[Pelvic vas deferens abscess: a case report and review of the literature]

OBJECTIVE

To investigate the clinical characteristics, diagnosis, misdiagnosis and treatment of pelvic vas deferens abscess.

METHODS

The clinical data of one case of pelvic vas deferens abscess were reported and the relevant literature was reviewed.

RESULTS

The patient underwent incision and drainage of pelvic vas deferens abscess. After the catheter was removed, he could urinate easily. With a follow-up of one year, he was found free of dysuria and recurrence.

CONCLUSION

Pelvic vas deferens abscess tends to be misdiagnosed when enwrapped. Surgical procedures are the most effective treatment for this disease.

Testicular prostheses: development and modern usage

INTRODUCTION

Testicular prostheses produced from various materials have been in use since 1941. The absence of a testicle has been shown to be a psychologically traumatic experience for males of all ages. The indications for insertion of a prosthesis include absence or following orchidectomy from a number of causes such as malignancy, torsion and orchitis. The most common substance used around the world in the manufacture of these implants is silicone; however, in the US, this material is currently banned because of theoretical health risks. This has led to the development of saline-filled prostheses as an alternative.

PATIENTS AND METHODS

A Medline search was carried out on all articles on testicular prosthesis between 1966 and 2006.

CONCLUSIONS

This review highlights the controversies regarding prosthetic materials, the complications of insertion and the potential benefits of this commonly performed procedure.

Seminal vesicle-rectal fistula with preceding right acute epididymitis

A case of seminal vesicle-rectal fistula is reported. A 74-year-old Japanese man was admitted to our hospital due to repeated right scrotal swelling and high fever with pneumaturia. A diagnosis of the right acute epididymitis was made. Bilateral vesiculography showed contrast medium leakage to the rectum, and colonoscopy revealed ostium of the fistula in the anterior wall of the rectum. Symptoms were improved by extirpation of the right scrotal contents.

Sperm Granuloma of the Inguinal Vas Deferens Mimicking Recurrent Incarcerated Inguinal Hernia

Masses of the spermatic cord are rare and can be neoplastic or inflammatory lesions. We present a case of a sperm granuloma of the inguinal vas deferens presenting as a recurrent incarcerated inguinal hernia in a 42-year-old man.

[Clinical study on operative treatment of acute scrotum]

Between July 1986 and March 2006, 102 patients underwent an operation for acute scrotum. Median age was 12.0 years old (range 0-51). Post-operative diagnosis revealed 50 cases (49%) of spermatic cord torsion, 29 cases (28%) of epididymal appendix torsion, and 13 cases (13%) of acute epididymitis. Spermatic cord torsion was most frequent in the age between 0 and 5, and 11 and 20, while epididymal appendix torsion was most frequent between 6 and 10. Moreover, acute epididymitis was most frequently seen in the age over 20. There were no apparent differences in the clinical symptoms such as scrotal pain, scrotal swelling, and abdominal pain. In the physical examinations, pyuria was the only finding to indicate acute epididymitis. In case of spermatic cord torsion, 'golden time' is defined as the time from onset to operation when testicular function can be expected for preservation. In this study golden time was defined as 8 hours because the testes was preserved in all 23 patients receiving the operation within 8 hours, but in only 10 (37%) out of 27 patients receiving the operation after 8 hours. Moreover, the operation within 24 hours saved the testes in approximately 90% of the patients. In patients with acute scrotum, emergency operation should be performed as speedily as possible for preservation of testicular function.

[Penoscrotal elephantiasis]

Penoscrotal elephantiasis is not an uncommon clinical picture that may arise as a symptom of many diseases; it is usually a sequela of a recurring inflammatory process, eczema or malignancy. Elephantiasis often occurs after radical operations in the pelvic region. Displacement of lymphatic pathways leads to a local edema which over the course of time may lead to a considerable increase in volume of the patient's genitals or other affected parts. The diagnosis of elephantiasis is not difficult. It is much more difficult to determine which disease has caused the obstruction of the lymphatic pathways. If it is a reversible stage, the object of treatment is to remove the obstruction and reinstate the physiological lymph flow. Conservative measures such as administration of anti-inflammatory drugs and diuretics, physical measures such as baths, massage, elevation of the affected parts and treatment of the underlying disease may be considered. On progression to irreversible elephantiasis a chronic lymphatic edema occurs for which conservative measures will be unsuccessful. For cases where physical and anti-inflammatory measures are unsuccessful, excision and amputation of the affected penoscrotal region is recommended in order to eliminate the functional dysfunction. We report on two cases of penoscrotal elephantiasis, one in a child and the other in an adult man.

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.

Hematocele crónico calcificado: A propósito de un caso

OBJECTIVE

Chronic hematoceles are rare scrotal masses. Most of them include trauma, torsion, tumor, and surgery as possible causes. We describe the case of an old diabetic patient, who is attended for presenting a marked increase in size of the right hemiescrotum and pain.

METHODS

We described computed tomography and sonographic findings.

RESULTS/CONCLUSIONS

Frequently, a varicocele is an associated finding. Presumibly, minor trauma results in rupture of dilated vessels. In sonographic exploration, they have a more complex heterogeneous appearance with echogenic debris and septations. Most hematoceles spontaneously resolve with conservative therapy.

[Lymphedema of the penis and scrotum: surgical treatment and reconstruction]

Penile and scrotal lymphedema causes significant functional, cosmetic and psychological problems. We present two patients with penoscrotal lymphedema successfully treated with wide radical excision of the lymphedematous tissue and reconstruction with skin flaps and split thickness grafts. No complications occurred postoperatively. Good cosmetic results and functionality are preserved 8 and 15 years after the surgery, with no recurrences.

Comparative study of photodynamic therapy vs. CO2laser vaporization in treatment of condylomata acuminata, a randomized clinical trial

BACKGROUND

Most conventional therapies for condylomata acuminata (CA) are traumatic and have high recurrence rates.

OBJECTIVES

To investigate the efficacy and safety of topical application of 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) for the treatment of CA.

METHODS

Sixty-five patients with CA were allocated into the treatment (ALA-PDT) group and treated with 20% ALA solution under occlusive dressing for 3 h followed by irradiation with the helium-neon laser at a dose of 100 J cm(-2) and a power of 100 mW. Another 21 CA patients were allocated into the control group and treated with the CO(2) laser. The treatment was to be repeated 1 week later if the lesion was not completely removed after the first treatment.

RESULTS

After one treatment, the complete removal rate was 95% in the ALA-PDT group and 100% in the control group. After two treatments with ALA-PDT, the complete removal rate in the treatment group was 100%. The recurrence rate for ALA-PDT group was 6.3% which was significantly lower than that in control group (19.1%, P < 0.05). Moreover, the proportion of patients with adverse effects in the ALA-PDT group (13.9%) was also significantly lower than that in control group (100%, P < 0.05). The side-effects in patients treated with ALA-PDT mainly included mild burning and/or stinging restricted to the illuminated area.

CONCLUSIONS

The present study shows that topical application of ALA-PDT is a simpler, more effective and safer therapy with a lower recurrence for treatment of CA compared with conventional CO(2) laser therapy.

Transverse testicular ectopia with persistent Muellerian duct syndrome

A one-year-old boy was admitted with complaints of swelling in the left inguinoscrotal region and an empty right scrotum since birth. The inguinoscrotum contained two ovoid solid swellings one above the other. The swellings were testes like in feel, size and shape. The diagnosis was transverse testicular ectopia. The case was managed by surgery. Tissue from gonads, the tubular structures and the fallopian tubes were sent for histopathological examination for confirmation. This was a case of an otherwise normal male with transverse testicular ectopia with persistent Muellerian duct syndrome in the left inguinoscrotal hernial sac.

[Giant scrotal lymphedema]

OBJECTIVE

To report the case of a patient with long-term giant genital lymphedema as a consequence of partial penectomy with bilateral inguinal lymphadenectomy 26 years before.

METHODS

58-year-old male patient consulting for genital volume increase (penis and scrotum). Diagnostic tests were performed and surgery was indicated.

RESULTS

Complete bilateral scrotal excision including testicles and complete amputation of the penile remnant were carried out. Urethra was anastomosed to skin in the root of the scrotum. Post-operative outcome was satisfactory.

CONCLUSIONS

Genital lymphedema is a disease associated with severe aesthetic and psychological disorders. The present case demonstrates that these patients may be rehabilitated.

Case report: Endoscopic laser lithotripsy of seminal-vesicle stones

A 25-year-old man presented with painful ejaculation, an ejaculate volume of 0.75, and complaints of passing "granules" in the semen. Transrectal ultrasonography showed bilateral seminal vesicle enlargement. The patient underwent transurethral resection of the ejaculatory duct. The entry point of duct was resected using pure cutting current, resulting in the passage of multiple proteinaceous-appearing stones. Approximately 10 months later, the patient reported recurrent painful ejaculation and passage of granules in his semen. At cystoscopy, the ejaculatory duct openings were intubated with a cone-tipped catheter to perform bilateral seminal vesiculograms, which showed numerous mobile filling defects and a Steinstrasse appearance at the ejaculatory ducts. A 7F semirigid ureteroscope entered the lumen without difficulty over a guidewire, and the stones were fragmented with a 270-microm holmium laser fiber. The ejaculatory ducts were balloon dilated to 18F. To our knowledge, this is the first reported case where a ureteroscope was utilized to treat seminal-vesicle stones. The seminal vesiculogram proved to be extremely valuable in the diagnosis.

Renal agenesis associated with ipsilateral ectopic ureter entering a large seminal vesicle cyst

We describe a case of right renal agenesis with ipsilateral ectopic ureter opening into a large seminal vesicle cyst in a 24-year old man. The patient presented with left flank pain and the imaging studies showed absent right kidney and a large pelvic cyst possibly arising from seminal vesicle. The cyst was removed together with the right ureter and kidney remnant through a laparotomy.

A review of the efficacy of surgical treatment for and pathological changes in patients with chronic scrotal pain

OBJECTIVES

To assess the efficacy of surgical treatment for chronic scrotal pain (CSP) and to examine histopathological changes in epididymectomy and orchidectomy specimens in these patients.

PATIENTS AND METHODS

CSP is a rare condition that for some patients can be severely debilitating. Although first-line treatment is conservative and includes the use of analgesics, many patients still complain of persistent pain. Nerve denervation and spermatic cord block might be attempted, but often patients proceed to surgery. The clinical notes of 26 patients (mean age 49 years) who had surgery for CSP were analysed retrospectively. Data included: the duration of pain before presentation, investigations before treatment, risk factors for CSP, initial conservative management, pain team referral, history of previous scrotal surgery and clinical outcome. All pathological specimens were examined to identify any changes in the epididymis and testis.

RESULTS

In 16 patients (62%), the pain resolved completely after surgery, but the other 10, despite showing an improvement, had residual pain. Histopathological examination of epididymectomy specimens revealed changes associated with obstruction, including sperm extravasation, tubule distension and focal fibrosis. All testis specimens had a variable degree of tubular sclerosis and chronic inflammation, with nine showing extensive infarction, suggestive of previous episodes of infection or ischaemia.

CONCLUSION

In this review, 62% of patients had complete resolution of pain and the remainder had a partial response after surgical treatment for CSP. All specimens showed pathological changes in the epididymis or testis, with changes suggestive of recurrent episodes of ischaemia or infection. The results show that CSP can be successfully treated surgically in many cases where conservative methods fail to provide symptomatic relief.

Fournier gangrene

Fournier gangrene is a necrotizing infection involving the soft tissues of the male genitalia. It was first described in 1764 by Baurienne and given its eponymous name after Jean-Alfred Fournier in 1883 presented a case of perineal gangrene in an otherwise healthy young man. While only 600 cases of Fournier gangrene have been reported in the world literature since 1996, it is a common and serious disease in Africa. In Maputo Central Hospital alone, between 12 and 16 cases are admitted every year and treated with a 20% mortality. The typical patient is an elderly male in his sixth or seventh decade with co-morbid diseases. While considered to affect males only, a similar condition may occasionally affect the female genitalia.

Resources and costs associated with incidental extracolonic findings from CT colonogaphy: a study in a symptomatic population

CT colonography (CTC) is increasingly used to detect colonic polyps and cancers, but its impact in practice is also influenced by frequent detection of extracolonic lesions. We have previously documented the frequency and nature of such lesions. The current study was performed to assess the clinical resources and costs associated with the investigation and treatment of extracolonic lesions. We reviewed the reports of 225 consecutive CTC examinations carried out on patients with symptoms of bowel cancer. 116 of the 225 were reported to have one or more extracolonic findings. All 116 patients with an abnormality were followed up for 12-24 months. 24 patients underwent further actions (outpatient attendance, investigations, or surgical procedures) as a result of previously undiagnosed lesions unrelated to bowel cancer. The costs of these further actions were derived from the NHS Reference Costs manual 2004. The total cost for further investigations and interventions was 34,329 pounds sterling and the mean cost over the sample of 225 patients was 153 pounds sterling--more than the cost of the CTC itself. The costs were mainly generated by surgical procedures. Resources consumed as a result of extracolonic findings approximately doubled the costs of diagnostic CTC. These costs, along with inconvenience, anxiety, morbidity and occasionally even mortality suffered by patients, must be offset by the good done to some of those with sub-clinical but potentially lethal diseases.

Ectopic adrenal tissue in the spermatic cord in pediatric patients: surgical implications

OBJECTIVE

To study the incidence and relevance of ectopic adrenal tissue in pediatric patients who underwent groin surgical explorations.

MATERIALS AND METHODS

We studied 1120 patients with groin surgical explorations during a period of 8 consecutive years. Patients' clinical data and histological findings were analyzed.

RESULTS

We found ectopic adrenal tissue in 13 patients in 1120 groin surgical exploration (1.16%). Of the 13 cases, 5 were diagnosed as having undescended testes, 6 inguinal hernia and 2 communicating hydrocele. Median age at diagnosis was 5.6 years. Histological sections showed adrenal cortical tissue with no medulla present.

CONCLUSION

Based on the clinical implications of those adrenal rests it is mandatory the removal of this ectopic tissue whenever encountered during surgical interventions in the groin region in children.

Coalition for the Advancement of Prosthetic Urology: History, Accomplishments, and Continuing Mission

The Coalition for the Advancement of Prosthetic Urology (CAPU) is the leading policy advocacy group representing the prosthetic urology community and has been very effective in educating federal health care policy-makers.

Use of negative-pressure dressings and split-thickness skin grafts following penile shaft reduction and reduction scrotoplasty in the management of penoscrotal elephantiasis

From 1988 to 2005, 8 men who presented with penoscrotal elephantiasis underwent penile shaft degloving and reduction scrotoplasty, followed by transplantation of a split-thickness skin graft (STSG) to the penile shaft. The etiology of elephantiasis in these patients included self-injection of viscous fluid and postsurgical obstructive lymphedema. In the 6 most recent cases, negative-pressure dressings were applied over the STSG to promote graft take, and STSG take rate was 100%. The results of our series corroborate those of a previous report, which showed circumferential negative-pressure dressings to be safe and efficacious in bolstering STSGs to the penile shaft. Furthermore, these results suggest that the use of negative-pressure dressings may improve graft take in this patient population.

Endoscopic Management of Seminal-Vesical Cyst with Right Renal Agenesis Causing Acute Urinary Retention: Case Report

Seminal-vesicle cysts associated with renal agenesis are rare congenital or acquired lesions. We report a case of seminal-vesicle cyst causing urinary retention in a young patient with right renal agenesis who was treated successfully with transurethral unroofing. Magnetic resonance imaging aided us in making the conclusive diagnosis without the need for any invasive investigations.

[A case of non-traumatic rupture of varicocele]

We report a case of a non-traumatic rupture of varicocele. A 28-year-old man visited our hospital complaining of left scrotal swelling with severe spontaneous pain of sudden onset after straining for defecation. MRI revealed a dilated spermatic cord with scrotal hematoma surrounding the left testis, which leads to the diagnosis of varicocele rupture. Conservative treatment with oral analgesics for a couple of weeks relieved the swelling and pain. Subinguinal microscopic ligation of left spermatic veins was performed 4 months later.