Research progress in diagnosis and treatment of scrotal masses / 中国基层医药

Scrotal mass is a common problem in the outpatient department of urology, accounting for 1% of all emergency patients. The diagnosis of scrotal masses is challenging due to the overlapping symptoms and signs of various scotal masses. Failure to correctly identify and treat scrotal masses, such as testicular torsion, testicular cancer, varicocele, and hydrocele, may lead to infertility, testicular loss, or even death. Misdiagnosis or missed diagnosis of scrotal masses may result in infertility, testicular loss, or even death. Therefore, we must maintain a high degree of vigilance and accurately identify scrotal masses that may affect life and testicular function. A full understanding of the manifestations and differences of various scrotal masses can help clinicians make accurate diagnoses and provide optimal treatment plans. The most critical aspect is to exclude emergency situations that may endanger life or testicular function, such as testicular torsion, testicular cancer, and necrotizing fasciitis, which require immediate medical attention. Scrotal ultrasonography is the best method for distinguishing scrotal masses based on their origin. Magnetic resonance imaging is the best tool for diagnosing scrotal hematoma. However, good clinical judgment and decision-making are still the most important factors for successful treatment of scrotal masses. The purpose of this article is to describe correct evaluation methods for scrotal masses and identify potential conditions that may threaten testicular survival, enabling accurate pathological diagnosis, evaluation, and treatment plans for each scrotal mass.

Application of Veress Needle in Single-port Laparoscopic High Ligation of Processus Vaginalis / 中国微创外科杂志

Objective To explore the application value of single-port laparoscopic high ligation of processus vaginalis by using the Veress needle.Methods A retrospective analysis was conducted on data of 51 cases of single-port laparoscopic high ligation of processus vaginalis with the Veress needle from January 2021 to March 2023.A Veress needle was used instead of hernia needle to perform high ligation of processus vaginalis.Results All the operations were successful without additional auxiliary ports or conversion to open surgery.The time of unilateral operation in 46 cases was 6-15 min(mean,8.9±1.9 min).The bilateral operation time in 5 cases was 13-19 min(mean,15.4±2.3 min).After 6 months of follow-up after surgery,there was no recurrence in all children,and no complications such as suture knot reaction,scrotal edema,scrotal hematoma,iatrogenic cryptorchidism,and testicular atrophy occurred.Conclusions Single-port laparoscopic high ligation of processus vaginalis by using the Veress needle has the advantages of single-port surgery,single puncture,and simple performance.The therapeutic effect is definite and it is worthy to be popularized.

A new type of hydrocelectomy under trans-interfascial plane surgical technique: 15 cases of experience / 现代泌尿外科杂志

【Objective】 A new type of testicular hydrocele reversal resection is described under the concept of trans-interfascial plane surgery, in order to improves the understanding of the anatomical level of testicular hydrocele surgery and to optimize the surgical approach. 【Methods】 During Jan. and June 2021, 15 patients with primary testicular hydrocele were treated with hydrocelectomy and gubernaculum preservation.Demographic information, indications of treatment, success rate and complications were collected.The anatomical structures were analyzed using intraoperative findings and photographs. 【Results】 All operations of 15 patients were successful, with the surgery time of 25-48 minutes, with an average of (34.0±6.2) minutes.No patients experienced scrotal hematoma or incision infection.There were no relapses during the 3-month follow-up after surgery.The anatomical points observed during surgery were as follows: we further confirmed that the internal spermatic fascia completely surrounded the testis, epididymis, and the spermatic cord; this layer was an avascular plane, the cremaster muscle and fascial layer between the internal and external spermatic fasciae were absent; intraoperative preservation of the gubernaculum helped to fix the testicles in its natural position. 【Conclusion】 Our novel technique of hydrocelectomy is reliable, and the precise anatomical description of the concept of trans-interfascial plane surgery can help to improve the related surgical techniques.

Hidrocele del canal de Nuck / Hydrocele of the canal of Nuck

RESUMEN El hidrocele del canal de Nuck es una condición poco frecuente en mujeres adultas, a quienes puede causar tumefacción inguinal-vulvar. Ocurre debido al fallo de obliteración del proceso vaginal, que es la extensión del peritoneo parietal que acompaña al ligamento redondo del útero a través del canal inguinal hasta los labios mayores. La acumulación de líquido seroso en el saco provoca su aparición. Los hallazgos clínicos inespecíficos, como tumefacción indolora y fluctuante que se extiende desde el canal inguinal superficial hasta los labios mayores, no permiten realizar un diagnóstico preoperatorio de esta condición. La ecografía y la resonancia magnética pueden contribuir al diagnóstico. El diagnóstico definitivo solo puede hacerse durante la cirugía y con los hallazgos anatomopatológicos. El tratamiento consiste en la resección quirúrgica de la lesión por vía local o laparoscópica. Se presenta un caso de hidrocele del canal de Nuck.

ABSTRACT Hydrocele of canal of Nuck is a rare condition in adult women which can cause inguinal-vulvar swelling. It occurs due to failure of obliteration of the vaginal process, which is the extension of the parietal peritoneum accompanying the round ligament of the uterus through the inguinal canal to the labia majora. Accumulation of serous fluid in the sac causes its appearance. Nonspecific clinical findings such as painless, fluctuating swelling extending from the superficial inguinal canal to the labia majora do not allow a preoperative diagnosis of this condition. Ultrasonography and magnetic resonance imaging can contribute to the diagnosis. The definitive diagnosis can only be made during surgery and with anatomopathological findings. Treatment consists of surgical resection of the lesion locally or laparoscopically. A case of hydrocele of canal of Nuck is presented.

Abdominoscrotal hydrocele with ipsilateral hydroureteronephrosis in an adult: A case report

Abdominoscrotal hydrocele (ASH) is very rare in adults and difficult to suspect on clinical examination. ASH is a very unusual presentation of scrotal hydrocele with extension intra-abdominally through the inguinal canal either communicating to the peritoneal cavity or non-communicating. An ASH is a congenital pathology involving a scrotal hydrocele expanding through the inguinal canal and reaching the abdominal cavity. Here, we present the case of a 25-year-old man admitted with a complaint of pain and lump in the left lower abdomen for 2 months and swelling in the left groin for 2 years. Ultrasound and computed tomography suggest left ASH with left-sided hydroureteronephrosis. A left DJ stent was placed and on exploration, a large cystic mass was seen intraperitoneally extending into the scrotum through the inguinal canal. Excision of the abdominal part and partial excision of the scrotal part were done with eversion of the remaining tunica vaginalis sac. Although ASH is a rare entity, it should always be kept on the list of differential diagnoses during the complaint of large abdominal mass in adults.

Clinical efficacy of minimal hydrocelectomy with the aid of scrotoscope in the treatment of testicular hydrocele / 现代泌尿外科杂志

【Objective】 To explore the application value of scrotoscopy in the treatment of testicular hydrocele. 【Methods】 The clinical data of 27 patients with testicular hydrocele who were successfully treated with minimal hydrocelectomy with the aid of scrotoscope (MHS group) and 32 patients with traditional open surgery (TH group) during Dec.2017 and Dec.2021 were retrospectively analyzed and compared. 【Results】 Compared with TH group, the MHS group needed shorter average operation time [(32.22±5.25) min vs.(57.34±8.71) min, P<0.01], shorter incision length [(0.95±0.15) cm vs.(5.09±0.55) cm, P<0.01], shorter hospital stay [(3.63±0.97) d vs.(4.72±0.89) d,P<0.01] and lower postoperative incision visual analogue scale (VAS) (P<0.01), and milder degree of edema on the 3rd and 7th day after operation (P<0.05), but higher recurrence rate (14.81% vs.3.13%, P=0.256) 24 weeks after operation. 【Conclusion】 Scrotoscopy is safe in the treatment of testicular hydrocele, which has the advantages of short operation time, small incision, mild postoperative incision pain, mild scrotal edema and short hospital stay, but the recurrence rate tends to be higher than that of traditional open surgery.

Effects of individualized treatment of contralateral patent processus vaginalis during laparoscopic high ligation of processus vaginalis / 现代泌尿外科杂志

【Objective】 To explore the rational management of contralateral patent processus vaginalis (CPPV) in laparoscopic high ligation of processus vaginalis. 【Methods】 A total of 300 children with unilateral oblique inguinal hernia/hydrocele who received laparoscopic high ligation of processus vaginalis in Baoding Children’s Hospital during Jun.2018 and Jun.2022 were selected and divided into two groups by random number table method, with 150 in either group. In the control group, 53 cases of CPPV were found intraoperatively, which were treated simultaneously. In the study group, 58 cases of CPPV were detected, among which 11 met the indications of high ligation and received simultaneous surgical treatment. The incidence of recurrence was compared between the two groups. 【Results】 After 1 year of follow-up, the recurrence rate was 8.62% in the study group and 1.88% in the control group (P>0.05). The detection rate of CPPV was 23.02% in children with unilateral inguinal hernia, significantly lower than that in children with unilateral hydrocele (49.07%, P<0.001). The detection rate of CPPV was 42.71% in children with left patent processus vaginalis and 32.95% in children with right patent processus vaginalis (P=0.19). The detection rate of CPPV was 62.93% in the age group of 1-2 years, significantly higher than that in other age groups (P<0.001). 【Conclusion】 The incidence of CPPV conversion into oblique inguinal hernia or hydrocele is low. Only children who meet the indications can be treated at the same time during surgery.

Clinical application of laparoscopic partial excision of the cyst wall combined with internal inguinal ring repair in the treatment of pediatric abdominoscrotal hydrocele in 12 cases / 现代泌尿外科杂志

【Objective】 To evaluate the feasibility and safety of laparoscopic partial excision of the cyst wall combined with internal inguinal ring repair in the treatment of pediatric abdominoscrotal hydrocele (ASH). 【Methods】 Clinical data of 12 ASH children treated during Mar.2017 to May 2020 were retrospectively analyzed, including clinical manifestations, preoperative diagnosis, intraoperative findings, and postoperative results. 【Results】 A preoperative diagnosis of ASH was made in 9 cases. In the other 3 cases, ASH was detected during laparoscopic repair of the hydrocele. The opening of the internal inguinal ring was wide and cavernous, and patent processus vaginalis (PPV)was detectedin all cases. Contralateral pathologies were detected in 5 cases, including hydrocele in 4 and inguinal hernia in 1. All patients received laparoscopic partial excision of the cyst wall combined with internal inguinal ring repair. During the follow-up of 6-37 months, no recurrence of ASH or ipsilateral hernias occurred, and no testicular atrophy was observed. 【Conclusion】 Laparoscopic partial excision of the cyst wall combined with internal inguinal ring repair is effective, safe and feasible in the treatment of the pediatric ASH.

Neonato de 39 semanas de gestación con taquipnea transitoria, criptorquidia e hidrocele, con el modelo de Dorothea E. Orem / Neonate 39 weeks gestation with transient tachypnea, cryptorchidism and hidrocele, with the model of Dorothea E. Orem

Introducción: a nivel mundial la taquipnea transitoria del recién nacido se presenta entre el 0.3 y 0.5 % de todos los recién nacidos, aunque existen algunas series mexicanas que reportan hasta el 2 % de todos los recién nacidos vivos. Comprende entre el 35 y 50 % de todos los casos de dificultad respiratoria no infecciosa que ingresan a los cuneros patológicos o unidades de cuidado intensivo neonatal.1 Mientras que las tasas de criptorquidia e hidrocele son más altas en los niños nacidos por cesárea (3.3 y 4.7 %, respectivamente), en comparación con los obtenidos por vía vaginal (1.7 y 1.6 %).2 Descripción del caso: neonato de 39 semanas de gestación con taquipnea transitoria del recién nacido, criptorquidia e hidrocele atendido en el servicio de atención al recién nacido de un hospital de segundo nivel de atención. Objetivo: proporcionar cuidados especializados, utilizando el proceso de atención de enfermería basado en los conceptos teóricos del modelo de autocuidado de Dorothea E. Orem. Método: estudio de caso, dado que en este diseño se observan los fenómenos en su contexto natural, el cual se realizó en la tercera semana de mayo 2021. Consideraciones éticas: se tomaron en cuenta aspectos bioéticos para la investigación clínica basada en evidencia científica, como la ley de Helsinki y el código de Nuremberg. Resultado: se logró que el neonato y su cuidador primario alcanzaran las metas propuestas al inicio del ingreso hospitalario, mediante la continua capacitación sobre los cuidados generales del recién nacido. Conclusión: la taquipnea transitoria, criptorquidia e hidrocele son alteraciones que pueden ser detectadas al momento de la exploración al neonato.

Introduction: worldwide, transient tachypnea of the newborn occurs in 0.3 to 0.5% of all newborns, although there are some Mexican series that report up to 2% of all live newborns. It comprises 35-50% of all cases of noninfectious respiratory distress admitted to pathological nurseries or neonatal intensive care units.1 While the rates of cryptorchidism and hydrocele are higher in infants born by cesarean section (3.3% and 4.7%, respectively), compared to those obtained vaginally (1.7% and 1.6%).2 Case description: the case study was conducted on a 39-week gestational neonate with Transient Tachypnea of Newborn, Cryptorchidism and Hydrocele seen in the Newborn Care service of a second-level care hospital. Objective: to provide specialized care, using the nursing care process based on the theoretical concepts of Dorothea E. Orem's Self-Care Model. Orem. Method: is a case study, given that in this design the phenomena are observed in their natural context, which was carried out in the third week of May 2021. Ethical considerations: bioethical aspects for clinical research based on scientific evidence, such as the Helsinki law and the Nuremberg code, were taken into account. Result: the neonate and his primary caregiver were able to achieve the goals proposed at the beginning of hospital admission, through continuous training on general newborn care. Conclusion: transient tachypnea, cryptorchidism and hydrocele are alterations that can be detected at the time of examination of the newborn.

The value of laparoscopy in the diagnosis and treatment of abdominoscrotal hydrocele / 中华泌尿外科杂志

Abdominoscrotal hydrocele is rare in clinic. In the past, routine examination and diagnosis were difficult, easy to be misdiagnosed. The daily operations were mostly completed through the groin area or abdominal incision, the wound is large. The application of laparoscopy can clearly diagnose the abdominoscrotal hydrocele through "springing back ball" sign, and can cure the disease by laparoscopic resection of interperitoneal mass and closure of the internal ring. It is worthy of clinical application. In this article, we summarized and analyzed the clinical experience of 15 cases of children with abdominoscrotal hydrocele diagnosed and treated by laparoscopy, to explore the value of the laparoscopic technology in the diagnosis and treatment of the abdominoscrotal hydrocele.

Comparison of outcomes and costs of surgery versus sclerotherapy to treat hydrocele / Comparação entre resultados e custos de cirurgia e de escleroterapia para tratamento de hidrocele

ABSTRACT Objective: To evaluate the outcomes and costs associated with surgery versus sclerotherapy as treatment of hydroceles. Methods: A total of 53 men consecutively treated for hydrocele at our organization, between December 2015 and June 2019, were retrospectively analyzed (39 with Jaboulay technique and 14 with sclerotherapy). All charts were reviewed, assessing clinical data, ultrasound findings, surgical data, and post-procedure outcomes. The hospital finance department calculated the cost of outpatient evaluation, complementary tests, supplies, drugs, and professionals' costs throughout all procedures. Results: The median age for both groups was similar (58 and 65 years old). Comorbidities were less frequent in the Surgery Group (20; 51%) than in the Sclerotherapy Group (14; 100%, p<0.05). The median length of hospital stay was 34.5±16.3 hours for the Surgery Group and 4 hours for the Sclerotherapy Group. The mean follow-up period was similar for both groups (85.4±114.8 days after surgery, and 60.9±80.1 days after sclerotherapy, p=0.467). No significant complications occurred in any patient. Success rates were 94.8% after surgery and 92.8% after sclerotherapy. The mean cost per patient was US$2,558.69 in the Surgery Group (Hydrocelectomy Group) and US$463.58 in the Sclerotherapy Group (p<0.0001). Costs directly related to in-hospital treatment procedures were significantly higher for surgery versus sclerotherapy (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0.0001). Conclusion: Sclerotherapy is an excellent treatment option for idiopathic hydrocele as compared to traditional Jaboulay. It has a high success rate, low complication rates, fast discharge and patients return quicker to activities of daily living.

RESUMO Objetivo: Avaliar resultados e custos associados à cirurgia e à escleroterapia como tratamentos das hidroceles. Métodos: Foram tratados consecutivamente para hidrocele em nossa instituição 53 homens, entre dezembro de 2015 e junho de 2019, os quais foram analisados retrospectivamente (39 pela técnica de Jaboulay e 14 por escleroterapia). Todos os prontuários foram revisados, avaliando dados clínicos, achados de ultrassom, dados cirúrgicos e desfechos pós-procedimento. O departamento financeiro do hospital calculou o custo da avaliação ambulatorial, dos exames complementares, dos insumos, dos medicamentos e dos profissionais em todos os procedimentos. Resultados: A idade mediana foi semelhante nos dois grupos (58 e 65 anos). Comorbidades foram menos frequentes no Grupo Cirurgia (20; 51%) do que no Grupo Escleroterapia (14; 100%; p<0,05). O tempo mediano de internação hospitalar foi 34,5±16,3 horas para o Grupo Cirurgia e 4 horas para Grupo Escleroterapia. O período médio de seguimento foi semelhante nos dois grupos (85,4±114,8 dias após a cirurgia e 60,9±80,1 dias após escleroterapia; p=0,467). Nenhuma complicação significativa ocorreu nos pacientes. As taxas de sucesso foram de 94,8% após a cirurgia e 92,8% após a escleroterapia. O custo médio por paciente foi de US$2,558.69 para Grupo Cirurgia e US$463.58 para Grupo Escleroterapia (p<0,0001). Os custos relacionados aos procedimentos de tratamento hospitalar foram significativamente maiores para cirurgia em relação à escleroterapia (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0,0001). Conclusão: A escleroterapia é uma excelente opção de tratamento para hidrocele idiopática em comparação com a tradicional Jaboulay. Apresenta alta taxa de sucesso, baixas taxas de complicações e alta rápida, além de os pacientes retornarem mais rapidamente às atividades diárias.

Inguinoscrotal swellings in childhood: a clinico-diagnostic approach to differential diagnosis

Background: Inguinoscrotal diseases are one of the commonest group of disorders seen in clinical surgical practice. A wide range of swellings are seen in this region in children and includes hydrocele, torsion testis, ectopic testis, lymphadenopathy, inguinal hernias, cysts, epididymitis, orchitis, tumors etc. Vigilant clinical and radiological evaluation of inguinoscrotum for varying diseases helps in proper diagnosis and surgical management of its differential diagnosis.Methods: The present study was conducted as an observational study over a period of 10 months and enrolled a total of 50 patients.Results: In this study, 31 cases had hydrocele, 14 cases had inguinal hernia, 2 cases had epididymorchitis, 2 cases had lymphadenopathy and one case had idiopathic scrotal edema. Individual diseases had varying presentations, clinical findings and post-operative findings.Conclusions: There is a varying broad spectrum of swellings in the inguinoscrotal region in young male children. It was concluded that proper clinical and radiological evaluation of the patient helps to timely diagnose the disease and hence help in identifying correct approach to the management of the case.

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.

A rare case of hydrocele in a female

Vulval swellings have always been a case of a difficult and a puzzling situation and more so when they are huge in size. Vulvar swellings are of various types such as Bartholin cyst, sebaceous cyst, cyst of canal of nuck, inguino-labial hernia and vulval varicosities. Most common vulvar cysts are epidermal inclusion cysts. Usual location is beneath the epidermis. An alternative histogenesis is embryonic remnants or occlusion of pilosebaceous ducts of sweat glands. Cutaneous cysts which are lined by ciliated epithelium are very rare, and authors present a rare case of a cyst arising from a left labium majus resembling a hydrocele seen in males with histopathology suggestive of ciliated cyst of the vulva.

Successful Treatment in a Newborn Infant with Chylous Ascites and Chylous Hydrocele

Chyle only occurs in the peritoneal cavity or around the pericardium through damage to the lymph nodes or improper drainage of the lymph and is characterized by a colostrum-like color and being rich in triglyceride. We encountered a case of a newborn infant with abdominal distention and further diagnosed chylous ascites and hydrocele by inspecting and analyzing the fluid obtained from the abdominal cavity and scrotum. Additionally, a lymphoscintigraphy was performed, which showed a decrease in the uptake of radioactive isotopes in the left iliac nodes and a delayed appearance. Here, we report a case of chyle diagnosed through puncture analysis and its subsequent successful treatment.

Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar / Hydrocele as initial manifestation of genitourinary and miliary tuberculosis / Hidrocele como manifestação inicial da tuberculose geniturinária e miliar

Introducción. La tuberculosis es una enfermedad infectocontagiosa que puede afectar cualquier órgano del cuerpo, incluyendo el sistema genitourinario, representando el 33.7-45.5 % de las tuberculosis extrapulmonares. El objetivo de este trabajo es reportar el caso de un paciente con hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar, enfermedad que no se sospechaba. Presentación del caso. Paciente masculino previamente sano, que consulta a urgencias por orquialgia e hidrocele bilateral, con secreción purulenta por escroto, requiriendo manejo antibiótico intravenoso e hidrocelectomía derecha, con hallazgos intraoperatorios de engrosamiento del epidídimo derecho, y drenaje de material caseoso y purulento. Se realizó epididimectomía ipsilateral, se solicitaron pruebas de detección de bacilos tuberculosos en espécimen y derivado proteico purificado, que fueron positivas. En el postoperatorio presentó sintomatología respiratoria; paraclínicos evidenciaron compromiso pulmonar, pleural y de la vía urinaria por bacilos tuberculosos. Se inicia manejo antituberculoso con evolución satisfactoria. Discusión. El genitourinario es considerado el segundo sistema con mayor afectación de tuberculosis extrapulmonar. El órgano más afectado es el riñón (en un 80 % con respecto a los demás) y el órgano genital es el epidídimo (22 - 55 %). Debe sospecharse en pacientes con síntomas urinarios crónicos sin causa aparente. Se asocia a una alta tasa de morbimortalidad por infertilidad y falla renal. Conclusiones. A pesar de su sintomatología inespecífica y de tratarse de una entidad poco sospechada, la tuberculosis genitourinaria debe descartarse al existir tuberculosis pulmonar. Su diagnóstico y tratamiento oportuno serán de gran importancia para evitar complicaciones secundarias. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Introduction. Tuberculosis is an infectious disease that can affect any organ in the body, including the genitourinary system, which accounts for 33.7 - 45.5 % of non-pulmonary tuberculosis cases. The purpose of this paper is to report a case of hydrocele as initial manifestation of genitourinary and miliary tuberculosis, which was an unsuspected disease. Case Presentation. Previously healthy male patient is admitted to emergencies due to orchialgia and bilateral hydrocele, with purulent secretion from the scrotum. Was managed with intravenous antibiotic and right hydrocelectomy. Intraoperative findings of thickening of right epididymis and drainage of caseous and purulent material. Ipsilateral epididymectomy was performed; testing for detection of tubercle bacillus in specimen and purified protein derivative was requested, and was found positive. In the postoperative period, respiratory symptoms arose; paraclinical tests found compromised lungs, pleura and urinary tract by tubercle bacillus. Antituberculous treatment was initiated with satisfactory evolution. Discussion. The genitourinary system is the second-most affected system by nonpulmonary tuberculosis. The most affected organ is the kidney (by 80 % compared to the others) and the most affected genital organ is the epididymis (22 - 55 %). It should be suspected in patients with chronic urinary symptoms with no apparent cause. It is associated with a high rate of morbidity and mortality due to infertility and kidney failure. Conclusions. Despite the non-specific symptoms and because it is not normally a suspected entity, genitourinary tuberculosis should be ruled out when pulmonary tuberculosis exists. Timely diagnosis and treatment are very important in order to prevent secondary complications. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

Introdução. A tuberculose é uma doença infecciosa que pode afetar qualquer órgão do corpo, incluindo o sistema geniturinário, representando 33.7 a 45.5 % da tuberculose extrapulmonar. O objetivo deste trabalho é relatar o caso de um paciente com hidrocele como uma manifestação inicial de tuberculose geniturinária e miliar, uma doença que não se suspeitava. Apresentação do caso. Paciente do sexo masculino previamente saudável, que consultou a emergência para orquialgia e hidrocele bilateral, com secreção purulenta do escroto, necessitando de tratamento antibiótico endovenoso e hidrocelectomia direita, com achados intraoperatórios de espessamento do epidídimo direito e drenagem de material purulento e caseoso. Foi realizada uma epididimectomia ipsilateral e foram solicitados exames de bacilos tuberculosos em espécime e derivado proteico purificado, que foram positivos. No pós-operatório, apresentou sintomas respiratórios; testes para-clínicos mostraram comprometimento pulmonar, pleural e do trato urinário devido a bacilos da tuberculose. Começa-se o tratamento antituberculose com evolução satisfatória. Discussão. O sistema geniturinário é considerado o segundo com maior comprometimento da tuberculose extrapulmonar. O órgão mais afetado é o rim (80 % em relação aos demais) e o órgão genital é o epidídimo (22 a 55 %). Deve-se suspeitar em pacientes com sintomas urinários crônicos sem causa aparente. Está associada a uma alta taxa de morbimortalidade devido à infertilidade e insuficiência renal. Conclusões. Apesar de sua sintomatologia inespecífica e de ser uma entidade pouco suspeitada, a tuberculose geniturinária deve ser descartada quando existir tuberculose pulmonar. Seu diagnóstico e tratamento oportuno serão de grande importância para evitar complicações secundárias. Cómo citar: Álvarez-Jaramillo J, Ortiz-Zableh AM, Tarazona-Jiménez P, Ortiz-Azuero A. Hidrocele como manifestación inicial de tuberculosis genitourinaria y miliar. MedUNAB. 2019;22(1):71-78. doi:10.29375/01237047.3534

A Prospective Study on Prevalence and Management of Inguinal Hernia in Infants and Children

Introduction: Inguino-scrotal swellings are frequently observed in patients of pediatric age group. Inguinal hernia and Hydrocele are the most common causes of such swellings in children. For their effective management, it is essential to study various factors like age, sex etc. associated with inguinal hernia in pediatric age group. Objectives: To study the epidemiology, management and outcome of inguinal hernia in children. Methods: A prospective study was conducted on pediatric patients with inguinal hernia for a period of 18 months. Patients from newborn to 14 years of age were selected for this study on the basis of inclusion and exclusion criteria.  Result: Inguinal hernia can occur at any age, but the majority of patients are seen between 1 to 5 years of age. It is more commonly seen in male children and incidence is slightly higher on right side. Almost all of the inguinal hernia in pediatric age group is of indirect type, which develops due to congenitally patent processus vaginalis. Conclusion: Early surgical intervention in form of Inguinal herniotomy is the most appropriate management of inguinal hernia in children.

Mini Hydrocelectomy – Outcome of A Short Term Study and Comparison with Conventional Jaboulays Technique

Background: Hydrocele is among the commonest benign conditions of scrotum. Its incidence is around 1% in adult male population with a predilection for males above 40 years of age. Conventional surgical procedures like Jaboulays Eversion of Sac (EOS) and Lords plication of redundant tunica vaginalis remain the most commonly used procedures used in the treatment of idiopathic adult hydrocele. Both procedures are invasive and are associated with durable success and low incidence of recurrence. These procedures are however associated with many post-operative complications like pain, hematoma, infection, persistent swelling and induration of scrotal skin, wound related complications, chronic pain and reduced fertility. All these translate into high morbidity, loss of work hours and increased surgical expenses. To avoid / minimize these complications associated with plication or excision of the redundant hydrocele sac fenestration has been proposed as a minimal access procedure. Fenestration exposes the secretory surface of the tunica vaginalis sac to the lymphatic-rich subcutaneous tissues, from where the hydrocele fluid is cleared off the scrotal cavity.  Methods: The present study was carried out in the Department of General Surgery, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard during the time period of June 2014 - December 2015. 120 patients of primary vaginal type hydrocele with ASA grade 1 were randomly allocated into two groups of 60 patients each – one group for the Mini-Hydroceletomy MiH-(Group A) and the other group for routine Jaboulays EOS (Group B). All the patients were followed up for a period ranging from 6-18 months. Results: Mean age of patients was 42 years for jabouleys and 45 for mini hydrocelectomy group. Mean hydrocele volume for Group A was 240 ml and for group B was 252 ml. Average time for the procedure in group A was 10-12 min (mean 11min) and for group B was 25 -30min (mean 27min). In Group A, Average incision length was 2.1 cm whereas in Group B it was 5.4 cm. Conclusions: We hereby present our experience that mini-hydrocelectomy (MiH) technique to be the procedure of choice for medium sized uncomplicated hydroceles.

A Study of Inguinal Hernia in Infants and Children.

Background: Inguino-scrotal swellings are frequently observed in patients of pediatric age group. Inguinal hernia and Hydrocele are the most common causes of such swellings in children. For their effective management, it is essential to study various factors like age, sex etc. associated with inguinal hernia in pediatric age group. Objectives: To study the epidemiology, management and outcome of inguinal hernia in children. Methods: A prospective study was conducted on pediatric patients with inguinal hernia for a period of 18 months, between February 2015 to July 2016. Patients from newborn to 14 years of age were selected for this study. Results: Inguinal hernia can occur at any age, but the majority of patients are seen between 1 to 5 years of age. It is more commonly seen in male children and incidence is slightly higher on right side. Almost all of the inguinal hernia in pediatric age group is of indirect type, which develops due to congenitally patent processus vaginalis. Conclusion: Early surgical intervention in form of Inguinal herniotomy is the most appropriate management of inguinal hernia in children.

Acute Scrotum in an Infant with Kawasaki Disease

Kawasaki disease (KD) is a systemic vasculitis that occurs predominantly in infants and young children. The etiology of KD is unknown and coronary heart disease is a major complication of KD. Acute scrotum is a rare complication of acute KD, and not as well recognized as other manifestations of the disease. We report a 2-month-old boy with acute scrotum in the acute phase of KD. He was treated with intravenous immunoglobulin (total 2 g/kg) and aspirin (50 mg/kg/day). The treatment was effective in resolving his fever and other clinical symptoms, but 2 days after starting treatment he experienced scrotal swelling. Scrotal ultrasound and transillumination were used in the diagnosis of acute scrotum. After 2 months, a follow-up testicular ultrasound revealed a remission of the acute scrotum. Subsequently, he has been followed up for KD.