1
|
Abou El-Ella SS, Tawfik MA, Abd El-Aziz TF, Shalaby AMA, Barseem NF. The G178A polymorphic variant of INSL3 may be linked to cryptorchidism among Egyptian pediatric cohort. Pediatr Surg Int 2020; 36:1387-1393. [PMID: 32865613 DOI: 10.1007/s00383-020-04735-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 11/26/2022]
Abstract
Cryptorchidism (CO) is a genital disorder of multifactorial etiology, with serious remote complications. Mutations in insulin-like 3 hormones (INSL3) G/A variant remain a matter of inquiry. We aimed to investigate the association between G178A-INSL3 polymorphism and undescended testis in a cohort of Egyptian children. In this study, a total of 160 children, including 80 cases with primary non-syndromic undescended testes and 80 healthy children with normal external genitalia as controls, both, were analyzed after detailed history, physical examination and imaging for mutations of G178A polymorphism of INSL3 gene by restriction fragment length polymorphism (RFLP) technique. We found most of the undescended testes were inside the inguinal canal mainly on the left side. Genetic analysis revealed that the mutant A allele of G178A INSL3 variant was significantly detected in the patient group with a frequency of 26.2% against 12.5% for control subjects, especially among cases with an evident family history of similar cases as shown by p value = 0.001 and odd's ratio (CI95%) of 0.13 (0.04-0.723). In conclusion, G178A-INSL3 gene polymorphism could be a susceptibility factor for testicular maldescent in Egyptian children. Also, family history of similar cases was considered as significant predictive risk for cryptorchidism, added to the shared genetic links to consanguinity in our locality.
Collapse
Affiliation(s)
- Sohier S Abou El-Ella
- Genetic and Endocrinology Unit, Pediatric Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Maha Atef Tawfik
- Genetic and Endocrinology Unit, Pediatric Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | | | - Naglaa Fathy Barseem
- Genetic and Endocrinology Unit, Pediatric Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
| |
Collapse
|
2
|
Anitha B, Aravindhan K, Sureshkumar S, Ali MS, Vijayakumar C, Palanivel C. The Ideal Size of Mesh for Open Inguinal Hernia Repair: A Morphometric Study in Patients with Inguinal Hernia. Cureus 2018; 10:e2573. [PMID: 29974028 PMCID: PMC6029728 DOI: 10.7759/cureus.2573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction This study was done to analyze the morphometric features of the inguinal canal with different types of inguinal hernias to determine the appropriate size of mesh required to cover potential sites of recurrence. A morphometric assessment in the particular population is essential to recommend the appropriate mesh size in inguinal hernias to cover all the potential sites of recurrence. Materials and methods This was a prospective observational study, including all consecutive patients undergoing open inguinal hernia repair under local/regional/general anesthesia over a period of three years. Surgeries that were done in emergencies for complicated hernias, laparoscopic repair, and recurrent inguinal hernias were excluded. Intra-operative parameters were studied to predict the appropriate mesh size, which included the position of the superficial and deep inguinal ring (SIR and DIR) with the diameter, the distance of SIR and DIR from the anterior superior iliac spine (ASIS), and the distance from the summit of the muscular arch to the inguinal ligament. The differences in morphometric details between the types of hernias and categorical variables were assessed using the chi-square test. Results The study included a total of 170 patients with a mean age of 50.67 + 17.59 years. An indirect hernia was the most common type in patients less than 60 years. The mean distance from ASIS to SIR was 10.2+ 1.9 cm, and in indirect hernia patients, it was found to be significantly increased (p=0.042). The mean distance from ASIS to DIR was 4.14+1.57 cm, where the indirect hernia patients had a significantly less distance (p=0.029). The mean length of the inguinal canal in a direct hernia was 5.66 + 0.5 cm, whereas, in an indirect inguinal hernia, it was 6.46 + 0.8 cm, which was significant (p=0.029). The mean distance from the midpoint of the inguinal ligament to the summit of the muscular arch was 4.03 cm, and there was no significant difference between the indirect and direct hernia patients. Conclusion After considering the morphometric assessments of the length of the inguinal canal, the mean distance from the midpoint of the inguinal ligament to the summit of the muscular arch, the mean distance from ASIS to DIR, the ideal mesh size for the population would be 9 X 15 cm to cover all the potential sites of recurrence.
Collapse
Affiliation(s)
- Balaiya Anitha
- Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Karuppusamy Aravindhan
- Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sathasivam Sureshkumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chinnakali Palanivel
- Preventive Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|
3
|
Nazem M, Dastgerdi MMH, Sirousfard M. Outcomes of pediatric inguinal hernia repair with or without opening the external oblique muscle fascia. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2015; 20:1172-6. [PMID: 26958052 PMCID: PMC4766824 DOI: 10.4103/1735-1995.172985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 01/04/2015] [Accepted: 06/23/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Considering that complications and outcome of each method of pediatric inguinal hernia repair are one of the determinants for pediatric surgeons for selection of the appropriate surgical technique, we compared the early and late complications of two inguinal repair techniques, with and without opening the external oblique muscle fascia. MATERIALS AND METHODS In this double-blind clinical trial study, boy children aged 1-month to 6 years with diagnosed inguinal hernia were included and randomly allocated into two groups for undergoing two types of hernia repair techniques, with and without opening the external oblique muscle fascia. Surgical complications such as fever, scrotal edema and hematoma, and wound infections classified as early complication and recurrence, testis atrophy and sensory impairment of inguinal area classified as late complications. The rates of mentioned early and late complications were compared in the two interventional groups. RESULTS In this study, 66 patients were selected and allocated to the two interventional groups. The prevalence of early and late complications in two studied groups were not different significantly in two interventional groups (P > 0.05). Operation time was significantly shorter in inguinal repair techniques without opening the external oblique muscle fascia than the other studied technique (P = 0.001). CONCLUSION The findings of our study indicated that though early and late complications of the two repair methods were similar, but the time of procedure was shorter in herniotomy without opening the external oblique muscle, which considered the superiority of this method than inguinal hernia repair with opening the external oblique muscle.
Collapse
Affiliation(s)
- Masoud Nazem
- Department of Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Motaherh Sirousfard
- Department of Pediatric Nursing, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
4
|
Taghavi K, Geneta VP, Mirjalili SA. The pediatric inguinal canal: Systematic review of the embryology and surface anatomy. Clin Anat 2015; 29:204-10. [PMID: 26400820 DOI: 10.1002/ca.22633] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/06/2022]
Abstract
The inguinoscrotal region is one of the most common areas operated on in pediatric surgery. Despite this, the surface anatomy of the pediatric inguinal canal is variably defined. The aim of the current systematic review is to evaluate the development and surface anatomy of the pediatric inguinal canal. A systematic review of inguinal canal anatomy in children was conducted using the electronic databases: Medline, PubMed, Scopus, and Google Scholar. Relevant anatomical measurements and relationships were reviewed. The anatomical structures forming the walls of the inguinal canal were identified in fetuses as early as 8-10 weeks gestation. No studies addressed the developmental basis of this early defect in the lower anterior abdominal. Later gonadal development and descent has a defined role. In vivo measurements of children carried out during open surgery are inconsistent. Some studies showed rapid growth velocity of the length of the inguinal canal up to 2 years of age (with height and growth of the bony pelvis) before plateauing, while others suggested no increase in canal length prior to 10 years of age. The position of the deep inguinal ring was equally unclear; some studies suggested this was medial to the midpoint of the inguinal ligament. No studies described the position of the superficial ring, challenging the assumption that the rings are superimposed in the neonate. The dearth of studies analyzing pediatric inguinal anatomy means that changes in the position of the rings with respect to the lengthening of the canal remain unclear.
Collapse
Affiliation(s)
- Kiarash Taghavi
- Department of Pediatric Surgery, Wellington Hospital, Wellington, New Zealand
| | - von Paolo Geneta
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| |
Collapse
|
5
|
Türk E, Memetoglu ME, Edirne Y, Karaca F, Saday C, Güven A. Inguinal herniotomy with the Mitchell-Banks' technique is safe in older children. J Pediatr Surg 2014; 49:1159-60. [PMID: 24952808 DOI: 10.1016/j.jpedsurg.2013.09.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/18/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE There is a tendency for the majority of surgeons to open the inguinal canal in children over two years old when performing inguinal hernia repair. On the other hand, in small children, most surgeons perform the herniotomy superficially to the external ring, as in Mitchell-Banks' technique (MBT). Our aim was to compare the Ferguson hernioplasty (FH) and Mitchell-Banks' technique in terms of recurrence and complication rates in older children. METHODS We retrospectively reviewed the office medical records of children who were at least two years old and who underwent a herniotomy procedure for inguinal hernia between 1997 and 2012. RESULTS The 4520 inguinal herniotomy procedures in boys who were over two years old were included in this study. Of these cases, 1607 cases (40.2%) were operated on by a FH with opening the inguinal canal, and 2388 cases (59.8%) by MBT superficially to the external ring. The median ages were 5.1 years (range, 2.0-16.2) in the FH group and 4.6 years (2.0-14.6) in the MBT group. The total complication rates were 2.3% in the FH group and 2.9% in the MBT group (P>.05). Early complications such as wound infection, scrotal edema, and hematoma were seen in 13 (0.8%), 15 (1%), and 10 (0.6%) in the FH group, and 12 (0.5%), 18 (0.7%), and 15 (0.6%) in the MBT group, respectively (P>.05). Late complications such as recurrence, trapped undescended testis, and testicular atrophy were seen in 2 (0.12%), 1 (0.06%), and 2 (0.12%) in the FH group, and 3 (0.12%), 1 (0.04%), and 2 (0.08%) in the MBT group (P>.05). CONCLUSION The Mitchell-Banks technique is a simple and safe procedure in older boys.
Collapse
Affiliation(s)
- Erdal Türk
- Department of Pediatric Surgery, Izmir University, Faculty of Medicine, Izmir, Turkey.
| | | | - Yesim Edirne
- Denizli State Hospital, Clinics of Pediatric Surgery, 20100, Denizli, Turkey
| | - Fahri Karaca
- Denizli State Hospital, Clinics of Pediatric Surgery, 20100, Denizli, Turkey
| | - Cezmi Saday
- Aydin State Hospital, Clinics of Pediatric Surgery, 09000, Aydin, Turkey
| | - Ahmet Güven
- Department of Pediatric Surgery, Gulhane Military Medical Faculty, Etlik, 06018, Ankara, Turkey
| |
Collapse
|
6
|
Lin CD, Tsai YC, Chang SJ, Yang SS. Surgical Outcomes of Mini Laparoscopic Herniorrhaphy in Infants. J Urol 2011; 185:1071-6. [DOI: 10.1016/j.juro.2010.10.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Chia-Da Lin
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei and Department of Urology, Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - Yao-Chou Tsai
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei and Department of Urology, Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - Shang-Jen Chang
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei and Department of Urology, Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - Stephen S. Yang
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei and Department of Urology, Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
7
|
Ho CH, Yang SSD, Tsai YC. Minilaparoscopic High-ligation With the Processus Vaginalis Undissected and Left In Situ is a Safe, Effective, and Durable Treatment for Pediatric Hydrocele. Urology 2010; 76:134-7. [DOI: 10.1016/j.urology.2010.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 01/16/2010] [Accepted: 03/01/2010] [Indexed: 11/29/2022]
|
8
|
Figueiredo CMDO, Lima SO, Xavier Júnior SD, Silva CBD. Morfometria dos canais e anéis inguinais de fetos natimortos e cadáveres adultos humanos e sua relação com as hérnias inguinais. Rev Col Bras Cir 2009; 36:347-9. [DOI: 10.1590/s0100-69912009000400013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 01/15/2009] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar as diferenças anatômicas na região inguinal de fetos e adultos do gênero masculino, assim como a existência de uma possível base morfológica para a maior incidência de hérnias inguinais à direita em crianças e adultos. MÉTODOS: Foram dissecados 20 fetos natimortos e 20 cadáveres humanos adultos in natura, todos do gênero masculino, comparando-se o comprimento do canal inguinal, o maior diâmetro dos anéis inguinais superficial e profundo em ambos os lados de cada cadáver e a existência ou não de superposição entre os anéis superficial e profundo. RESULTADOS: Não foram observadas, nos dois grupos, diferenças significativas na comparação das medidas dos anéis profundos e superficiais, assim como dos canais inguinais, com seus respectivos contralaterais em cada espécime. Entretanto, houve diferença significativa entre os diâmetros dos anéis inguinais homolaterais, sendo o anel superficial maior do que o profundo nos fetos (p = 0,0002) e nos cadáveres adultos (p < 0,0001). A razão canal inguinal/altura mostrou diferença significativa entre os grupos (p<0,0001), evidenciando que o canal inguinal em fetos é relativamente mais curto que em adultos. Foi observada, também, superposição dos anéis inguinais superficial e profundo ipsilaterais em dois fetos, porém não houve em nenhum dos adultos. CONCLUSÃO: A morfometria dos canais e anéis inguinais não justifica a maior incidência de hérnia do lado direito no gênero masculino.
Collapse
|
9
|
An old technique for surgery of 'high' undescended testis revisited. J Pediatr Urol 2008; 4:330-2. [PMID: 18790413 DOI: 10.1016/j.jpurol.2008.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 02/25/2008] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Most undescended testes resolve spontaneously in the first year of life. If the testis remains undescended by the second year, the most probable means of scrotal placement is orchiopexy. After the first successful operation for orchiopexy, many surgical modifications were described. This study presents our limited experience with Prentiss' maneuver in six boys with high undescended testes. PATIENTS AND METHODS Two left, two right and two bilateral testes, in six patients, were operated. Five patients were admitted with the complaint of unilaterally or bilaterally 'empty scrotum'. The sixth patient previously had a right high undescended testis which had been placed in a high scrotal position. Following the standard steps of inguinal orchiopexy Prentiss' maneuver were performed and yielded adequate distance to place the testes mid scrotum. RESULTS On follow-up, Doppler ultrasound examination revealed normal sized testes with normal blood flow in all patients with dimensions correlated with age. CONCLUSION Although perhaps only useful in orchiopexy for high undescended testis, incision of the transversalis fascia preserves testicular blood flow by relieving tension on the testicular vessels.
Collapse
|
10
|
Osifo OD, Osaigbovo EO. Congenital hydrocele: prevalence and outcome among male children who underwent neonatal circumcision in Benin City, Nigeria. J Pediatr Urol 2008; 4:178-82. [PMID: 18631921 DOI: 10.1016/j.jpurol.2007.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 12/10/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the prevalence and spontaneous resolution of congenital hydrocele diagnosed in male neonates who underwent circumcision at our centre. PATIENTS AND METHODS All male neonates presented for circumcision at the University of Benin Teaching Hospital, Benin City, Nigeria between January 2002 and December 2006 were examined for the presence of hydrocele. Those diagnosed with this condition were recruited and followed up in a surgical outpatient clinic for 2 years. The number of cases of spontaneous resolution and age at which this occurred were documented on a structured pro forma. RESULTS A total of 2715 neonates were circumcised and 128 (4.7%) were diagnosed with 163 cases of hydrocele, while 27 cases in 25 (0.9%) children failed to resolve at the age of 2 years. Neonatal hydrocele was bilateral in 112 (68.7%), and there were 20 (12.3%) right and 31 (19.0%) left. Among those with hydrocele, 28.1% were delivered preterm and resolution was spontaneous in many of them, with no observed significant statistical difference to those delivered full term (P=0.4740). Of the 163 hydrocele cases, 136 (83.4%) resolved spontaneously by age 18 months with peak resolution at 4-6 months. No spontaneous resolution occurred after 18 months and no hydrocele-related complication occurred during follow up. CONCLUSION Neonates with congenital hydrocele should be observed for spontaneous resolution for at least 18 months before being subjected to surgery.
Collapse
Affiliation(s)
- O D Osifo
- Paediatric Surgery Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria.
| | | |
Collapse
|
11
|
Tsai YC, Wu CC, Yang SSD. Minilaparoscopic herniorrhaphy with hernia sac transection in children and young adults: a preliminary report. Surg Endosc 2007; 21:1623-5. [PMID: 17353989 DOI: 10.1007/s00464-007-9207-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 12/12/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND We designed a technique of pure minilaparoscopic hernia sac transaction and ligation to repair primary inguinal hernias in children and young adults. METHODS Between September 2003 and December 2004, 83 patients with primary inguinal hernia were treated surgically with minilaparoscopic herniorrhaphy. The mean patient age was 6.8 years. Before the operation there were synchronous bilateral hernias in 2 (2.4%) patients, left inguinal hernias in 39 (47%) patients, and right inguinal hernias in 42 (50.6%) patients. The minilaparoscopic herniorrhaphy was carried out with the 3-mm laparoscopic and hand instrument system. Three 3.5-mm trocar ports were used for the telescope and 3-mm instruments. The peritoneum overlying the internal ring was circumferentially incised, then the peritoneal defect was closed with intracorporeal sutures. RESULTS One hundred and fourteen minilaparoscopic herniorrhaphies were performed. The mean followup period was 12.9 months. The mean operation time was 52 min. There was only one recurrence (1.2%) that was detected nine months after primary repair. All patients were able to return to unrestricted activity immediately and were discharged within 24 h after the operation. There was no reported case of testicular atrophy to date. CONCLUSIONS Minilaparoscopic herniorrhaphy with hernia sac transaction is a safe and effective technique in children and young adults with indirect inguinal hernias.
Collapse
Affiliation(s)
- Yao Chou Tsai
- Division of Urology, Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan
| | | | | |
Collapse
|
12
|
|
13
|
Hosgor M, Karaca I, Ozer E, Erdag G, Ulukus C, Fescekoglu O, Aikawa M. The role of smooth muscle cell differentiation in the mechanism of obliteration of processus vaginalis. J Pediatr Surg 2004; 39:1018-23. [PMID: 15213890 DOI: 10.1016/j.jpedsurg.2004.03.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE Development of indirect inguinal hernia and hydrocele in childhood is readily explained by the persistence of smooth muscle component around the processus vaginalis (PV) after the descent of the testis into the scrotum. The aim of this study was to investigate the expression of smooth muscle myosin heavy chain (SM MHC) isoforms as the markers of smooth muscle cell (SMC) differentiation in childhood inguinal hernia and hydrocele and in age-matched controls. METHODS The authors analyzed sacs from patients with inguinal hernia (male, 10; female, 10) and hydrocele (n = 10) immunohistochemically using monoclonal antibodies against alpha-smooth muscle actin, SM1, SM2 and SMemb. Peritoneal samples (male, 5; female, 5) obtained from age-matched patients served as controls. Immunostaining was evaluated with semiquantitative scoring and chi2 test. RESULTS The expression pattern of SM MHC isoforms did not differ among sacs obtained from female inguinal hernia when compared with that of controls. However, strong expression of SMemb within the sac walls of male inguinal hernia and SM1 in hydrocele groups were observed. CONCLUSIONS Our results indicate that SMC differentiation may play an important role in the obliteration of processus vaginalis in male inguinal hernia and hydrocele after the descent of the testis.
Collapse
Affiliation(s)
- Munevver Hosgor
- Department of Pediatric Surgery, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | | | | | | | | | | | | |
Collapse
|
14
|
Tanyel FC, Erdem S, Büyükpamukçu N, Tan E. Smooth muscle within incomplete obliterations of processus vaginalis lacks apoptotic nuclei. Urol Int 2003; 69:42-5. [PMID: 12119438 DOI: 10.1159/000064359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Incomplete obliteration of processus vaginalis (PV) has been suggested to result from the persistence of smooth muscle, which should normally disappear after taking part in the descent of testis. Since apoptosis is the mechanism of disappearance, the presence or absence of apoptotic nuclei was evaluated within sacs that result from failed obliteration of PV. MATERIALS AND METHODS Twenty sacs associated with female inguinal hernia (n = 5), male inguinal hernia (n = 6), hydrocele (n = 5), hydrocele of the cord (n = 2), and undescended testis (n = 2) were evaluated. 10-microm sections were cut from the snap-frozen samples and stained for nuclear DNA fragmentation. RESULTS Apoptotic nuclei were detected within the vascular structures and mesothelium. However, none of the samples from different diagnostic sources have revealed any apoptotic nucleus within the smooth muscle component. CONCLUSIONS While the vascular and mesothelial structures within the sacs reveal evidence of apoptosis, the smooth muscle component lacks apoptotic process. The failed apoptosis of smooth muscle may have a role in the persistence of PV.
Collapse
Affiliation(s)
- F Cahit Tanyel
- Department of Pediatric Surgery, Hacettepe University, Children's Hospital, Ankara, Turkey.
| | | | | | | |
Collapse
|
15
|
Tanyel FC, Talim B, Kale G, Büyükpamukçu N. A reevaluation of the structures accepted to represent the postnatal gubernaculum. Urol Int 2002; 69:116-9. [PMID: 12187041 DOI: 10.1159/000065559] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The structure called the residual gubernaculum (G) has been evaluated to define its origin. MATERIALS AND METHODS Girls operated for inguinal hernia (n = 7) and boys operated for undescended testis (n = 12), inguinal hernia (n = 7), hydrocele of the cord (n = 1), and ectopic (n = 1) and entrapped (n = 1) testes were evaluated. Attachments of the structures coursing distally from the sacs were identified, and they were removed en block. Three samples, first from the distal part of the sac with the beginning of the fibrous structure, second from the midportion, and third from the most distal part, were prepared and stained with hematoxylin-eosin, trichrome and elastic van Gieson. Histologic structures within the samples were determined and compared with Mann-Whitney U test. RESULTS AND CONCLUSIONS Structures called the residual G differed from the walls of accompanying sacs by only the absence of mesothelial lining. Therefore, the structure called the residual G in boys with an undescended testis and the round ligament in girls actually represent the obliterated processus vaginalis.
Collapse
Affiliation(s)
- F Cahit Tanyel
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | | | | | | |
Collapse
|
16
|
Tanyel FC, Müftüoğlu S, Dağdeviren A, Karakoç L, Büyükpamukçu N. Ultrastructural deficiency in autonomic innervation in cremasteric muscle of boys with undescended testis. J Pediatr Surg 2001; 36:573-8. [PMID: 11283880 DOI: 10.1053/jpsu.2001.22285] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE The cremaster muscles (CM) associated with undescended testis reveal neurogenic alterations that mainly affect type 2 fibers. The ultrastructure of CM has been evaluated to define if further evidence to explain the alterations could be identified. METHODS CM of 8 boys with inguinal hernia and 8 boys with undescended testis at similar ages were biopsied. Samples were processed for electron microscopic evaluations. Semithin and thin sections were examined under an electron microscope. RESULTS The CM associated with inguinal hernia showed normal ultrastructure. However, some alterations were encountered in CM associated with undescended testis. Unmyelinated fibers were diminished in number, and myelinated fibers were outnumbering the unmyelinated fibers. Marked disorientation of myofibers, redundant sarcolemma, empty sleeves of basal lamina, disarray of myofibrils, densely packed myofilaments, Z disk streaming, dilated sarcoplasmic reticulum, and dense-irregularly shaped mitochondria were repeatedly encountered. Satellite cells appeared inactive. Most of the fibers were contracted. CONCLUSIONS The decrease in number of unmyelinated fibers appears to represent a decrease in autonomic nerve fibers. The alterations within muscle fibers may reflect a deficiency in autonomic innervation. Autonomic nervous system is highly responsive to circulating androgens. Factors decreasing the vulnerability of autonomic nervous system against androgenic effects may result in a CM with neurogenic alterations, thus inhibiting testicular descent. J Pediatr Surg 36:573-578.
Collapse
Affiliation(s)
- F C Tanyel
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, 06100 Ankara, Turkey
| | | | | | | | | |
Collapse
|
17
|
Tanyel FC, Talim B, Kale G, Boyokpamukçu N. Differences in the morphology of the processus vaginalis with sex and underlying disease condition. Pathol Res Pract 2001; 196:767-70. [PMID: 11186172 DOI: 10.1016/s0344-0338(00)80109-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The structures of sacs from boys and girls with inguinal hernia, and from boys with undescended testis or hydrocele were evaluated and compared. Particular attention was directed to determine if a clue helpful in describing the mechanism of obliteration of processus vaginalis (PV) exists. Sacs from boys (n: 8) and girls (n: 11) with inguinal hernia, and sacs from boys with undescended testis (n: 11) and hydrocele (n: 10) were obtained and stained with hematoxylin-eosin, trichrome and elastic van Gieson. The histologic structures of each group of samples were determined and compared. Smooth muscle was presented as a layer within the sacs of girls and boys with inguinal hernia. However, smooth muscle bundles were sparsely presented in sacs associated with undescended testis and hydrocele. Myofibroblasts were commonly encountered in sacs associated with inguinal hernia. The smooth muscle was invariably presented in sacs that contained myofibroblasts. While sacs from boys only had smooth muscle, sacs from girls also had striated muscle. Since the muscle components of sacs vary, PV is sexually dimorphic. Persistence of PV seems to be associated with the presence of smooth muscle and myofibroblasts within the sac wall. Myofibroblasts may have originated from the smooth muscle, and reflect the attempts at obliteration of PV.
Collapse
Affiliation(s)
- F C Tanyel
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | | | | | | |
Collapse
|
18
|
Tanyel FC, Ocal T, Büyükpamukçu N. Excessive sac pressures: the pathogenesis and innocence of hydroceles in children. BJU Int 2001; 87:372-5. [PMID: 11251533 DOI: 10.1046/j.1464-410x.2001.00076.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether paediatric hydroceles result entirely from a small-calibre patent processus vaginalis, allowing free communication between the abdominal cavity and hydrocele sac, or whether there are other mechanisms. PATIENTS AND METHODS Twenty-five hydroceles were studied prospectively in 24 boys (aged 18-132 months). Consent for the intraoperative measurements was obtained before surgery. The hydrocele was repaired under general anaesthesia with endotracheal intubation, using a standard approach, taking care not to open the sac during mobilization. Intra-abdominal pressures during surgery were measured indirectly via a nasogastric tube after gastric decompression. The pressure in the sac was measured via a 20 G intravenous cannula inserted via a purse-string suture. The relative pressure was then calculated by subtracting the intra-abdominal from the sac pressure. The effects of age and laterality were evaluated. RESULTS The median (range) intra-abdominal, sac and relative pressures were 8 (2-18), 11 (3-30) and 4 (3-30) cmH2O, respectively. The sac pressure in the sac was greater than the intra-abdominal pressure in 17 of 25 (68%; P = 0.004) patients. Age or laterality had no significant influence on any of the pressures. CONCLUSIONS These results suggest that in a significant proportion of hydroceles in children the pressures are higher than the intra-abdominal pressure. Therefore, they cannot be explained simply as a freely communicating, narrow-calibre processus. In addition, the pressures may reach levels which are potentially damaging to the testis.
Collapse
Affiliation(s)
- F C Tanyel
- Department of Paediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | | | | |
Collapse
|
19
|
Tanyel FC, Müftüoglu S, Dagdeviren A, Kaymaz FF, Büyükpamukçu N. Myofibroblasts defined by electron microscopy suggest the dedifferentiation of smooth muscle within the sac walls associated with congenital inguinal hernia. BJU Int 2001; 87:251-5. [PMID: 11167652 DOI: 10.1046/j.1464-410x.2001.02028.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To ascertain the presence of myofibroblasts in sacs associated with inguinal hernia in children, through an ultrastructural evaluation using electron microscopy. MATERIALS AND METHODS Sacs were obtained from 10 boys and 10 girls (of similar age, approximately 45 months) with inguinal hernia and processed for electron microscopy. Thin sections were examined specifically for the presence of myofibroblasts. RESULTS The ultrastructural evaluation showed myofibroblasts with classical electron microscopic features within all of the sacs, regardless of the gender of origin. CONCLUSION The persistence of smooth muscle hinders the obliteration of the processus vaginalis; myofibroblasts are found in association with smooth muscle and thus such cells within the sac walls seem to originate from the smooth muscle, reflecting the dedifferentiation of smooth muscle. This dedifferentiated state may represent attempted apoptosis, which usually causes the disappearance of the smooth muscle and obliteration of the processus vaginalis after the descent of the testis into the scrotum.
Collapse
Affiliation(s)
- F C Tanyel
- Department of Paediatric Surgery, University, Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | |
Collapse
|