The excisional, plication and internal drainage techniques: a comparison of the results for idiopathic hydrocele

Diagnosis and management of a rare case of encysted hydrocele of spermatic cord: Case report and literature review

INTRODUCTION AND IMPORTANCE

A hydrocele is typically a non-cancerous condition that arises from the accumulation of fluid between the layers of the vaginal process. Diagnosis primarily involves a physical examination. In instances where the condition is mistaken for other pathological conditions, additional investigations may be undertaken. Surgical intervention is typically deferred until after the age of one year, unless the hydrocele is significantly large.

CASE PRESENTATION

A case was presented of a 4-year-old boy who was referred to the hospital with a suspected deep inguinal hernia. Upon examination, it was determined that the mass was actually an encysted hydrocele of spermatic cord. The patient underwent a minimally invasive surgery to remove the spermatocele, and the procedure was successful.

CLINICAL DISCUSSION

This emphasizes the importance of obtaining a detailed patient history and conducting a comprehensive physical examination, which often provide sufficient information to make a diagnosis. In many instances, these initial steps can spare patients from undergoing additional tests that may be invasive or pose unnecessary risks.

CONCLUSION

It is important to note that in cases of hydroceles, conservative treatment, such as observation, is the primary approach before the age of one year. Surgery is typically reserved for older children or those with large hydroceles.

Early Surgery Versus Watchful Waiting Strategy for Infantile Abdominoscrotal Hydrocele

BACKGROUND

Infantile abdominoscrotal hydrocele is generally managed with early surgery. However, whether these patients actually benefit from an initial watchful waiting strategy is yet to be determined.

METHODS

This single-center, comparative observational analysis included 36 consecutive patients (9 bilateral cases) diagnosed between January 1998 and December 2019. Initial 16 patients (21 lesions) underwent surgical repair shortly after diagnosis (Group A) at a mean (SD) age of 8 (4) months. Remaining 20 patients (24 lesions) underwent initial nonoperative management (Group B). Overall follow-up was 82.74 (63.84) months.

RESULTS

Six lesions of Group B spontaneously regressed at a mean age of 23.8 (7.8) months. Remaining 18 hydroceles underwent surgical management at a mean age of 18.7 (12.6) months. Early postoperative morbidity was high (43%) in both groups (Clavien-Dindo grade I-II). During follow-up, there were 1 recurrent hydrocele and 1 testicular atrophy, both events occurring in Group A patients. Group B patients required a higher need for concomitant ipsilateral orchidopexy (61% versus 14%; p = 0.001), and developed a higher rate of ipsilateral inguinal hernia (39% versus 5%; p = 0.01), occurring within 8.3 (3.53) months of surgery. On multivariable analysis, nonoperative management was associated with unplanned second surgery (odds ratio 5.5, 95% CI 1.25-24.17, p = 0.02), regardless of the type of hydrocelectomy performed.

CONCLUSIONS

Nonoperative management provides effective spontaneous resolution in about 25% of infantile abdominoscrotal hydrocele. Clinicians must balance the potential benefits of such strategy against the impact of pressure induced detrimental effects on the success of future surgery when dealing with longstanding lesions.

LEVEL OF EVIDENCE

III.

Comparison of outcomes and costs of surgery versus sclerotherapy to treat hydrocele

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.

Adolescent de novo hydroceles - should they be dealt with by inguinal or scrotal approach?

AIM

The objective of this study was to investigate the optimal approach for the treatment of hydroceles in adolescents.

MATERIALS AND METHODS

A retrospective chart review of all adolescents (10-16 years old) diagnosed with a de-novo hydrocele in 2 tertiary care institutions over a 10 year period (2007-2016) was performed comparing the inguinal and trans-scrotal (Jaboulay) approaches.

RESULTS

Fifty-three boys with a mean age of 13.4 years (range 10-16 years) were diagnosed with hydrocele. The inguinal approach was used in 31 (59%) patients for treatment of their hydrocele. In 19 (61%) of these cases a patent processus vaginalis (PPV) ligation was performed. In the other 12 (39%) patients the PPV was closed or not found and a further repair of the hydrocele through the same inguinal incision was performed. A transcrotal Jaboulay procedure was performed in 22 (41%) of the patients. There was no difference in the complications rate between inguinal and trans-scrotal approaches (p = 0.71). Age of presentation less than 12 years was associated with the presence of a PPV (p < 0.05).

CONCLUSIONS

A trans-scrotal approach should be considered as first-line in adolescents when the history is not suggestive of a communicating hydrocele. Children less than 12 years of age are more likely to have a PPV and an inguinal approach may be more appropriate.

TYPE OF STUDY

Retrospective comparative study LEVEL OF EVIDENCE: Level II.

Tunica Vaginalis Thickening, Hemorrhagic Infiltration and Inflammatory Changes in 8 Children with Primary Hydrocele; Reactive Mesothelial Hyperplasia? A Prospective Clinical Study

The aim of this study is to describe an entity of primary hydrocele accompanied with fibrosis, thickening and hemorrhagic infiltration of parietal layer of tunica vaginalis (PLTV). During a 4-year period (2011-2014), 94 boys (2.5-14 years old) underwent primary hydrocele repair. Hydrocele was right sided in 55 (58.5 %), left sided in 26 (28.7%) and bilateral in 12 patients (13.8%). Eighty three out of 94 patients (88.30%) had communicating hydrocele and the rest eleven patients (11.7%) had non-communicating. Our case group consists of 8 patients (8.51%) based on operative findings consistent with PLTV induration, thickening and hemorrhagic infiltration. Preoperative ultrasonography did not reveal any pathology of the intrascrotal structures besides hydrocele. There weren't hyperechoic reflections or septa within the fluid. Evaluation of thickness of the PLTV was not feasible. Presence of lymph or exudate was excluded after fluid biochemical analysis. Tunica vaginalis histological examination confirmed thickening, hemorrhagic infiltration and inflammation, while there was absence of mesothelial cells. Immunochemistry for desmin was positive, excluding malignant mesothelioma. One patient underwent high ligation of the patent processus vaginalis and PLTV sheath fenestration, but one year later, he faced a recurrence. An elective second surgery was conducted via scrotal incision and Jaboulay operation was performed. The latter methodology was our treatment choice in other 7 out of 8 patients. During a 2-year postoperative follow-up, no other patient had any recurrence. We conclude that in primary hydrocele with macroscopic features indicative of tunica vaginalis inflammation, reversion of the tunica should be a part of operative strategy instead of sheath fenestration, in order to minimize the recurrence.

Minimally access versus conventional hydrocelectomy: a randomized trial

Objective:

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.

Primary new-onset hydroceles presenting in late childhood and pre-adolescent patients resemble the adult type hydrocele pathology

AIM

The aim of this study was to investigate the presence of a patent processus vaginalis (PPV) in children of late childhood and pre-adolescence presenting with new onset hydrocele.

MATERIAL AND METHODS

All males with hydrocele presenting at our department from January 2011 to January 2013 were followed. Patients with secondary hydroceles were excluded. Demographic data, medical history, clinical symptoms and signs relative to their pathology and U/S findings were recorded. According to their indications, patients were either operated or followed up. Patients surgically treated, consisted our study group.

RESULTS

Sixty patients were identified. Thirteen were followed until resolution of their hydrocele. Forty-seven patients were surgically treated. Twenty-seven had right sided hydrocele (57.44%), 13 had left sided hydrocele (27.66%) whereas in 7 patients the hydroceles were bilateral (14.9%). All patients were operated by an inguinal approach. In all 9 patients (19.14%) presenting with new-onset hydrocele at the age >10 years (range: 10-15 years), intraoperative exploration did not reveal a PPV. All patients were followed at least for 6 months post-operatively.

CONCLUSION

Early evidence shows that primary new onset hydroceles presenting in late childhood and pre-adolescence seem to be non-communicating and resemble the adult type hydrocele pathology.

Encysted hydrocele of cord in an adult misdiagnosed as irreducible hernia: a case report

A number of pathologies can present as groin swellings in adults.Among these, encysted hydrocele of the cord presenting as swelling in an adult is a rare. A case of encysted hydrocele of cord in 36 year old male mimicking as as an irreducible hernia is reported. The diagnosis of hydrocele was made intraoperatively. An excision of the sac was performed.

Observations on hydroceles following adolescent varicocelectomy

PURPOSE

There is wide variation in the reported incidence of hydrocele after varicocelectomy (0% to 29%). We determined the incidence of hydroceles and hydrocelectomy following adolescent varicocelectomy, the time it took for them to manifest, and the results of aspiration and surgical correction.

MATERIALS AND METHODS

Our adolescent varicocele registry was reviewed to identify patients with a post-varicocelectomy hydrocele. We evaluated physical examination and ultrasound findings, postoperative interval to development and treatment results.

RESULTS

A total of 400 patients with at least 6 months of postoperative followup underwent 521 varicocelectomies (16 redo, 1 right, 104 bilateral) from 1987 to 2010. Mean followup was 32 months (range 6 to 182). Hydrocele was detected in 80 of 521 (15.4%) at a mean of 2 years after surgery. The incidence of hydrocele was higher in open vs laparoscopic (p <0.001), bilateral vs unilateral (p = 0.013), nonlymphatic sparing vs lymphatic sparing (p = 0.043) and Palomo vs laparoscopic nonlymphatic sparing (p = 0.001) procedures. Eight patients underwent aspiration for a large postoperative hydrocele. In all 8 patients fluid returned to pre-aspiration status. There were 29 patients (5.6%) who underwent Jaboulay bottleneck hydrocelectomy and none had recurrence.

CONCLUSIONS

Hydroceles are a common sequela of varicocelectomy, with the fewest hydroceles occurring after laparoscopic lymphatic sparing varicocelectomy. Patients should be followed for at least 2 years after varicocelectomy to examine for the presence of hydroceles. Although there have been reports on the use of aspiration for post-varicocelectomy hydrocele, we have not had success in those with a single aspiration. Jaboulay bottleneck hydrocelectomy had a 100% success rate in this select group.

Management of hydrocele in adolescent patients

Hydrocele is defined as an abnormal collection of serous fluid in the potential space between the parietal and visceral layers of the tunica vaginalis. In the majority of affected adolescents, hydrocele is acquired and is idiopathic in origin. The pathogenesis of idiopathic hydrocele is thought to be an imbalance in the normal process of fluid production and reabsorption. The diagnosis is usually clinical. Taking a thorough history is essential to rule out any fluctuation in size, which is an indication of a patent processus vaginalis. Scrotal ultrasonography is mandatory in nonpalpable testicles to rule out a subtending testicular solid mass requiring inguinal exploration. Otherwise, open hydrocelectomy via a scrotal incision is the standard treatment of idiopathic hydroceles. The second most common cause of hydrocele in adolescents is varicocelectomy. The risk of hydrocele formation is higher with non-artery-sparing procedures or those performed without microsurgical aid, and in surgery requiring cord dissection. If hydrocele occurs after varicocelectomy, initial management should include observation with or without hydrocele aspiration. Large persistent hydroceles are best served by open hydrocelectomy.

A mechanism for chronic filarial hydrocele with implications for its surgical repair

BACKGROUND

Chronic hydrocele is the most common manifestation of bancroftian filariasis, an endemic disease in 80 countries. In a prospective study, we evaluated the occurrence of intrascrotal lymphangiectasia, gross appearance/consistency of the testis, and the efficacy of complete excision of hydrocele sac in patients living in a bancroftian filariasis endemic area who underwent hydrocelectomy at the Center for Teaching, Research and Tertiary Referral for Bancroftian Filariasis (NEPAF).

METHODOLOGY/PRINCIPAL FINDINGS

A total of 968 patients with uni- or bilateral filarial hydrocele (Group-1) and a Comparison Group (CG) of 218 patients from the same area who already had undergone hydrocele-sac-sparing hydrocelectomy elsewhere were enrolled at NEPAF. Twenty-eight patients from the Comparison Group with hydrocele recurrence were re-operated on at NEPAF and constitute Group-2. In Group-1 a total of 1,128 hydrocelectomies were performed (mean patient age of 30.3 yr and mean follow-up of 8.6 yr [range 5.3-12]). The hydrocele recurrence rates in Group-1 and in the Comparison Group (mean age of 31.5 yr) were 0.3%, and 19.3%, respectively (p<0,001). There was no hydrocele recurrence in Group-2 (mean patient age of 25.1 yr and mean follow-up of 6 yr [range 5-6.9]). Per surgically leaking or leak-prone dilated lymphatic vessels were seen in the inner or outer surface of the hydrocele sac wall or in surrounding tissue, particularly in the retrotesticular area, in 30.9% and in 46.3% of patients in Group-1 and Group-2, respectively (p = 0.081). The testicles were abnormal in shape, volume, and consistency in 203/1,128 (18%) and 10/28 (35.7%) of patients from Group-1 and Group-2, respectively (p = 0,025).

CONCLUSIONS/SIGNIFICANCE

Lymph fluid from ruptured dilated lymphatic vessels is an important component of chronic filarial hydrocele fluid that threatens the integrity of the testis in an adult population living in bancroftian filariasis endemic areas. To avoid hydrocele recurrence the authors advise complete excision of hydrocele sac and when identified, leaking or leak-prone dilated lymphatic vessels should be sutured or excised.

Complications of Scrotal Surgery for Benign Conditions

OBJECTIVES

Frequent complications have been reported after scrotal surgery. We reviewed our experience to determine the complication rates, risk factors, and how our experience might differ from other series.

METHODS

We reviewed all scrotal surgery for benign conditions at the Veterans Affairs Puget Sound Health Care System from 1998 to 2004. The abstracted data included indications, comorbidities, perioperative antimicrobial use, operative procedures, use of drains, and complications.

RESULTS

Ninety-five patients underwent 110 procedures, including hydrocelectomy (55%), spermatocelectomy (15%), epididymectomy (4%), and bilateral or combination procedures (27%). Preoperative antimicrobial administration was documented before 80 (73%) of the 110 procedures. The follow-up ranged from 0 to 85 months (mean 36). Complications occurred after 22 (20%) of the 110 procedures and included recurrences (6%), hematomas (5%), and infections (3.6%), with 95% of complications occurring after hydrocelectomy (odds ratio 9.1, 95% confidence interval 1.1 to 71.6). The potential patient and surgical risk factors considered were immunocompromised status, undergoing a bilateral procedure, a high American Society of Anesthesiologists score, body mass index, and the use of drains.

CONCLUSIONS

Our overall complication rate was 20%, with most occurring after hydrocele surgery (chi-square, P = 0.01). The 3.6% wound infection rate was substantially lower than that in recent series in which preoperative antimicrobial agents were not prescribed. In the absence of a prospective clinical trial, these findings suggest that scrotal procedures might merit consideration of routine antimicrobial prophylaxis.

A novel parameter by EFOV US for the quantification and the distinction of physiological amount of scrotal fluid and hydrocele: ratio of testis volume/scrotum volume

OBJECTIVE

To determine the limits for the amount of tunical fluid enough to be termed as hydrocele by using extended-field of view US technology and to define hydrocele for the first time with standard numerical criteria.

METHODS

A total of 60 patients were evaluated in this prospective study. Group 1 consisted of 20 patients with unilateral clinical hydrocele. Group 2 included 20 patients referred for scrotal US for reasons other than hydrocele. Group 3 comprised 20 male controls with no scrotal complaints. Testis volume (V(t)), scrotum volume (V(s)) and V(t)/V(s) ratio were calculated for each subject by dimensions measured in longitudinal and tranverse planes.

RESULTS

Mean V(t)/V(s) ratio was 0.28 +/- 0.17 (range, 0.07-0.57), 0.69 +/- 0.08 (range, 0.53-0.80) and 0.71 +/- 0.07 (range, 0.61-0.85) for groups 1, 2 and 3, respectively. Mean V(t)/V(s) for group 1 was significantly lower than those for groups 2 and 3, respectively (p<0.001 for each). Based on the ROC curve analysis, 0.55 for V(t)/V(s) ratio was determined as the optimal cut-off point below which the US diagnosis of hydrocele could be made (sensitivity 95.0% and specificity 97.5%).

CONCLUSIONS

We propose a novel US parameter of V(t)/V(s) ratio below 0.55 for a standard distinction between hydrocele and physiological amount of scrotal fluid.

Unilateral idiopathic hydrocele has a substantial effect on the ipsilateral testicular geometry and resistivity indices

OBJECTIVE

The purpose of this study was to determine whether hydrocele has any effect on the volume and shape of the ipsilateral testis and can be implicated as a cause of testicular ischemia.

METHODS

Group 1 consisted of 23 patients with unilateral idiopathic hydrocele, whereas 30 healthy men constituted group 2. All patients underwent scrotal ultrasonography by which testicular dimensions in craniocaudal (D(cc)), anteroposterior (D(ap)), and mediolateral axes were measured, followed by calculation of the D(cc)/D(ap) ratio and testicular volume. By color Doppler analysis, the resistivity index of the subcapsular artery (RI(sc)) and the resistivity index of the intratesticular artery were determined.

RESULTS

The mean D(cc)/D(ap) ratio +/- SD for group 1 was 1.7 +/- 0.3 (range, 1.1-2.3), significantly lower than that of group 2, which was 1.9 +/- 0.3 (range, 1.3-2.2) (P = .028). Mean testicular volume values of subjects having hydrocele for more than and less than 6 months were 13.4 +/- 7.3 and 22.5 +/- 5.1 cm3, respectively; the difference between the subgroups was significant (P = .003). For the ipsilateral testis, mean RI(sc) values were 0.70 +/- 0.06 (range, 0.60-0.80) in group 1 and 0.65 +/- 0.06 (range, 0.59-0.83) in group 2. The mean RI(sc) was significantly higher in group 1 (P = .006).

CONCLUSIONS

Unilateral idiopathic hydrocele has a tendency for rounding rather than flattening the ipsilateral testis as well as elevating the RI(sc) on the affected side. To the best of our knowledge, no strict spectral Doppler analysis criteria have been proposed for testicular ischemia yet. Therefore, the impact of the difference of the RI(sc) should raise the suspicion for ischemia, and further research is needed to elucidate any effect on spermatogenesis.

Inguinal approach in adult hydrocele surgery: preliminary randomized study

This prospective study compared the effects of scrotal and inguinal approaches in hydrocele repair. Thirty-two adult patients, enrolled between January 1994 and May 2000, were randomly assigned to an inguinal (n=17) or a scrotal (n=15) approach. Scrotal size (at the surgical site) was measured preoperatively and postoperatively. Edema, infection, and hematoma formation were evaluated on the first, second, and third days after operation. Hematoma occurred in 4 patients in the scrotal approach group and in 1 patient in the inguinal approach group. Scrotal size was significantly smaller in the scrotal approach group on all postoperative evaluation days. Three months after surgery, all patients in both groups were free of hydrocele. The inguinal approach is a feasible option in the surgical treatment of adults with hydrocele; it results in less edema than is noted with the scrotal approach. Larger studies are needed to confirm these results.

Testicular Size and Vascular Resistance Before and After Hydrocelectomy

OBJECTIVE

We sought to determine whether there is an association between hydroceles and testicular size and vascular resistance.

SUBJECTS AND METHODS

Twenty-three patients with a mean age of 42.8 years who had a unilateral idiopathic hydrocele and who underwent unilateral hydrocelectomy were included in the study. Testicular size and resistive (RI) and pulsatility (PI) indexes of the intratesticular arteries on the involved and uninvolved sides were measured before and after the hydrocelectomy.

RESULTS

We found statistically significant differences in the testicular volumes between the normal side (mean +/- SD, 15.40 +/-3.41 mL) and the side with the hydrocele (20.67 +/- 4.01 mL) before surgery (p < 0.001) and in the volumes in the side with the hydrocele before (20.67 +/- 4.01 mL) and after (16.20 +/- 2.99 mL) surgery (p < 0.001). No such a difference in volume was seen in the normal side before (15.40 +/- 3.41 mL) and after (15.28 +/- 3.24 mL) surgery (p = 0.200). The mean decrease in volume in the testis with the hydrocele after hydrocelectomy was 21%. There were statistically significant differences of RI and PI values between the normal testis (0.59 +/- 0.07 and 1.02 +/- 0.34, respectively) and the testis with hydrocele (0.79 +/- 0.11 and 1.70 +/- 0.56, respectively) before surgery (p < 0.001). In the testis with the hydrocele, we found a statistically significant decrease in RI and PI values (0.62 +/- 0.05 and 1.00 +/- 0.14, respectively) of intratesticular arteries after surgery (p < 0.001). The mean decreases in RI and PI values after hydrocelectomy were 21% and 36%, respectively.

CONCLUSION

There is an association between the development of an idiopathic hydrocele and testicular size and vascular resistance. We believe that the increase in volume and vascular resistance is due to an increase in impedance to venous and lymphatic flow.

A population based assessment of complications following outpatient hydrocelectomy and spermatocelectomy

PURPOSE

We determine the incidence of complications following outpatient scrotal surgery for the treatment of hydroceles and spermatoceles.

MATERIALS AND METHODS

A retrospective study of all patients undergoing hydrocelectomy or spermatocelectomy between April 1, 1997 and March 31, 1999 at 1 institution was performed. The hospital and office charts were reviewed, and postoperative complications (infection, persistent swelling, chronic pain) were recorded. The type of preoperative antiseptic preparation (iodine based versus chlorhexidine) and the presence or absence of surgical drains were also recorded.

RESULTS

A total of 161 patients were included in the study with an average age of 53.7 years. The overall complication rate was 19.2%. Infection/scrotal abscess formation occurred in 9.3% of patients, persistent swelling (treatment failure) in 9.3% and chronic pain in 0.6%. There was no significant difference in the complication rate when the preoperative preparations and the presence or absence of surgical drains were compared.

CONCLUSIONS

The most common complications following scrotal surgery for hydroceles and spermatoceles are persistent scrotal swelling, inflammation and postoperative infection. Further prospective investigation is required to study factors such as the use of drains, preoperative and/or perioperative antibiotics and the type of surgical preparations, which may have a role in complication rates.

Desmopressin is not always effective in mild haemophilia A patients undergoing urological surgery: the need of standardized protocols

Desmopressin may be an efficient haemostatic treatment for mild A haemophiliacs because its infusion raises plasma factor VIII level. We report the use of desmopressin in five mild haemophilia A patients undergoing urological surgery. They all received a preoperative infusion (0.3 microg kg(-1), i.v.) 1 h before incision followed by repeated injections at 12- or 24-h intervals according to the severity of the procedure. Nevertheless, four patients presented a postoperative bleeding requiring again surgery performed for 3 of them under clotting factor concentrate instead of desmopressin. The occurrence of haemorrhage was not always correlated with particularly low plasma factor VIII level. Surgical management of urological procedures with desmopressin in mild haemophilia A patients requires standardized protocols.

Why not use a small incision to treat large hydroceles?

BACKGROUND

Operative treatment of large hydroceles generally requires a large incision.

METHODS

A technique is described which permits a traditional Jaboulay's or Lord's repair to be done through a 3 cm incision.

RESULTS

Twenty patients with large hydroceles were operated on from June 2000 to November 2001 using this technique and to date, only one patient has had a recurrence. There has been no occurrence of either scrotal wound infection or haematoma -formation.

CONCLUSIONS

A hydrocele repair of the surgeon's choice can be done safely through a 3 cm incision.