Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2019; 7(6): 727-733
Published online Mar 26, 2019. doi: 10.12998/wjcc.v7.i6.727
Individualized minimally invasive treatment for adult testicular hydrocele: A pilot study
Le Lin, Huai-Shan Hong, Yun-Liang Gao, Jin-Rui Yang, Tao Li, Qing-Guo Zhu, Lie-Fu Ye, Yong-Bao Wei
Le Lin, Huai-Shan Hong, Tao Li, Qing-Guo Zhu, Lie-Fu Ye, Yong-Bao Wei, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, Fujian Province, China
Le Lin, Huai-Shan Hong, Tao Li, Qing-Guo Zhu, Lie-Fu Ye, Yong-Bao Wei, Department of Urology, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China
Yun-Liang Gao, Jin-Rui Yang, Department of Urology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Author contributions: All authors helped to perform the research; Lin L and Hong HS drafted the manuscript; Gao YL and Ye LF reviewed the published articles and analyzed the data; Yang JR and Zhu QG performed the surgeries and participated in the case diagnosis and follow-up; Li T and Wei YB sponsored the study; all authors read and approved the final manuscript.
Supported by the Joint Funds for Innovation of Science and Technology, Fujian Province, No. 2017Y9064.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Fujian Provincial Hospital (No. K2018-12-010).
Informed consent statement: Written informed consent was obtained from all of the patients.
Conflict-of-interest statement: The authors have stated that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong-Bao Wei, MD, Attending Doctor, Shengli Clinical Medical College of Fujian Medical University; Department of Urology, Fujian Provincial Hospital, No. 134, Dong Street, Fuzhou 350001, Fujian Province, China. weiyb2008@163.com
Telephone: +86-591-88217270 Fax: +86-591-88217270
Received: January 14, 2019
Peer-review started: January 15, 2019
First decision: January 26, 2019
Revised: February 2, 2019
Accepted: February 26, 2019
Article in press: February 26, 2019
Published online: March 26, 2019
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.

Keywords: Testicular hydrocele, Individual treatment, Minimal invasion, Complications, Scrotoscope

Core tip: Hydrocelectomy, the gold standard for the treatment of hydrocele, often causes complications. We report a minimally invasive technique for individualized treatment of testicular hydrocele. We retrospectively analyzed the records of 52 adult patients with idiopathic hydrocele who underwent this procedure. The extent of tunica vaginalis sheath resection was based on the maximum hydrocele diameter (d) by ultrasound, with the maximum diameter of the resected portion estimated as πd/2. Only a 2-cm incision was required, through which part of the sheath was pulled, separated, and removed. All patients were successfully treated within a short time and with few complications.