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Altay MS, Uslu Ö, Bedir F, Kocatürk H, Karabulut I, Bedir B, Demirdöğen ŞO, Özbey I. Microscopic single-tubule technique for spermatocelectomy in cases of spermatocele: a rarely used surgical method and ıts outcomes. Int Urol Nephrol 2025:10.1007/s11255-025-04464-8. [PMID: 40121582 DOI: 10.1007/s11255-025-04464-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2025] [Accepted: 03/14/2025] [Indexed: 03/25/2025]
Abstract
PURPOSE This study aims to promote the microscopic single-tubule spermatocelectomy technique. The technique significantly reduces the risks of epididymal injury, infertility, and spermatocele recurrence rates. METHODS From January 2015 to June 2024, male patients aged between 18 and 50 years who underwent microscopic single-tubule spermatocelectomy with the intent to preserve fertility were included in this study. Data on patient age, preoperative and postoperative sperm analysis results, and complication rates were recorded. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) v26 for Windows. RESULTS The mean age of the patients was 40.93 ± 6.20 years. The average size of the spermatoceles was 6.44 ± 2 cm. The mean duration of the operation was 45.44 ± 8.82 min. While there was no statistically significant difference in sperm count and volume averages between preoperative and postoperative measurements, a statistically significant was observed in sperm motility. In terms of complications, 3.7% of the patients (n = 1) developed an infection. No epididymal bleeding or iatrogenic tubule opening was detected under the microscope. None of the patients experienced bleeding, spermatocele recurrence, testicular atrophy, or sperm granuloma. Pathological evaluations revealed no epididymal tissue in any of the cases. CONCLUSION Microscopic single-tubule spermatocelectomy reduces the risk of epididymal injury and testicular atrophy, and it is associated with low complication rates. Particularly in male patients desiring fertility preservation, microscopic single-tubule spermatocelectomy offers high success rates and low complication rates and should be considered the preferred surgical technique.
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Affiliation(s)
- Mehmet Sefa Altay
- Department of Urology, Health Sciences University, Erzurum City Hospital, Erzurum, Turkey.
| | - Ömer Uslu
- Department of Urology, Health Sciences University, Erzurum City Hospital, Erzurum, Turkey
| | - Fevzi Bedir
- Department of Urology, Health Sciences University, Erzurum City Hospital, Erzurum, Turkey
| | - Hüseyin Kocatürk
- Department of Urology, Health Sciences University, Erzurum City Hospital, Erzurum, Turkey
| | - Ibrahim Karabulut
- Department of Urology, Health Sciences University, Erzurum City Hospital, Erzurum, Turkey
| | - Banu Bedir
- Provincial Health Directorate, Public Health Services Presidency, Erzurum, Turkey
| | | | - Isa Özbey
- Department of Urology, Atatürk University Faculty of Medicine, Erzurum, Turkey
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Bal DS, Chung D, Urichuk M, Shah J, Fidel MG, Panchendrabose K, Sidhom K, Bard R, Nayak JG, Patel P. Utilizing Local Anesthesia Only for Penile and Scrotal Urologic Surgery: A Prospective Study on Patient Tolerability and Surgical Outcomes for a Sedation-free Option. Urology 2024; 194:7-13. [PMID: 39208947 DOI: 10.1016/j.urology.2024.08.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To prospectively assess surgical outcomes, complications, and patient-reported tolerability of invasive scrotal surgeries under local anesthesia (LA) alone, without sedation, compared to tolerability of penile procedures commonly performed in this manner. METHODS Adult patients undergoing penile and scrotal surgeries under LA only were enrolled from August 2022 to June 2023 (NCT05617261). Demographics, surgeon-perceived and patient-reported pain, and surgical variables were collected. Tolerability to the procedures and future anesthetic choice for a repeat procedure was assessed on follow-up. Complication data were collected, including recurrence, infection, excessive pain, and emergency room and family physician visits. RESULTS Hundred and seven patients were enrolled with a mean age ± SD of 42.2 ± 16.4 years. There was a 100% procedural success rate and no cases of perioperative complications or escalation of anesthetic. Around 92.4% (n = 97) of patients indicated they would opt for LA only for a hypothetical repeat procedure. Of the minority opting for general anesthetic, most indicated discomfort or preferring an element of amnesia. No differences between intraoperative pain or tolerability scores of invasive scrotal procedures compared to penile procedures were observed. On univariate analysis, longer procedure duration (P = .003), cannabis use (P = .01), and higher intra-operative pain (P = .005) was associated with lower tolerability. CONCLUSION LA alone in an office-based setting is promising for scrotal surgeries. It offers similarly high patient tolerability compared to procedures that are routinely performed under LA, with the preservation of outcomes. Adopting this method has the potential for substantial cost savings, reduced wait times, enhanced accessibility, and improved surgical efficiency.
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Affiliation(s)
- Dhiraj S Bal
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - David Chung
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB
| | - Matthew Urichuk
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Jainik Shah
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | | | | | - Karim Sidhom
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB
| | - Robert Bard
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB; Men's Health Clinic Manitoba, Winnipeg, MB
| | - Jasmir G Nayak
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB; Men's Health Clinic Manitoba, Winnipeg, MB
| | - Premal Patel
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB; Men's Health Clinic Manitoba, Winnipeg, MB.
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Sakhalkar OV, Mehta DS, Morganstern BA. Chronic testicular pain after routine hydrocelectomy cured with epidural injection. Urol Case Rep 2024; 56:102829. [PMID: 39280127 PMCID: PMC11402055 DOI: 10.1016/j.eucr.2024.102829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/11/2024] [Accepted: 08/20/2024] [Indexed: 09/18/2024] Open
Affiliation(s)
- Om V Sakhalkar
- Department of Urology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Dipen S Mehta
- Department of Urology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Bradley A Morganstern
- Department of Urology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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Filmar S, Gross AJ, Hook S, Rosenbaum CM, Netsch C, Becker B. [Hydrocele]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:607-617. [PMID: 38780784 DOI: 10.1007/s00120-024-02367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
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.
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Affiliation(s)
- S Filmar
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - S Hook
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - C M Rosenbaum
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland
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Filmar S, Gross A, Netsch C, Rosenbaum C, Becker B. [Randomised comparison of different exit strategies in hydrocele resection]. Aktuelle Urol 2023. [PMID: 37963580 DOI: 10.1055/a-2159-1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Adult hydrocele is a benign enlargement of the scrotum seen in approximately 60/100,000 men >18 years of age. Surgical resection of the hydrocele has been established as the gold standard for the treatment of symptomatic hydroceles. Postoperative complications are common with this surgery. Due to the lack of guidelines for the therapy of hydrocele, treatment is based primarily on clinical experience. The aim of the study was to conduct a randomised study on the influence of drains on complications in hydrocele resection according to von Bergmann. MATERIAL AND METHODS A total of 60 patients were prospectively randomised into three groups. The groups each received an Easy-Flow drainage, a Cuti-Med Sorbact drainage, or no drainage. Haematoma and swelling, postoperative bleeding, infection, epididymal injury and revision surgery were clinically diagnosed as complications. RESULTS A complication was observed in 31.6% (n=19/60) of all patients. The complication rate was 50% (n=10) for the easy-flow drainage, 30% (n=6) for the Cuti-Med-Sorbact and 15% (n=3) for the group without drainage. Overall, a haematoma with swelling was observed most frequently, in 20% (n=12) of the cases. Revision surgery was required in 5% (n=3) of cases. Epididymal injuries were found histologically in 10% (n=6). Comparing the collective with the Easy-Flow drainage with the collective without drainage, the occurrence of complications was observed significantly more frequently in the drainage group (p<0.018). A statistically significant correlation regarding complications between the group of Cuti-Med-Sorbact and no drainage could not be shown (p<0.25). CONCLUSIONS Hydrocele resection is a complicated procedure. Based on the data presented here, the insertion of a drain is associated with an increased risk of postoperative complications. If the decision to insert a wound drainage is made intraoperatively, the Cuti-Med-Sorbact drainage appears to be associated with fewer complications.
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Affiliation(s)
- Simon Filmar
- Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Andreas Gross
- Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
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Marinaro JA, Goldstein M. Unilateral Scrotal Swelling: Diagnosis and Management. Urology 2023:S0090-4295(23)00069-9. [PMID: 36773954 DOI: 10.1016/j.urology.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/15/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Jessica A Marinaro
- Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine, New York, NY; Department of Urology, Weill Cornell Medicine, New York, NY
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine, New York, NY; Department of Urology, Weill Cornell Medicine, New York, NY.
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Baierl MA, Strauß A, Uhlig A, Hahn O, Reichert M, Schneider TR, Lüdecke J, Mohr MN, Voß JW, von Knobloch HC, Trojan L, Leitsmann C, Leitsmann M. [Use of men's support underwear after elective scrotal surgery-a prospective, randomized assessment of postoperative complication rates and health-related quality of life : A prospective, randomized assessment of postoperative complication rates and health-related quality of life]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:56-65. [PMID: 36418539 PMCID: PMC9684802 DOI: 10.1007/s00120-022-01975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Elective scrotal surgery is associated with a high rate of postoperative complications. There is no specific recommendation for postoperative care. AIM We investigated whether support underwear has an impact on postoperative complications and quality of life. MATERIALS AND METHODS From July 2020 to November 2021, patients with prior elective scrotal surgery were randomized into the intervention group "support underwear" or the control group. In addition to patient characteristics, intraoperative and postoperative findings were documented. The primary endpoint comprised postoperative complications. Secondary endpoints were prolonged length of hospital stay, emergency visits, unplanned readmissions, increased use of analgesics, and quality of life, which was recorded using the EQ5D (European Quality of Life 5 Dimensions) questionnaire preoperatively, on day 1 and 4 weeks postoperatively. RESULTS Data from 50 patients were analyzed. The mean age was 46.7 years (standard deviation [SD] 18.6). Inguinal surgery with/without orchiectomy (52%), hydrocele resection (22%), or ligation of varicocele (14%) were performed most frequently. The mean operating time was 62.8 min (SD 35.2); length hospital stay was 2.6 days (SD 1.2). In all, 20% of the patients suffered a postoperative complication. Type of surgery was significantly associated with postoperative complications (p = 0.01) and unplanned readmission (p = 0.04). Regarding biometric and perioperative data, there were no significant differences between the interventional group (n = 27) and control group (n = 23). CONCLUSION A nonnegligible number of complications occurs after elective scrotal surgery. Complications affects quality of life up to 4 weeks after the surgery. Postoperative care with support underwear does not appear to affect the postoperative complication rate, but it positively influences the quality of life in patients with scrotal access.
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Affiliation(s)
- Maxi Ann Baierl
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Arne Strauß
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Annemarie Uhlig
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Oliver Hahn
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Mathias Reichert
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Till Rasmus Schneider
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Jan Lüdecke
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Mirjam Naomi Mohr
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Joost Wilhelm Voß
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | | | - Lutz Trojan
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Conrad Leitsmann
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland
| | - Marianne Leitsmann
- Klinik für Urologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen, Deutschland.
- Klinik für Urologie, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich.
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Mäki-Lohiluoma L, Kilpeläinen TP, Järvinen P, Söderström HK, Tikkinen KA, Sairanen J. Risk of Complications After Hydrocele Surgery: A Retrospective Multicenter Study in Helsinki Metropolitan Area. EUR UROL SUPPL 2022; 43:22-27. [PMID: 36353068 PMCID: PMC9638760 DOI: 10.1016/j.euros.2022.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Despite being one of the most frequent urological procedures, the risk estimates for complications after hydrocele surgery (hydrocelectomy) are uncertain. Decision-making about hydrocelectomy involves balancing the risk of complications with efficacy of surgery—a tradeoff that critically depends on the complication risks of hydrocele surgery. Objective To examine the 90-d risks of complications of hydrocele surgery in a large, contemporary sample. Design, setting, and participants We retrospectively reviewed all surgeries performed for nonrecurrent hydroceles conducted in all five Helsinki metropolitan area public hospitals from the beginning of 2010 till the end of 2018, and evaluated the complication outcomes. Outcome measurements and statistical analysis The following outcomes were evaluated: (1) risk of moderate or severe (Clavien-Dindo II–V) hydrocele surgery complications, (2) risk of reoperation due to a surgical complication, and (3) risk of an unplanned postoperative visit to the emergency room or outpatient clinic, all within 90 d after surgery. Results and limitations We identified 866 hydrocele operations (38 [4.3%] bilateral operations). A total of 139 (16.1%) patients had moderate or severe hydrocele surgery complications within 90 d after surgery. Of the 139 complications, 94 were (10.9% of all or 67.6% of patients with moderate or severe complications) Clavien-Dindo grade II, 43 (5.0% and 30.9%, respectively) grade III, two (0.2% and 1.4%, respectively) grade IV, and none grade V. A total of 45 patients (5.2% of all and 32.4% of those who had moderate or severe complications) required immediate reoperation due to complications. All together 219 operated patients (25.3% of all operated patients) had an unplanned visit to the emergency room. The retrospective study design limits the reliability of the results. Conclusions Complications after hydrocele surgery are common and warrant further research. These estimates can be useful in shared decision-making between clinicians and patients. Patient summary We investigated the complication rates after hydrocele surgery and found that complications are common after a procedure often considered minor: every ninth patient had a moderate and every 20th a severe complication. Every fourth patient had an unplanned postoperative visit to the emergency room.
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Rezaee ME, Swanton AR, Gross MS. Current Findings Regarding Perioperative Complications in Benign Scrotal Surgery. Urology 2022; 169:23-28. [PMID: 35952807 DOI: 10.1016/j.urology.2022.06.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To characterize patients at the greatest risk of morbidity and mortality after benign scrotal surgery. METHODS A secondary data analysis was conducted of adults undergoing elective scrotal surgery for benign conditions using 2015-2020 American College of Surgeons National Surgical Quality Improvement data. Patients who experienced a postoperative complication, an unplanned procedure, or who died within 30-days of surgery were identified using the composite outcome "postoperative event". Multiple logistic regression was used to examine the association between patient characteristics and the odds of experiencing a postoperative event. RESULTS The study consisted of 12,917 patients, of which 4.1% experienced a postoperative event. After adjustment, malnourishment (OR 4.1, 95% CI: 1.2 - 14.5) decreased functional status (OR 3.8, 95% CI: 2.0 - 7.1), bleeding disorders (OR 3.4, 95% CI: 2.2 - 5.4), age ≥ 40 years (OR 1.6, 95% CI: 1.2 - 2.0), chronic obstructive pulmonary disease, (COPD, OR 1.8, 95% CI: 1.2 - 2.6), smoking (OR 1.4, 95% CI: 1.2 - 1.8), diabetes (OR 1.3, 95% CI: 1.1 - 1.7) and increased body mass index (BMI, OR 1.1, 95% CI: 1.1-1.1) were identified as risk factors for a postoperative event. The risk of a postoperative event was 2.7%, 4.5%, and 11.2% for patients with none, 1 to 2, and > 2 risk factors, respectively. CONCLUSION Complications after benign scrotal surgery are not infrequent. Risk factors include malnourishment, decreased functional status, bleeding disorders, age, COPD, smoking, diabetes, and increased BMI. Our results can be used to counsel patients on their risk of negative outcomes following these procedures.
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Affiliation(s)
- Michael E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, NH, Lebanon.
| | - Amanda R Swanton
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, NH, Lebanon
| | - Martin S Gross
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, NH, Lebanon
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Qin C, Yang J, Zhang R, Yang Y, Cai W, Li T, Zhu Q, Ye L, Gao Y, Wei Y. The Application of Scrotoscope-Assisted Minimally Invasive Excision for Epididymal Mass: An Initial Report. Front Surg 2022; 9:804803. [PMID: 35284490 PMCID: PMC8907580 DOI: 10.3389/fsurg.2022.804803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To compare the middle-term efficacy and safety results between scrotoscope-assisted (SA) minimally invasive excision and traditional open excision (OE) for the treatment of epididymal mass. METHODS A total of 253 males with surgery excision of epididymal mass from 2012 to 2018 were included in this retrospective study. Patients were divided into two groups: the traditional OE group and the SA group. Patient demographics and intraoperative and postoperative outcomes were obtained and compared between these two groups. RESULTS About 174 patients (68.8%) underwent SA, and the other 79 (31.2%) underwent OE. Demographic data were similar between the two groups. Compared with OE surgery, SA could significantly shorten the operating time (19.4 ± 4.1 vs. 53.8 ± 12.9 min), reduce blood loss (5.3 ± 1.5 vs. 21.3 ± 5.6 ml), and downsize the operative incision (1.5 ± 0.3 vs. 4.5 ± 0.8 cm). Additionally, postoperative complications were significantly less occurred in the SA group than those in OE (15.5% vs. 21.5%), in particular scrotal hematoma (1.7% vs. 12.7%) and incision discomfort (2.8% vs. 6.3%). Patients in the SA group had a significantly higher overall satisfaction score (94.8 ± 3.7 vs. 91.7 ± 4.9) and a significantly shorter length of hospital stay (4.1 ± 0.9 vs. 5.0 ± 1.5 days) than those in the OE group. No postoperative testicular atrophy occurred in the SA group. CONCLUSION SA is emerging as a novel and effective option with promising perspectives for epididymal mass therapy.
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Affiliation(s)
- Chuying Qin
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jinrui Yang
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ruochen Zhang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Yaojin Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Wanghai Cai
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Tao Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Qingguo Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Liefu Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
| | - Yunliang Gao
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yongbao Wei
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou, China
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Korkes F, Teles SB, Nascimento MP, Almeida SSD, Codeço AM. Comparison of outcomes and costs of surgery versus sclerotherapy to treat hydrocele. EINSTEIN-SAO PAULO 2021; 19:eGS5920. [PMID: 34287565 PMCID: PMC8277233 DOI: 10.31744/einstein_journal/2021gs5920] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/08/2020] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Fernando Korkes
- Hospital Municipal Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | - Artur Martins Codeço
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Abstract
OBJECTIVE Gold standard treatment of symptomatic hydrocele or spermatocele is surgery. Despite a minor procedure, complications such as bleeding and infections leading to reoperations may be devastating for the patients. In autumn 2018, an accumulation of complications was seen in our department. The aim of this study was to investigate the rate and grade of complications and to identify potential means to reduce these. MATERIALS AND METHODS Patient records of all patients undergoing surgical repair of hydrocele or spermatocele from December 2017 to November 2018 were examined. Results were audited to identify potential causes of complications. The focus was on the perioperative hemostasis and postoperative activity restrictions. The outcome was compared to a consecutive patient series operated the following year. RESULTS Sixty-five men were operated on during the first period. Twenty-two patients contacted the department postoperatively due to swelling or pain, 19 patients were examined at the hospital and six patients were re-operated 1-9 times. The following year, 69 patients were operated on. Of these, 16 patients contacted the department postoperatively (p = 0.17), 13 patients were examined at the hospital, and five patients were re-operated (p = 0.68). There was the same complication rate in patients operated by specialist urologists or supervised younger doctors. However, patients preoperatively examined and informed by a specialized urologist had significantly fewer complications compared to those informed by urological residents and interns (p = 0.012). CONCLUSION Despite the change in patient information and increased awareness of possible complications, a high proportion of patients still were in need of unplanned contact to the department and reoperation.
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Affiliation(s)
- Anna Krarup Keller
- Department of Urology, Regional Hospital West Jutland, Holstebro, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Bjerggaard Jensen
- Department of Urology, Regional Hospital West Jutland, Holstebro, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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13
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Sawers L, Stillwaggon E, Chiphwanya J, Mkwanda SZ, Betts H, Martindale S, Kelly-Hope LA. Economic benefits and costs of surgery for filarial hydrocele in Malawi. PLoS Negl Trop Dis 2020; 14:e0008003. [PMID: 32210436 PMCID: PMC7094819 DOI: 10.1371/journal.pntd.0008003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is endemic in 72 countries of Africa, Asia, Oceania, and the Americas. An estimated 25 million men live with the disabling effects of filarial hydrocele. Hydrocele can be corrected with surgery with few complications. For most men, hydrocelectomy reduces or corrects filarial hydrocele and permits them to resume regular activities of daily living and gainful employment. METHODOLOGY AND PRINCIPAL FINDINGS This study measures the economic loss due to filarial hydrocele and the benefits of hydrocelectomy and is based on pre- and post-operative surveys of patients in southern Malawi. We find the average number of days of work lost due to filarial hydrocele and daily earnings for men in rural Malawi. We calculate average annual lost earnings and find the present discounted value for all years from the time of surgery to the end of working life. We estimate the total costs of surgery. We compare the benefit of the work capacity restored to the costs of surgery to determine the benefit-cost ratio. For men younger than 65 years old, the average annual earnings loss attributed to hydrocele is US$126. The average discounted present value of lifetime earnings loss for those men is US$1684. The average budgetary cost of the hydrocelectomy is US$68. The ratio of the benefit of surgery to its costs is US$1684/US$68 or 24.8. Sensitivity analysis demonstrates that the results are robust to variations in cost of surgery and length of working life. CONCLUSION The lifetime benefits of hydrocelectomy-to the man, his family, and his community-far exceed the costs of repairing the hydrocele. Scaling up subsidies to hydrocelectomy campaigns should be a priority for governments and international aid organizations to prevent and alleviate disability and lost earnings that aggravate poverty among the many millions of men with filarial hydrocele.
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Affiliation(s)
- Larry Sawers
- Department of Economics, American University, Washington, District of Columbia, United States of America
| | - Eileen Stillwaggon
- Department of Economics, Gettysburg College, Gettysburg, Pennsylvania, United States of America
| | | | | | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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14
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Ziegelmann M, Dodge N, Alom M, Wymer K, Kohler T, Trost L. Office-based, Minimal-Incision Modified Fenestration Technique for Symptomatic Hydroceles Under Local Anesthesia. Urology 2019; 135:159-164. [PMID: 31626858 DOI: 10.1016/j.urology.2019.08.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe a minimal-incision modified fenestration technique (MIMFeT) for symptomatic hydroceles utilizing local anesthesia. METHODS A database was maintained for men undergoing in-office MIMFeT for symptomatic hydroceles between June 2015 and August 2018. Following local anesthesia, the hydrocele was sequentially everted through a small upper hemiscrotal incision, excised, and oversewn without delivering the testicle through the wound. Patient demographics and clinical outcomes were subsequently reviewed. RESULTS A total of 54 men (median age 67) underwent MIMFeT under local anesthesia for symptomatic hydrocele. Median estimated hydrocele size was 250 mL (IQR 150;500). Medical comorbidities included coronary artery disease (12%), hypertension (43%), diabetes (13%), and current antiplatelet or anticoagulant (44%) use. Six patients (11%) were deemed unsafe for monitored or general anesthesia. About 48 patients had follow-up data available (median 9 months; IQR 2-18). Mild recurrent scrotal swelling occurred in 4 patients (8%) and 9/48 (18%) experienced postoperative complications including hematoma (n = 2), prolonged pain (n = 3), wound infection (n = 2), and partial incisional separation (n = 2). No patient required repeat hydrocelectomy. CONCLUSION Our early results suggest that the MIMFeT for management of symptomatic hydroceles can be safely performed in the office setting under local anesthesia, including in those patients who are determined to be unsafe for monitored and general anesthesia.
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Affiliation(s)
| | - Nicole Dodge
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Manaf Alom
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Kevin Wymer
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Landon Trost
- Department of Urology, Mayo Clinic, Rochester, MN
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15
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Lei J, Luo C, Zhang Y, Guo Y, Su X, Wang X. A comparison of a novel endoscopic "Su-Wang technique" with the open "Jaboulay's procedure" for the surgical treatment of adult primary vaginal hydrocele. Sci Rep 2019; 9:9152. [PMID: 31235709 PMCID: PMC6591509 DOI: 10.1038/s41598-019-45229-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 05/30/2019] [Indexed: 11/09/2022] Open
Abstract
This paper was aimed to introduce and compare outcomes of a novel “Su-Wang (S-W) technique” for endoscopic treatment of adult hydrocele with conventional open hydrocelectomy with “Jaboulay’s (JA) procedure” regarding adverse events (AEs) and patient satisfaction. In the randomized controlled trial, adult males with primary hydroceles were prospectively assigned into S-W or JA group. We recorded perioperative data and postoperative AEs (incision length, recurrence, hematoma, wound infection and edema vanished time). Finally, a total of 42 adult patients underwent the S-W (n = 22) or JA (n = 20) procedure. Procedures were successfully completed for all 42 patients. No significant differences were found between the two groups regarding age, symptom duration, body mass index, and size of the hydrocele. The incision length was significantly shorter in the S-W group (1.00 ± 0.24 cm) than in the JA group (6.10 ± 1.46 cm). After 6 months’ follow-up, complete data of 90.5% (38/42) were obtained. Severe AEs did not occur in any patient. Recurrence, hematoma, wound infection, edema vanished time values, and satisfaction in the S-W group were superior to those in the JA group. All patients in the S-W group were satisfied with this novel procedure, particularly due to the minimally invasive incision. In conclusion, the novel “S-W technique” for hydrocelectomy provided satisfactory cosmetic results with a 1-cm scrotal incision only. With the near-complete excision of the parietal TV, it resulted in no recurrence, fewer AEs, and rapid postoperative rehabilitation in comparison to the traditional “JA procedure.” The endoscopic “S-W technique” may be a viable alternative for the surgical treatment of adult primary vaginal hydrocele.
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Affiliation(s)
- Junhao Lei
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Chunhua Luo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China.,Operating room, Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Yangyang Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Yuming Guo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China
| | - Xinjun Su
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China.
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, 430071, China. .,Center for Evidence-based and Translational Medicine, Wuhan University, Wuhan, 430071, China.
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16
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O'Kelly F, McAlpine K, Abdeen N, Keays MA, Guerra LA, Leonard MP. The futility of continued surveillance of epididymal cysts - A study of the prevalence and clinico-demographics in pre- vs. post-pubertal boys. Can Urol Assoc J 2019; 13:E398-E403. [PMID: 31039113 DOI: 10.5489/cuaj.5667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The first description of epididymal cysts in children appears from a 1976 case study. Since then, there have been a total of 24 indexed publications relating to pediatric epididymal cysts. Risk factors that may exist for children presenting with epididymal cyst remain unknown, as has the best method of management. And there have not been any studies looking at the cost implications of this diagnosis. The aim of this study was to assess the incidence, clinico-demographics, outcomes, and costs of epididymal cysts in pre-pubertal boys compared with a post-pubertal epididymal cyst cohort, and to assess whether this cohort requires continued surveillance METHODS:: Our institutional ultrasound (US) database was searched for all scrotal US. From these, a filtered, institution review board-approved search was performed for any reports containing the word "cyst." These were then cross-referenced with a retrospective chart review (October 2006 to September 2017). Clinico-demographics, cyst characteristics, and outcomes were analysed for both pre- and post-pubertal boys using descriptive and non- parametric statistical methods RESULTS:: Of 4508 boys undergoing scrotal US during the study period, 191 were indicated to contain cysts. This was manually reduced to 109 scans (2.4%) that met inclusion criteria (85 pre-pubertal; 24 post-pubertal). Thirty-one scans were ordered by urology, including all those with abnormal testicular echotexture (n=5). The average age of the post-pubertal cohort was 15.8 years, compared with 3.8 years in the pre-pubertal cohort. Most (70.5%) epididymal cysts were incidental. There was no difference between the pre- and post-pubertal cohorts in terms of presence of hydrocoeles (p=0.9), symptoms (p=0.9), ordering service (p=0.61), rate of resolution (4.2% vs. 8.2%; p=0.68), or length of followup (4 vs. 4.5 years; p=0.44). Pre- pubertal cysts were significantly smaller in size (3.35 vs. 14.52 mm; p=0.025) and more likely to trigger repeat scanning (67 vs. 10; p=0.008). There were no operative interventions and no subsequent clinical deterioration occurred with observation. At a cost of $71.10 CAD per US, $15 002.10 CAD was expended on epididymal cyst surveillance in direct cost to the healthcare system. CONCLUSIONS Epididymal cysts are comparable in both pre- and post-pubertal boys and can be safely managed non-operatively without the use of continued US surveillance or urological referral. The higher than expected rate of detection may be a result of the improved ultra-resolution of modern scanners. These children should not require continued followup with repeat surveillance imaging solely for epididymal cysts and could be managed in the primary care setting as part of routine clinical examination.
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Affiliation(s)
- Fardod O'Kelly
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Kristen McAlpine
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Nishard Abdeen
- University of Ottawa, Ottawa, ON, Canada.,Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Melise A Keays
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Luis A Guerra
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Michael P Leonard
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
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17
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Lundström KJ, Söderström L, Jernow H, Stattin P, Nordin P. Epidemiology of hydrocele and spermatocele; incidence, treatment and complications. Scand J Urol 2019; 53:134-138. [DOI: 10.1080/21681805.2019.1600582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karl-Johan Lundström
- Institution of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Lars Söderström
- Unit of Research, Education and Development, Östersund Hospital, Östersund, Sweden
| | | | - Pär Stattin
- Institution of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pär Nordin
- Institution of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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18
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Lin L, Hong HS, Gao YL, Yang JR, Li T, Zhu QG, Ye LF, Wei YB. Individualized minimally invasive treatment for adult testicular hydrocele: A pilot study. World J Clin Cases 2019; 7:727-733. [PMID: 30968037 PMCID: PMC6448079 DOI: 10.12998/wjcc.v7.i6.727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/02/2019] [Accepted: 02/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hydrocelectomy is the gold standard for the treatment of hydrocele, but it often causes complications after surgery, including hematoma, infection, persistent swelling, hydrocele recurrence, and chronic pain. In recent years, several methods for minimally invasive treatment of hydrocele have been introduced, but they all have limitations. Herein, we introduce a new method of individualized minimally invasive treatment for hydrocele. AIM To present a new method for the treatment of adult testicular hydrocele. METHODS Fifty-two adult patients with idiopathic testicular hydrocele were included. The key point of this procedure was that the scope of the resection of the sheath of the tunica vaginalis was determined according to the maximum diameter (d) of the effusion measured by ultrasound and the maximum diameter of the portion of the sheath pulled out of the scrotum was approximately πd/2. The surgical procedure consisted of a 2-cm incision in the anterior wall of the scrotum, drainage of the effusion, and dissection of part of the sheath of the tunica vaginalis. After the sheath was peeled away to the predetermined target extent, the pulled-out sheath was removed. The intraoperative findings and postoperative complications were analyzed. RESULTS All patients were successfully treated with a median operation time of 18 min. The median maximum diameter of the effusion on ultrasound was 3.5 cm, and the median maximum diameter of the resected sheath was 5.5 cm. Complications occurred in four (7.7%) patients: two (3.8%) cases of mild scrotal edema, one (1.9%) case of scrotal hematoma, and one (1.9%) case of wound infection. All of the complications were grade I-II. Recurrent hydrocele, chronic scrotal pain, and testicular atrophy were not observed during a median follow-up of 12 mo. CONCLUSION We report a new technique for individualized treatment of testicular hydrocele, which is quantitative and minimally invasive and yields good outcomes. Further study is warranted to verify its potential value in clinical practice.
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Affiliation(s)
- Le Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian Province, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Huai-Shan Hong
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian Province, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Yun-Liang Gao
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Jin-Rui Yang
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - Tao Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian Province, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Qing-Guo Zhu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian Province, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Lie-Fu Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian Province, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
| | - Yong-Bao Wei
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian Province, China
- Department of Urology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
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19
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Comparison of Recurrence and Postoperative Complications Between 3 Different Techniques for Surgical Repair of Idiopathic Hydrocele. Urology 2019; 125:239-242. [DOI: 10.1016/j.urology.2018.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/30/2018] [Accepted: 12/03/2018] [Indexed: 11/18/2022]
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20
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Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions. Int Urol Nephrol 2018; 50:1923-1937. [DOI: 10.1007/s11255-018-1971-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
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21
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Videourology Abstracts. J Endourol 2018; 32:778-780. [PMID: 29901409 DOI: 10.1089/end.2018.29040.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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Turner HC, Bettis AA, Chu BK, McFarland DA, Hooper PJ, Mante SD, Fitzpatrick C, Bradley MH. Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis. Clin Infect Dis 2017; 64:728-735. [PMID: 27956460 PMCID: PMC5404931 DOI: 10.1093/cid/ciw835] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 01/30/2017] [Indexed: 11/25/2022] Open
Abstract
Background. It has been estimated that $154 million per year will be required during 2015–2020 to continue the Global Programme to Eliminate Lymphatic Filariasis (GPELF). In light of this, it is important to understand the program’s current value. Here, we evaluate the cost-effectiveness and cost-benefit of the preventive chemotherapy that was provided under the GPELF between 2000 and 2014. In addition, we also investigate the potential cost-effectiveness of hydrocele surgery. Methods. Our economic evaluation of preventive chemotherapy was based on previously published health and economic impact estimates (between 2000 and 2014). The delivery costs of treatment were estimated using a model developed by the World Health Organization. We also developed a model to investigate the number of disability-adjusted life years (DALYs) averted by a hydrocelectomy and identified the cost threshold under which it would be considered cost-effective. Results. The projected cost-effectiveness and cost-benefit of preventive chemotherapy were very promising, and this was robust over a wide range of costs and assumptions. When the economic value of the donated drugs was not included, the GPELF would be classed as highly cost-effective. We projected that a typical hydrocelectomy would be classed as highly cost-effective if the surgery cost less than $66 and cost-effective if less than $398 (based on the World Bank’s cost-effectiveness thresholds for low income countries). Conclusions. Both the preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health.
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Affiliation(s)
- Hugo C Turner
- London Centre for Neglected Tropical Disease Research, London, UK.,Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, UK.,Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Alison A Bettis
- London Centre for Neglected Tropical Disease Research, London, UK.,Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, UK
| | - Brian K Chu
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Atlanta, GA, USA
| | | | - Pamela J Hooper
- Neglected Tropical Diseases Support Center, Task Force for Global Health, Decatur, Atlanta, GA, USA
| | - Sunny D Mante
- Urology Unit, 37 Military Hospital, Korle-Bu, Accra, Ghana
| | - Christopher Fitzpatrick
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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23
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Sahu M, Anastasiadis E, Katmawi-Sabbagh S. A rare case of Fournier’s Gangrene following a hydrocele repair – should we be using antibiotic prophylaxis routinely in scrotal surgery? JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415814563823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mahua Sahu
- St George’s Healthcare NHS Trust, London, UK
- M.S. and E.A. are joint first authors of this manuscript
| | - Eleni Anastasiadis
- St George’s Healthcare NHS Trust, London, UK
- M.S. and E.A. are joint first authors of this manuscript
| | - Samer Katmawi-Sabbagh
- St George’s Healthcare NHS Trust, London, UK
- M.S. and E.A. are joint first authors of this manuscript
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24
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Alonso-Isa M, Medina-Polo J, Lara-Isla A, Pérez-Cadavid S, Arrébola-Pajares A, Sopeña-Sutil R, Benítez-Sala R, Justo-Quintas J, Gil-Moradillo J, Passas-Martínez JB, Tejido-Sánchez A. Surgical wound infection in urology. Analysis of risk factors and associated microorganisms. Actas Urol Esp 2017; 41:109-116. [PMID: 27567274 DOI: 10.1016/j.acuro.2016.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Open surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. MATERIAL AND METHODS This was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. RESULTS For genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam. In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. CONCLUSIONS We found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance.
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Affiliation(s)
- M Alonso-Isa
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Medina-Polo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - A Lara-Isla
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - S Pérez-Cadavid
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - A Arrébola-Pajares
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - R Sopeña-Sutil
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - R Benítez-Sala
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Justo-Quintas
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J Gil-Moradillo
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - J B Passas-Martínez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
| | - A Tejido-Sánchez
- Servicio de Urología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
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25
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Rowe NE, Martin P, Luke PP. The Western snip, stitch, and tug hydrocelectomy: How I do it. Can Urol Assoc J 2016; 10:E328-E330. [PMID: 27695592 DOI: 10.5489/cuaj.3780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Adult idiopathic hydrocele is a common benign disorder that merits surgical correction when symptomatic. The most popular techniques for repair are plication (Lord's procedure) or excision and eversion of the tunica vaginalis (Jaboulay procedure). Established complications from these traditional repairs include hematoma, recurrence, and infection. These procedures are performed through a scrotal incision. We describe a novel technique of hydrocele repair with gubernaculum preservation through a subinguinal incision. METHODS The novel technique is described in detail. A retrospective review was performed of those patients treated by a single surgeon with the subinguinal technique. Demographic information, indication for treatment, success rate, and details regarding complications were collected. RESULTS We term the technique the "Snip, Stitch & Tug" repair. Through a small subinguinal incision, the tunica is everted posterior to the spermatic cord and testis without resection of the hydrocele sac or division of the gubernaculum. Twelve patients with postoperative followup were identified. Eleven patients (92%) treated with the novel technique were cured. There was only one complication (superficial wound infection) recorded after this technique. CONCLUSIONS Idiopathic hydrocele repair with gubernaculum preservation can be easily and safely performed through a small subinguinal incision.
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Affiliation(s)
- Neal E Rowe
- Division of Urology, University of Ottawa, Ottawa, ON, Canada
| | - Paul Martin
- Western University Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Patrick P Luke
- Western University Schulich School of Medicine and Dentistry, London, ON, Canada
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The Effect of Resident Involvement on Surgical Outcomes for Common Urologic Procedures: A Case Study of Uni- and Bilateral Hydrocele Repair. Urology 2016; 94:70-6. [DOI: 10.1016/j.urology.2016.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 02/19/2016] [Accepted: 03/03/2016] [Indexed: 11/18/2022]
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Hicks N, Gupta S. Complications and risk factors in elective benign scrotal surgery. Scand J Urol 2016; 50:468-471. [DOI: 10.1080/21681805.2016.1204622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Natalie Hicks
- Worcestershire Acute Hospitals NHS Trust, Worcester, UK
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Saber A. Minimally access versus conventional hydrocelectomy: a randomized trial. Int Braz J Urol 2016; 41:750-6. [PMID: 26401869 PMCID: PMC4757005 DOI: 10.1590/s1677-5538.ibju.2014.0248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 09/28/2014] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Aly Saber
- Department of General Surgery, Port-Fouad general Hospital, Port-Fouad, Egypt
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29
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Abstract
INTRODUCTION Antibiotic prophylaxis (AP) is used to minimize infectious complications resulting from interventions. Due to high rates of development of bacterial resistance and side effects, the use of antibiotics must be weighed on the basis of high levels of evidence. The main endpoints of urology AP are the prevention of symptomatic urogenital infections, urosepsis and wound infections. The purpose of this review is to bring objectives, principles and recommendations on urology AP according to the latest scientific evidence. METHODS We carried out a systematic search of MEDLINE, EMBASE and the Cochrane Library using keywords such as AP, prophylaxis, antibiotics, urological surgery, urogenital surgery and the names of the urologic procedures. The results of studies on the AP for each procedure were classified according to the levels of evidence and grades of recommendation from the European Association of Urology. RESULTS There are a number of good quality studies on AP about endoscopic resection of the prostate (TURP), urodynamic studies and transrectal prostate biopsies (trPB). The majority of the studies about other procedures have several limitations (sample size, consistency of definitions, statistics and trial design). Lack of consistency in the definitions of infectious complications does not allow comparison between different studies. CONCLUSIONS The AP is evidence-based is indicated only for TURP and trPB. It is desirable to perform randomized, prospective and controlled trials in order to rationalize the use of antibiotics, improve the cost/benefit ratio and reduce bacterial antibiotic resistances.
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Abstract
There are specific indications in urological procedures [transurethral resection of the prostate (TURP), transurethral resection of the bladder (TURB), endoscopic procedures, and all interventions classified as contaminated or dirty] requiring antibiotic prophylaxis. Most postoperative infections are caused by enterococci of the Gram-positive strains and Enterobacteriaceae of the Gram-negative ones. As reported by the European Center for Disease Prevention and Control (ECDC), there are increasing numbers of antibiotic-resistant pathogens. Most Enterococcus faecium strains are ampicillin-resistant and the Enterobacteriaceae have a high prevalence of extended-spectrum beta-lactamase (ESBL) producers, for which the cephalosporins and penicillins are not drugs of choice. In recent years, there are also increasing numbers of Gram-negative strains that are able to produce carbapenemases and for which the only therapeutic options are gentamicin, tigecycline and colistin. An alternative to these drugs, from a prophylactic point of view, is fosfomycin, an old antibiotic that maintains bactericidal activity against both enterococci and multidrug-resistant Enterobacteriaceae. Available in an oral formulation as trometamol salt, fosfomycin reaches high plasma and urine concentrations, and is therefore a possible alternative to other drugs both for therapy and urological prophylaxis.
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Szabados B, Ketting B, Stief C, Tritschler S. [Scrotal space-occupying lesions]. Urologe A 2014; 53:1383-93; quiz 1393-4. [PMID: 25139774 DOI: 10.1007/s00120-014-3606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Palpable scrotal masses are common scenarios in any clinical practice. These tumors can be painful or painless, can be intratesticular or extratesticular and be cystic or solid. The distinction between benign and malignant tumors is of utmost importance to enable an adequate and differentiated therapy of patients. In clinical diagnostics besides the medical history, examination of the inguinoscrotal region, laboratory diagnostics and ultrasound examination of the inguinoscrotal area play a decisive role. During the last few years the increased use of contrast-enhanced ultrasound has helped clinicians in differentiating scrotal tumors. Malignant tumors are of particular importance because this entity is the most frequent malignant disease among younger men and according to the Robert Koch Institute there are approximately 3900 new patients in Germany each year (Robert Koch Institute, Krebs in Deutschland 2007/2008 and 2012).
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Affiliation(s)
- B Szabados
- Urologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Marchioninstr. 15, 81377, München, Deutschland,
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Metcalfe MJ, Spouge RJ, Spouge DJ, Hoag CC. The use of TPA in combination with alcohol in the treatment of the recurrent complex hydrocele. Can Urol Assoc J 2014; 8:E445-8. [PMID: 25024803 DOI: 10.5489/cuaj.1938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A hydrocele is an abnormal collection of serous fluid in the space between the parietal and visceral layers of the tunica vaginalis. Hydrocele is the most common cause of painless scrotal swelling which affects about 1% of men. Generally, adult hydroceles are idiopathic in origin; however, inguinal surgery, varicocelectomy, infection, trauma and a patent processus vaginalis are each associated with the subsequent development of a hydrocele. Surgical removal of hydroceles is the gold standard of care. However, multiple cases have reported high success rates (ranging from 85% to 96%) using a combination of aspiration and sclerotherapy. We present a case of a patient with recurring complex hydrocele and effective treatment utilizing a combination of thrombolytic therapy, catheter drainage and subsequent alcohol ablation.
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Affiliation(s)
- Michael J Metcalfe
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Rebecca J Spouge
- Undergraduate Department of Anatomy and Cellular Biology, McGill University, Montreal, QC
| | - David J Spouge
- Medical Imaging Department, Lions Gate Hospital, Vancouver, BC
| | - Chris C Hoag
- Department of Urology, Lions Gate Hospital, Vancouver, BC
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Bin Y, Yong-Bao W, Zhuo Y, Jin-Rui Y. Minimal hydrocelectomy with the aid of scrotoscope: a ten-year experience. Int Braz J Urol 2014; 40:384-389. [PMID: 25010305 DOI: 10.1590/s1677-5538.ibju.2014.03.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/22/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since hydrocelectomy remains the choice of surgical treatment of hydrocele and standard surgical procedures may cause postoperative discomfort and complications, a new minimal surgery procedure is needed. The scrotoscope was used for the diagnosis and treatment of intrascrotal lesions. The aim of the study is to illustrate a new minimal hydrocelectomy with the aid of scrotoscope, in an effort to decrease complications. MATERIALS AND METHODS Between 2002 and 2012, 65 patients underwent hydrocelectomy with the aid of a scrotoscope. Before carrying out hydrocelectomy, the scrotoscopy was first used to examine the intrascrotal contents to exclude any pathological lesions. After determining the condition of testis, epididymis and spermatic cord and excluding any other secondary causes of hydrocele, a 2.0 cm scrotal incision was performed. The parietal tunica vaginalis was then grasped out of scrotum, and the mobilized tunica was excised. The scrotoscopy was then performed again to inspect the intrascrotal contents. RESULTS Mean operative time was 35.4 minutes. No major complications occurred during the post-operative follow-up period. Of these 65 patients, 61 underwent scrotoscopy and minimal hydrocelectomy, two patients underwent open hydrocelectomy because thickening of hydrocele wall was identified; two patients with acute inflammation only underwent scrotoscopy. Pathological changes were observed among eight patients. All patients were satisfied with the outcomes. CONCLUSIONS Minimal hydrocelectomy shows commendable results and fewer complications. The combination of minimal hydrocelectomy and scrotoscopy seems to be an encouraging technique. This novel surgical procedure proves to be a viable option for the diagnosis and treatment of hydrocele.
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Affiliation(s)
- Yan Bin
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Yong-Bao
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yin Zhuo
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Jin-Rui
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
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Grabe M. Antibiotic prophylaxis in urological surgery, a European viewpoint. Int J Antimicrob Agents 2011; 38 Suppl:58-63. [DOI: 10.1016/j.ijantimicag.2011.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Reply by the Author. Urology 2011. [DOI: 10.1016/j.urology.2011.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Grabe M, Botto H, Cek M, Tenke P, Wagenlehner FME, Naber KG, Bjerklund Johansen TE. Preoperative assessment of the patient and risk factors for infectious complications and tentative classification of surgical field contamination of urological procedures. World J Urol 2011; 30:39-50. [PMID: 21779836 DOI: 10.1007/s00345-011-0722-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 06/14/2011] [Indexed: 12/21/2022] Open
Affiliation(s)
- Magnus Grabe
- Department of Urology, Skåne University Hospital, S-20502, Malmö, Sweden.
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37
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Microsurgical Spermatocelectomy: Technique and Outcomes of a Novel Surgical Approach. J Urol 2011; 185:238-42. [DOI: 10.1016/j.juro.2010.09.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 11/23/2022]
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Re: A novel pull-through technique for the surgical management of idiopathic hydrocele. S. Y. Onol, Y. O. Ilbey, F. F. Onol, E. Ozbek, B. Arslan and A. Akbas. J Urol 2009; 181: 1201-1205. J Urol 2010; 185:754-6; author reply 756. [PMID: 21172702 DOI: 10.1016/j.juro.2010.09.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Indexed: 11/20/2022]
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Abstract
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.
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40
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Saber A. New minimally access hydrocelectomy. Urology 2010; 77:487-90. [PMID: 20472274 DOI: 10.1016/j.urology.2010.02.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 12/15/2009] [Accepted: 02/15/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To ascertain the acceptability of minimally access hydrocelectomy through a 2-cm incision and the outcome in terms of morbidity reduction and recurrence rate. Although controversy exists regarding the treatment of hydrocele, hydrocelectomy remains the treatment of choice for hydroceles. However, the standard surgical procedures for hydrocele can cause postoperative discomfort and complications. METHODS A total of 42 adult patients, aged 18-56 years, underwent hydrocelectomy as an outpatient procedure using a 2-cm scrotal skin incision and excision of only a small disk of the parietal tunica vaginalis. RESULTS The operative time was 12-18 minutes (mean 15). The outcome measures included patient satisfaction and postoperative complications. CONCLUSIONS This procedure requires minor dissection and minimal manipulation during treatment. It also resulted in no recurrence and minimal complications and required a short operative time.
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Affiliation(s)
- Aly Saber
- Port-Fouad General Hospital, Port-Fouad, Egypt.
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41
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42
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A novel pull-through technique for the surgical management of idiopathic hydrocele. J Urol 2009; 181:1201-5. [PMID: 19152934 DOI: 10.1016/j.juro.2008.10.166] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Indexed: 12/20/2022]
Abstract
PURPOSE Standard surgical procedures for hydrocele may cause postoperative discomfort, temporary limitation of normal activities and complications, such as hematoma, infection, persistent swelling, chronic pain and decreased fertility. We describe a new technique in an effort to decrease these complications. MATERIALS AND METHODS Between April 2004 and December 2006, 21 patients underwent hydrocelectomy, which was bilateral in 1. Through a 15 mm transverse scrotal incision the tunica vaginalis parietalis was identified and grasped. Under gentle traction the sac was dissected bluntly and delivered out of the incision. The fully mobilized tunica was excised by electrocautery at its base, followed by wound closure. Patients were discharged home within 24 hours after surgery and were followed at 6-month intervals for a minimum of 18 months. RESULTS Mean operative time was 27.3 minutes. Postoperatively hematoma or wound infection was not evident in any case. Mild scrotal edema usually subsided within a few days after the procedure. Two patients with persistent edema and hardening of the scrotum required additional bed rest and anti-inflammatory agents. Patients were able to resume normal daily activity an average of 6 days after surgery (range 3 to 21). Cure was achieved in 21 of the 22 hydrocele cases (95%). CONCLUSIONS Our pull-through technique enables the surgeon to remove large hydrocele sacs through a small incision and with minimal dissection under direct vision of the testicular structures, resulting in early recovery and minimal complications. This procedure may be a viable option for the surgical management of idiopathic hydrocele.
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Barnett TE. The Not-So-Hidden Costs of Surgical Site Infections. AORN J 2007; 86:249-58. [PMID: 17683722 DOI: 10.1016/j.aorn.2007.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 03/21/2007] [Accepted: 03/21/2007] [Indexed: 10/23/2022]
Abstract
Surgical site infections (SSIs) adversely affect approximately 500,000 patients annually, causing immense human suffering and taking a huge financial toll on patients, hospitals, insurance companies, and the government. National organizations have made recommendations for reducing SSIs, and many advances have been made in evidence-based practice recommendations that result in fewer SSIs. Reusable electrocardiogram (ECG) lead wires can be a significant source of infection. One medical center near Richmond, VA, began using a disposable ECG lead wire set and wireless transceiver system and subsequently experienced a 40% decrease in SSIs.
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Swartz MA, Morgan TM, Krieger JN. Complications of Scrotal Surgery for Benign Conditions. Urology 2007; 69:616-9. [PMID: 17445635 DOI: 10.1016/j.urology.2007.01.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 09/29/2006] [Accepted: 01/03/2007] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Mia A Swartz
- Department of Urology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Dieckmann KP, Heinemann V, Frey U, Pichlmeier U. How Harmful is Contralateral Testicular Biopsy?—An Analysis of Serial Imaging Studies and a Prospective Evaluation of Surgical Complications. Eur Urol 2005; 48:662-72. [PMID: 16009484 DOI: 10.1016/j.eururo.2005.06.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Accepted: 06/14/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Testicular biopsy has recently gained a role in early detection of testicular cancer. However, its use is still limited mainly because of the fear of untoward consequences. There is a paucity of data regarding unfavourable effects of testicular biopsy. Therefore, we systematically looked to the consequences of the procedure by using clinical observational methods and by modern imaging techniques, respectively. PATIENTS, METHODS 1874 patients with testicular cancer enrolled in a nation-wide contralateral biopsy study were prospectively analyzed in regard to surgical complications. Serial scrotal imaging was performed by scrotal sonography (7.5 Mhz) in 55 patients and by magnetic resonance tomography (1.5 Tesla machine, surface coil, contrast media) in 60 patients, respectively. Imaging examinations were done preoperatively and again at 1 week, 6 months, 12 months, and 18 months respectively. Imaging results were tabulated according to an abnormality score and analyzed by descriptive statistics. RESULTS 52 patients (2.78%; 95% confidence intervals 2.05-3.60) experienced surgical complications. Forty minor complications were managed conservatively. Twelve patients (0.64%) required repeat surgery; 1 testicle was ultimately lost following a sequence of unfortunate events. No pre-existing clinical parameter was associated with complications. One week after surgery, abnormalities were detected in 33% by sonography and in 45% by MRI, respectively. Importantly, the abnormalities resolved in 96% of the cases, as found in both of the imaging modalities in the serial scans. CONCLUSIONS Testicular biopsy is associated with a low burden of clinically significant complications. However, scrotal imaging discloses intratesticular abnormalities in a high proportion of cases one week after the biopsy. These changes represent focal haematoma, oedema or circumscript injury to vascular supply. Most of these lesions resolve with time and are thus not significant, clinically. Evidently, testicular biopsy is a safe procedure provided the vascular anatomy of the testis is respected upon surgery.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Urologische Abteilung, Albertinen-Krankenhaus, Suentelstrasse 11a, D - 22 457 Hamburg, Germany.
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