[Scrotoscopy in the diagnosis and treatment of testicular and epididymal diseases: Analysis of 39 cases].

OBJECTIVE: To investigate the efficiency, safety and clinical application value of scrotoscopy in the diagnosis and treatment of testicular and epididymal diseases. METHODS: A total of 39 patients with testicular or epididymal diseases underwent scrotoscopic surgery in our hospital from February 2015 to February 2018. We retrospectively analyzed the clinical data, results of surgery, and postoperative scrotal pain scores, complications and recurrence. RESULTS: Scrotoscopic surgery was successfully performed in all the 39 cases, without such severe complications as testis rupture and scrotal hematoma. Thirteen cases of epididymal tumor were treated by total excision of the tumors by laser ablation; 10 of the 12 patients complaining of chronic testicular pain were diagnosed with incomplete torsion of testicular or epididymal appendages and treated by holmium laser ablation; of the 11 cases of suspected testicular torsion, 8 were confirmed as testicular torsion and the other 3 as acute epididymitis; and 3 cases of scrotal trauma-induced old hematoma underwent surgical removal under the scrotoscope. No infection of scrotal incision occurred postoperatively. The visual analog pain scores of the patients averaged 3.4 ± 1.2 (2－5) and their hospital stay 3.2 ± 0.8 (3－6) days. Scrotal ultrasonography at 1 month after surgery revealed no abnormality in the testis, epididymis or spermatic cord. CONCLUSIONS: Scrotoscopy is safe and effective for the diagnosis and treatment of testicular and epididymal diseases and deserves a wide clinical application.

Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non - functional kidney

ABSTRACT Objective: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous nonfunctional kidney. Materials and Methods: A total of 27 individuals diagnosed with unilateral nonfunctional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. Results: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). Conclusion: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.

Retroperitoneal laparoscopic nephroureterectomy with distal and intramural ureter resection for a tuberculous non - functional kidney.

OBJECTIVE: To evaluate the safety and feasibility of total retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection for a tuberculous non-functional kidney. MATERIALS AND METHODS: A total of 27 individuals diagnosed with unilateral non-functional kidney secondary to tuberculosis were treated between June 2011 and June 2015. All patients had normal renal function on the contralateral side and underwent the standard four-drug anti-tuberculosis treatment for at least four weeks before surgery. Total retroperitoneal laparoscopic nephroureterectomy was performed in all patients, and the urinary-bladder junction of distal ureter was managed using different auto-suture techniques. RESULTS: Nineteen male and 8 female patients with an average age of 47.3 years (range, 36-64 years) underwent surgery. All the operations were successfully performed without conversion. The median operative time was 109.3 min (range, 75-138 min), the median blood loss was 157.5 mL (range, 70-250 mL), and the median hospitalization time was 3.7 days (range, 3-6 days). No serious perioperative complications occurred. Anti-tuberculosis chemotherapy was prescribed to all patients, with the entire course of treatment lasting six months. No recurrence of tuberculosis of the bladder or the contralateral kidney was observed during the median follow-up period of 26.7 months (range, 6-54 months). CONCLUSION: Retroperitoneal laparoscopic nephroureterectomy with urinary-bladder junction resection is a safe and feasible approach for the treatment of tuberculous non-functional kidneys.

[Laparoscopic percutaneous extraperitoneal closure does not affect vas deferens orientation or testicular volume and perfusion].

OBJECTIVE: To investigate the influence of single-port laparoscopic percutaneous extraperitoneal closure (LPEC) on the orientation of the vas deferens and the volume and perfusion of the testis in pediatric patients undergoing inguinal hernia repair. METHODS: A total of 92 consecutively enrolled boys diagnosed with unilateral inguinal hernia underwent single-port LPEC between June 2013 and June 2014. The orientation of the vas deferens and the testicular volume and perfusion of the patients were ultrasonographically assessed preoperatively and at 1 and 6 months after surgery. RESULTS: All the surgical procedures were performed successfully without conversion or serious perioperative complications. Ultrasonography showed no angulation or distortion of the vas deferens on the surgical side during a six-month follow-up period. Similarly, no obvious changes were observed in the testicular volume or perfusion. CONCLUSIONS: Single-port LPEC is safe and effective in the treatment of pediatric inguinal hernia and does not affect the orientation of the vas deferens or testicular volume and perfusion.

Effects of single-port laparoscopic percutaneous extraperitoneal closure on the orientation of the vas deferens and testicular perfusion and volume: Experience from a single center.

OBJECTIVE: To investigate the influence of single-port laparoscopic percutaneous extraperitoneal closure (LPEC) on the orientation of the vas deferens and testicular perfusion and volume in pediatric patients undergoing inguinal hernia repair. METHODS: A total of 92 consecutively enrolled boys preoperatively diagnosed with a unilateral inguinal hernia underwent single-port LPEC between June 2013 and June 2014. The orientation of the vas deferens and the testicular perfusion and volume of these patients were ultrasonographically assessed preoperatively, one month after surgery and six months after surgery. RESULTS: The surgical procedures were performed successfully without conversion or serious perioperative complications. Ultrasonography showed no angulation or distortion of the vas deferens on the surgical side during a six-month follow-up period. Similarly, there were no perioperative changes in testicular perfusion or volume. CONCLUSION: Our experience suggests that the single-port LPEC technique can be safe and effective in pediatric patients with an inguinal hernia and that this technique does not affect the orientation of the vas deferens or testicular perfusion or volume.

Application of a Laparoscopic, Single-port, Double-needle Technique for Pediatric Hydroceles With Multiple Peritoneal Folds: A Trial From a Single-center 5-Year Experience.

OBJECTIVE: To report our 5-year experience with a modified single-port, double-needle, minilaparoscopic technique for patent processus vaginalis with multiple peritoneal folds in the hydrocele sac orifice. METHODS: A total of 125 consecutive cases of boys with unilateral pediatric hydrocele underwent minilaparoscopic repair between June 2008 and June 2013. The patients were divided into 2 groups. Group 1 consisted of 65 patients who underwent a 2-port laparoscopic procedure, during which a 3-mm grasping forceps was used to grasp the folds around the internal inguinal ring. Group 2 included 60 patients who received a modified single-port, double-needle, minilaparoscopic surgery. An Endo Close needle was used to spread the peritoneal folds and facilitate circular extraperitoneal suturing in group 2. The principal outcome factors were assessed between the groups. RESULTS: A total of 151 minilaparoscopic procedures were performed in 125 patients (age range, 12-68 months; median, 21.5 months). In total, 26 extra procedures were performed for simultaneous repair of a potential contralateral patent processus vaginalis. No significant difference in operation time was noted between group 1 and group 2 (25.9 ± 6.4 vs 27.1 ± 5.5 minutes). The procedures were performed successfully without serious preoperative complications. During a median follow-up period of 18 months (range, 6-36 months), no postoperative hydrocele recurrence was encountered. CONCLUSION: Our limited experience suggests that the modified single-port, double-needle, minilaparoscopic technique could be safe, effective, and more cosmetically appealing for the management of complicated pediatric hydroceles.