Hydrocele in Pediatric Population

Spigelian-cryptorchidism syndrome: Lesson based on a case report

The Spigelian hernia is a abdominal wall hernia that originates from a discontinuity of the Spigelian fascia located lateral to the rectus abdominis muscle. It can be acquired in adults or congenital in newborns. In very rare cases in male it can be associated with cryptorchidism, in which case it is known as "Spigellian-Cryptorchidism Syndrome". It can be clinically highlighted with abdominal swelling wall along the semilunar line and intestinal obstruction. The diagnosis, as in all pediatric emergencies, must be timely and the method of choice is ultrasound which allows a rapid localization of the hernia breach and herniated structures. The treatment of choice is surgical with herniopexy and repositioning of the testicle into the scrotal sac, or orchipessy in cases of testicular necrosis. We describe ultrasound characteristics of Spigellian-cryptorchidism syndrome presenting with acute intestinal obstruction in a newborn.

[Hydrocele]

The hydrocele is overall a rare condition in urology. A differentiation between primary and secondary hydrocele is essential for further treatment. A primary hydrocele with a patent vaginal process tends to spontaneously regress in the first 2 years of life in newborns. If treatment is necessary, open as well as laparoscopic methods are available with good results. The treatment of scrotal pathologies, especially secondary hydrocele, often poses a challenge in the clinical practice. Despite the benign nature, supposedly simple surgical techniques and good chances of healing, postoperative complications are frequent. In comparison to open surgery, sclerotherapy provides a good alternative for the treatment of secondary hydrocele.

Comparison of Percutaneous Internal Ring Suturing (PIRS) versus Open Ligation of the Patent Processus Vaginalis for the Treatment of Communicating Pediatric Hydrocele

BACKGROUND

Although the laparoscopic approach become standard for the treatment of many surgical conditions many studies still debating whether laparoscopic surgery has significant advantages over open surgery in regards to hernia or hydrocele treatment. This study aimed to evaluate the outcomes of treatment of treatment of communicating hydrocele in pediatric patients between laparoscopic percutaneous internal ring suturing (PIRS) and open ligation of the patent processus vaginalis (PPV).

METHODS

The medical records of pediatric patients who underwent surgery for communicating hydrocele between 1 January 2019 and 1 January 2024 were retrospectively reviewed. The primary objective of the study is to investigate the outcomes of treatment (complications and recurrence rates) of communicating hydrocele in children between laparoscopic and open surgical approaches. Secondary outcomes of the study are the duration of surgery and anesthesia, length of hospital stay (LOS), frequency of hospital readmissions (ReAd) and unplanned return to the operating room (uROR).

RESULTS

A total of 198 children underwent surgery for a communicating hydrocele (205 repairs, as 7 cases were bilateral) and were included in the study. Of these, 87 children underwent a PIRS, while the remaining 111 cases underwent open ligation of the PPV. No recurrence of the hydrocele was observed in any of the study groups. Intraoperative complication (epigastric vein injury) was noted in two cases in both groups (2.3% vs. 1.8%, p > 0.999). A slightly higher number of postoperative complications was observed in the open group (n = 7, 6.3%) compared to the PIRS group (n = 2, 2.3%) (p = 0.190). The median duration of surgery (15 min (IQR 10, 17) vs. 21 min (IQR 15, 25); p < 0.001) and anesthesia (30 min (IQR 25, 40) vs. 40 min (IQR 35, 40); p < 0.001) were significantly lower in the PIRS group compared to open ligation of the PPV. In addition, a significantly shorter median of LOS was observed in the PIRS group compared to the open PPV group (9 h (IQR 8, 12) vs. 24 h (IQR 12, 24; p < 0.001). No cases of ReAd and uROR were observed in any of the study groups.

CONCLUSIONS

PIRS is a safe and effective laparoscopic technique that can be used in the treatment of communicating hydrocele in children. PIRS showed excellent outcomes and a low incidence of complications and recurrences, comparable to traditional open surgery.

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.

Structured Examination of the Scrotum and Penis

Primary care pediatricians, family practitioners, and primary care advanced practice clinicians frequently need to examine male adolescent genitalia as part of a comprehensive physical examination. Although this part of the examination may be uncomfortable for clinicians, taking a structured approach to the examination can mitigate clinicians' apprehension as well as enhance their ability to use this evaluation to identify potential pathology for the patient. Familiarity with the male genitourinary examination will also allow clinicians to definitively identify medical urgencies and emergencies for timely intervention. This review will provide the clinician with a structured approach to the male genitourinary examination while highlighting common pathology that may be encountered during the examination. [Pediatr Ann. 2024;53(1):e5-e9.].

Comparison of the size of bilateral testis in children with unilateral non-communicating hydrocele and its correlation with age

BACKGROUND

Opinions on the optimal age for surgical management of hydroceles in young boys are not uniform. Scrotal ultrasonography can be used to diagnose hydroceles and measure testicular size. A comparison of bilateral testicular size with hydrocele and the change in trend with age has not been reported. We therefore aimed to analyze the bilateral testicular size of children with unilateral non-communicating hydroceles and examine the correlation between age and testicular volume.

METHODS

Non-communicating hydrocele cases in children were included. Ultrasound results, age, and diagnose time were retrospectively recorded. The bilateral testicular size was compared, and the correlation between age and testicular volume was analyzed.

RESULTS

There were 138 cases of non-communicating hydrocele, ranging in age from 11 to 72 months. The diagnose time ranged from 3 days to 54 months. The volume of the testis on the side of the hydrocele was larger than that on the normal side (P < 0.001). Testicular length was not different bilaterally. Testicular width and height were greater on the hydrocele side than on the normal testicular side (P<0.001). Age was positively correlated with testicular volume on the normal side (P = 0.004) but not on the hydrocele side.

CONCLUSIONS

An important finding was that when the contralateral normal testicular volume increases with age, the testicular volume does not increase on the hydrocele side. This finding confirms the adverse effects of hydrocele on testicular growth and provides a basis for early treatment.

"Dancing Coins?" Unexpected Finding During microsurgery and Potential Risk of Sperm Damage: Intrascrotal Calculi: A Retrospective Analysis

Objective

Microsurgery of andrology always brings unexpected findings. Scrotal calculi are rare and unique, which are easily confused with tumor. To understand its etiology and harm, our study retrospectively analyzed the clinical characteristics of men with scrotal calculi to provide a reference for clinical practice.

Methods

The clinical data of patients who underwent microscopic testicular sperm extraction (MTESE) and microscopic epididymal sperm aspiration (MESA) from January 1, 2018 to December 31, 2021 were retrospectively analyzed. Data screening was performed on cases in which calculi were found or not, and the relationship between calculi and spermatogenesis was analyzed.

Results

A total of 405 patients were recruited. After screening, 218 nonobstructive azoospermia (NOA), 83 obstructive azoospermia (OA), and 13 cryptozoospermia (CZ) patients were included in the study. Calculi were found in 3 patients [incidence was 0.74% (3/405)], in which 2 patients had obstructive azoospermia (1 was epididymal calculi, 1 was intrascrotal calculi) and 1 patient had cryptozoospermia (intrascrotal calculi). Pathological results showed that chronic granuloma with abscess infiltration appeared in epididymal tissue, basement membrane thickening and fibrosis appeared in seminiferous tubules, and fibrous hyperplasia with calcium deposition was found in scrotal calculus. White blood cells, lymphocytes, red blood cells, abstinence time and urethritis were closely related to the occurrence of calculi. While abstinence time might be a potential predictor, which increased the risk by approximately 1.2 times.

Conclusion

Disturbance of the testicular microenvironment caused by lymphocyte infiltration may be the main reason for scrotal calculi and ultimately cause spermatogenesis disorders. Prolonged sexual abstinence was a potential risk.