hospital por dolor de moderada intensidad en bolsa escrotal derecha, así como aumento de volumen ipsilateral, con antecedente de infección de vías urinarias y diagnóstico de hidrocele a los 3 años. A la exploración física se le encontró dolor a la palpación en testículo derecho y transiluminación positiva del mismo. El ultrasonido mostró múltiples imágenes puntiformes hiperecoicas difusas en ambos testículos, los cuales se encontraban en canal inguinal, diagnosticándose microlitiasis testicular e hidrocele. Segundo caso de esta edad reportado en la literatura mundial. Conclusiones. Es una entidad benigna; debido a su asociación con malignidad y falta de seguimiento en pediatría, obliga a una exploración física seriada, marcadores tumorales (alfa-fetoproteína, beta-gonadotropina coriónica), ultrasonido de alta resolución en la primera evaluación y cada 6 a 12 meses. Microlitiasis, testicular; niños.

Métodos laboratoriais disponíveis para o diagnóstico da filariose linfática / Available laboratorial diagnostic methods of the lymphatic filariasis

O presente trabalho tem como objetivo revisar os métodos laboratoriais disponíveis para se diagnosticar a filariose linfática bancroftiana. Doença transmitida pelo vetor Culex quinquesfasciatus, e que é encontrada no Brasil, na Regiäo Metropolitana de Recife - PE, Maceió - AL, e Belém - PA. Apesar de existir uma variedade de testes utilizando a pesquisa do parasito, anticorpo, antígeno e DNA, na rotina diagnóstica, um cuidado deve ser tomado pelo profissional de saúde na interpretaçäo dos resultados, quer para diagnóstico ou descarte de infecçäo filarial, quer principalmente para atribuir ou näo à filariose, um quadro de adenopatia, linfedema ou hidrocele de que o paciente seja portador

Evaluating the detection of circulating filarial antigen in diagnosis of bancroftian filariasis and filarial hydrocele

Four groups of patients were selected: 16 patients with clinical evidence of obstructive filarial lymphangiopathy without microfilaremia, 12 patients with clinical evidence of obstructive filarial lymphangiopathy with microfilaremia and 9 patients with microfilaremia. Two control groups were also included. Blood films, sera and hydrocele fluid samples were collected from all subjects. Polyclonal antibody against Dirofilaria immitis worm homogenate was prepared, fractionated and conjugated with HRP. Both polyclonal antibody and monoclonal antibody [AD12] were used in a sandwich ELISA. Using polyclonal antibody, both microfilaremic groups [groups 2 and 3] had significantly higher mean OD readings than that of control groups [P <0.05], whereas, the mean OD readings of patients with symptomatic amicrofilaremia had no significant difference than control groups. Symptomatic microfilaremic group had the highest percentage of antigen positivity 7/12 [58.3%] among all groups, while symptomatic amicrofilaremic group had the least antigen positivity 2/16 [12.5%]. Patients presented with elephantiasis only or with hydrocele had no antigen positive levels 0/12 [0%] in their serum or hydrocele fluid samples

Innovadora y efectiva escleroterapia del hidrocele / Innovative and effective esclerotherapy of the hidrocele

La comprobada acción local de la lodopovidona sobre las proteínas y su efecto antiexudativo en el linfocele, complicación del paciente transplantado renal, nos indujó a usarlo en el tratamiento del hidrocele. En esta experiencia se realizó un ensayo clínico prospectivo en doce pacientes de la consulta urológica del Hospital Universitario de Caracas, con hidroceles no complicados, los cuales fueron tratados con lodopovidona al 10 por ciento, localmente después de aspirar su contenido. Todos los pacientes fueron evaluados pre y postoperatoriamente por examen clínico y ultrasonido escrotal. En control a los 2 y 4 meses probó la acción eficaz de la lodopovidona en la resolución completa del hidrocele, sin complicaciones importantes ni efectos colaterales

Resultados antropométricos y del desarrollo neuromotor al primero y segundo años de vida en neonatos pretérmino con hidrocefalia posthemorrágica / Antropometric and neuromotor developmental outcome of its and 2nd year of life in preterm neonatles with poshaemorrhagie hydrocephalus

Se presentan los resultados antropométricos y del neurodesarrollo de una muestra de 13 neonatos con diagnóstico de hidrocefalia posthemorrágica evaluados al año y dos años de vida. Fueron evaluados en los dos cortes del estudio con la valoración neurológica de Amiel Tison, la escala de la reactividad de Vojita y un examen neuroconductual. Además de el peso, la talla y el perímetro cefálico. Antropométricamente se notó una tendencia a la estabilización del perímetro cefálico al término del estudio, encontrándose éste entre la percentila 10 y 50, el peso permaneció dentro de las curvas normales para neonatos pretérmino a los dos cortes de estudio. Con respecto a la valoración neuromotora, no se encontró mejoría ya que los 13 neonatos persistieron a los dos años con alteraciones, las que persistieron con mayor frecuencia fueron los signos oculares,, el tono activo y los reflejos. Las alteraciones motoras como el tono, postura y movimiento no presentaron cambios significativos a los dos años de vida.

Doppler color testicular / Testicular colour Doppler

Se describe con algunos ejemplos el valor del Doppler color en la patología escrotal en la cual se remarca, a los fines prácticos, su aplicación sólo para diferenciar inflamación y torción testicular. La presencia o ausencia de flujo es el único criterio tenido en cuenta para establecer el diagnóstico diferencial entre estas dos patologías

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