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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Benign mass lesions of the scrotum include spermatocele, hydrocele, varicocele, sperm granuloma after vasectomy, tuberculous masses, and epididymitis. A careful history and physical examination are paramount in making the diagnosis of a scrotal mass. Referral to a urologist is indicated for masses that do not transilluminate, are solid or fixed to the testicle, or for epididymitis that does not respond to antibiotics. Hydroceles associated with significant symptoms or with hernia and varicoceles with symptoms or associated infertility are also reasons for referral. After a sexual history is obtained, lesions of the anogenital area should be carefully inspected. Male partners of women with cervical dysplasia should be examined for evidence of human papillomavirus infection. Treatment of anogenital lesions resulting from a sexually transmitted disease involves both partners.
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PMID:Benign conditions of the external genitalia. 269 49

A thorough explanation of vasectomy is important for couples considering male sterilization in order to distinguish it from castration and to emphasize that the male sexual organs are not the focus of surgery and that there is no change in the hormones controlling male sexual behavior. Patients should be informed of the possibility of spontaneous canalization and the uncertainty of surgical reversal. Sterility after vasectomy is not immediate and a semen analysis should be prepared after 20 ejaculations. 2 successive analyses demonstrating absence of sperm are usually considered to indicate sterility. A complete general and local examination should be performed before vasectomy. Local anesthesia may be used unless the patient is tense or has a varicocele, hydrocele, or a large inguinal or scrotal hernia, in which case general anesthesia and extended surgical facilities are needed. During surgery, the cut ends of the vas should be microcauterized. Spontaneous canalization has occurred despite removal of a section of the vas, coagulation of the lumen with diathermy, and ligation of the ends with silk after turning them back. A recent study of 40 patients showed that placing the 2 cut ends of the vas in different fascial planes did not reduce the risk of spontaneous canalization. Among complications, bruising is common but resolves within a few weeks without treatment. In 1 series, minor hematomas occured in 3-5%, .7% of which required treatment. Large hematomas can require hospitalization or surgical drainage. Infection in the scrotum is potentially serious and occurs in 1.5-4.3% of patients. Sperm granuloma formation is a complication in 20-50% of cases, but a sperm granuloma at the vasectomy site allows decompression of the vas and epididymis, assuring good quality sperm in the vas fluid and improving the prospects for future reversal. Surgery in the genital area can cause castration anxiety even in normal, well-adjusted men, but problems can be prevented by preoperative assessment and counseling. 3 factors are most important to successful reversal: meticulous surgical technique at vasectomy and anastomosis, the length of time since vasectomy, and the presence of a sperm granuloma. It has been suggested that successful reversal is more likely if the vasectomy was performed at a distance from the epididymis, not more than 1 cm of the vas was removed, and the stumps were buried in different fascial planes.
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PMID:Vasectomy. 650 43

From December 1991 to October 1993, 230 laparoscopic operations were performed for urological indications in 205 patients, including 48 children aged between 6 months and 14 years. The rate of intra-operative complications was 2.5%. Intra-operative bleeding (2 patients), cardiovascular insufficiency (1 patient) and pneumothorax (1 patient) necessitated conversion to laparotomy in 4 patients. In another patient intra-operative bleeding occurred, which was successfully managed conservatively by means of blood transfusion. The only serious postoperative complication was a hernia at the entry site of a trocar in a 6-months-old child. A broad spectrum of different operations was performed, including diagnostic and therapeutic laparoscopy for cryptorchism and intersex states, varicocele ligature, pediatric hydrocele (transection of an open processus vaginalis), nephrectomy, ureterectomy, heminephroureterectomy, marsupialization of renal cysts and a lymphocele, pelvic and retroperitoneal lymphadenectomy, adrenalectomy, ureteral re-implantation, pyeloplasty, lumbar sympathectomy and herniotomy. The overall results were very satisfactory.
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PMID:[Laparoscopic interventions in urology]. 787 97

Between January 1992 and June 1993 a total of 36 children underwent laparoscopic surgery in our department. On account of its superior validity, diagnostic laparoscopic surgery for nonpalpable testicles has become a viable alternative to the currently available imaging techniques. Furthermore, diagnostic laparoscopy has the benefit of enabling the surgeon to proceed directly with adequate therapy. Our results gained in 29 pediatric laparoscopic procedures for varicoceles show that it is a very efficient technique that entails few complications. The varicocele persisted in only 1 of the 29 children. In 2 patients laparoscopic nephrectomy was performed, which in technical terms turned out to be less complicated than in adults. Postoperatively, 1 patient developed an incarcerated hernia at the site of trocar insertion. In 2 patients a laparoscopic Lich-Gregoir procedure was performed for vesicoureteral reflux, which, however, cannot yet be considered a viable alternative to the conventional operative techniques.
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PMID:[Laparoscopic interventions in pediatric urology]. 790 71

Intraoperative analgesia was performed using a combination of tramal at a dose of 2-2.5 mg/kg and transcranial electrical stimulation under halothane-nitrous oxide-oxygen mask anesthesia. The study was performed in 12 apparently healthy boys aged 11-13 operated on for II to III degree varicocele. The efficacy of postoperative analgesia was assessed in 68 children aged 8 to 14 subjected to surgery for inguinal and umbilical hernia, varicocele, cryptorchidism. Parameters of central hemodynamics and cardiopolygraphy have been assessed. Intraoperative use of tramal was accompanied by a prompt recovery of the balance between sympathetic and parasympathetic impacts on the heart and stability of central hemodynamic parameters. Postoperative analgesia with tramal is an effective technique enabling a prompt recovery of pain-induced disturbances in the relations between sympathetic and parasympathetic compartments of the autonomic nervous system. Among the adverse events one can name nausea (25%), repeated vomiting (12%) and allergic reactions (1.4%).
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PMID:[Use of tramal during minor surgical interventions in children]. 794 99

Laparoscopic urologic surgery has become increasingly more popular, with the majority of procedures and techniques that have been described based on intraperitoneal experience and anatomic considerations. Urologic surgery, traditionally confined mostly to the extraperitoneal space, has followed these intraperitoneal descriptions when undertaken laparoscopically. Our experience of controlled, laparoscopically monitored dilatation of the extraperitoneal space using a new trocar-mounted balloon dissector can create a working space in a surgical environment familiar to traditional open urologic surgery. We report our initial experience with the preperitoneal distention balloon in 15 patients, emphasizing the technique of extraperitoneal access and the laparoscopic visualization of anatomy relevant to pelvic lymph node dissection, varicocele ligation, nephropexy, and renal biopsy. In this early experience, laparoscopic pelvic lymph node dissection was performed successfully in 7 of 11 patients and in all other patients undergoing the retroperitoneal procedures. Patients with a prior history of hernia repair or appendectomy do not appear to be suitable to this approach when used for pelvic lymphadenectomy. The trocar-mounted balloon device allows direct visualization and control of the dissection process. Avoiding the transperitoneal approach may eliminate many of the complications associated with the transperitoneal access and procedure completion. We conclude that the extraperitoneal technique using this device merits further investigation and more widespread application in the laparoscopic approach to conventional extraperitoneal urologic procedures.
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PMID:Controlled balloon dilatation of the extraperitoneal space for laparoscopic urologic surgery. 794 82

Laparoscopy has been used in pediatric urology for the diagnosis of nonpalpable testes for more than fifteen years. Expansion of pediatric urologic applications of laparoscopic surgical techniques is inevitable with the recent explosion of urologic laparoscopy. While the needs are distinct and at times divergent from those in the adult population, many benefits may be realized with this developing technology in children. Refinement of diagnostic capabilities as well as interventional procedures for the undescended testis are being developed. Increased use for varicocele treatment and intersex evaluation can be expected. Potential applications of laparoscopic techniques for the pediatric urologist include nephrectomy for various benign diseases, ureteral surgery for reflux, bladder autoaugmentation, and hernia repair. Laparoscopic possibilities are limited only by imagination and technology. A skeptical approach is justified and judicious application of these technologies in children is essential. Just as the child is not a small adult, pediatric laparoscopy is not just the use of smaller instruments.
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PMID:Laparoscopy in pediatric urology. 809 68

It is accepted that a range of epididymal anomalies exists in boys with cryptorchidism, varying from ductal patency aberrations to abnormal attachments of the epididymis to the testes or even complete absence. Despite several series characterizing these variations, there are few studies of normal controls for comparison. We document normal epididymal anatomy in boys. During an 18-month period ending in 1991, 94 boys (mean age 4.8 years, range 1 month to 18 years) underwent inguinal or scrotal exploration unrelated to cryptorchidism. Epididymal anatomy was recorded for all exposed testes. Indications for surgery included hydrocele or hernia in 85 boys, torsion in 8 and varicocele in 1. A total of 112 epididymides was examined and the configurations were recorded as type 1-head and tail attachment with a "looped" body in 94 of 112 cases (83.9%), type 2-complete attachment to the testis in 14 (12.5%), type 3-head attachment only in 3 (2.7%), type 4-tail attachment only in 0 (0%), type 5-nonfusion in 1 (0.9%) and type 6-anomalies of ductal patency in 0 (0%). These data reveal that the most common epididymal configuration in normal boys is a looped epididymis with the head and tail attached (84%) followed by complete fusion with the testes (12.5%). Other variations are rare. Absence of the epididymis was not observed.
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PMID:Normal epididymal anatomy in boys. 830 96

After a short exposure of the main clinical and anatomical aspects of the varicocele, as arguments for a wider surgical indication, the authors present the technique of laparoscopic varicocelectomy. The operation implies general anesthesia and may be performed by transperitoneal or properitoneal approach--similar to laparoscopic hernia repair. The main step is the dissection, clipping or bipolar coagulation and section of the varicose spermatic veins.
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PMID:[The laparoscopic treatment of varicocele--a technical note]. 901 65

Polyorchidism is a rare anomaly with approximately 70 cases reported in literature. The exact explanation for the production of polyorchidism is not known, although several theories have been proposed, including anomalous appropriation of cells, initial longitudinal duplication of the genital ridge and transverse division of the genital ridge, either through some local accident of development of peritoneal bands. A functional classification based upon the embryogenic development is provided. Type I: the supernumerary testis lacks an epididymis and vas. The split-off part of the primordial gonad does not communicate with the mesonephric tubules from which the epididymis develops. Type II: the supernumerary testis is linked to the regular testis by a common epididymis and shares a common vas with it. The division of the genital ridge occurs in the region where the primordial gonads are attached to the mesonephric ducts, although the latter are not divided (incomplete division). Type III: the supernumerary testis has its own epididymis but shares the vas with the regular testis. This variant results from a complete transverse division of the genital ridge. In the majority of the reported cases, the patients are asymptomatic and have painless groin or testicular masses. Approximately 50% occur as maldescent or cryptorchidism, and about 30% are associated with indirect hernia. The remaining 20% are discovered variously in relation to torsion, or are associated with hydrocele, epididymitis, varicocele or infertility. Moreover, since there is a 20 to 40 fold increase in testicular malignancy in patients with cryptorchidism compared with the normal testis, tumours of the supernumerary testicles are not unusual. We reported two cases of polyorchidism: the first patient is probably a longitudinal division of the genital ridge and the second is a completely duplication of the primordial gonads. The patients described vague, intermittent, testicular pain. Physical examination and the scrotal sonography and magnetic resonance revealed in the first patient a supernumerary testis in the right scrotal space and in the second a bilateral double testis. In conclusion we think that in the absence of any concomitant disorder and if testicular tumor can be ruled out by ultrasonography and magnetic resonance imaging, surgical exploration with biopsy is unnecessary.
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PMID:[Polyorchidism: 2 case reports]. 947 18


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