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INTRODUCTION: Abdominoscrotal hydrocele is a rare condition of vaginal hydrocele. Ipsilateral cryptorchidism is frequently reported as an associated congenital anomaly, however, ipsilateral indirect inguinal hernia has never been reported as an accompanying anomaly. CASE PRESENTATION: We reported a case of 6-month-old boy with a huge cystic mass at left scrotum extending upward to lower abdomen passing through inguinal canal. There was an unusual presentation in that this bulging mass could be entirely reduced into abdomen, mimicking patients who presented with reducible inguinal hernia. Intraoperatively, the patient was found that not only abdominoscrotal hydrocele and undescended testes were presented, but also hernia sac was simultaneously encountered. He was successfully treated and recovered uneventfully. DISCUSSION: According to the natural history of abdominoscrotal hydrocele resembling that of non-communicating hydrocele, it could be treated conservatively without surgery. However, several conditions caused by pressure effect will not be relieved and testicular dysmorphism will also not be corrected. In addition, as presented in this report, should there also be an inguinal hernia, the hernia sac should be left in place without any surgical correction. As a result, we recommend that all patients with abdominoscrotal hydrocele should be surgically treated if there is no contraindication. CONCLUSION: The presence of hernia sac might produce a unique presentation. Since we do not know whether the patients who have abdominoscrotal hydrocele will be accompanied by indirect inguinal hernia, the patients should be treated with surgery unless they were in condition in which surgery cannot be performed.
RESUMO
OBJECTIVE: To evaluate the outcomes of retrograde intrarenal surgery (RIRS) treatment of calyceal diverticular calculi and identify the associated factors affecting post-operative stone-free rate. MATERIALS AND METHODS: From August 2015 to May 2019, data of 32 patients with calyceal diverticular calculi who were treated by RIRS in a Siriraj Hospital were retrospectively studied. All operations were performed by the same surgeon using flexible ureterorenoscopy (f-URS) and holmium YAG laser lithotripsy. Calyceal diverticula were identified by our refluxing technique and from the collected demographic, diverticular and stone data. Operative outcomes were retrospectively evaluated. Data were analysed to identify the factors associated with stone-free outcomes. Stone-free was defined as no residual stones remaining after surgery. RESULTS: Mean age of the patients was 55.7 years. Stone locations were non-lower pole in 81.2% of cases and lower pole for the remaining 18.8% of cases. Median stone size was 1.2 cm with three as the median number of stones per patient. Calcium oxalate was the most common stone composition (56.3%). Positions of the diverticulum were anterior calyx (34.4%) and posterior calyx (50%), while the remainder were undetermined (incomplete data). Average length of the diverticular neck was 0.4 cm. Mean operative time was 46 minutes and mean hospital stay was 2.9 days. Complications included fever in three patients (9.3%) and sepsis in two patients (6.3%), with overall post-operative stone-free rate at 75%. Factors significantly affecting stone-free status were stone size (P=0.003) and length of diverticular neck (P=0.038). Multivariate analysis determined that only stone size had a statistically significant effect on post-operative stone-free status (P=0.015). Cut off point for stone size that increased the chances of a post-operative stone-free outcome was less than 1.5 cm, as determined by the ROC curve. CONCLUSION: RIRS was found to be an effective and safe treatment option for the removal of calyceal diverticular calculi. Stone size of less than 1.5 cm offered a better chance of post-operative stone-free condition.
