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

Triorchidism, a rare anatomical phenomenon has been reported in 24 cases and in only 6 has spermatogenesis occurred. One of these 6 is a 45 year old man who had been bilaterly vasectomized without semen analysis following surgery. The patient's wife, complaining of 4 months amenorrhea, was thought to be pregnant. Examination of the patient revealed 2 lumps detected in the right hemi-scrotum which felt like small testes and did not permit transillumination. The left testis was normal and laboratory tests including excretory urography were normal. Semen analysis revealed normal spermatogenesis. At operation under local anesthesia, 2 vasa deferentia were detected in the right scrotum one of which had been partly resected. At no point did the 2 structures communicate. Resection of the supernumerary vas deferens was completed and biopsies of both right hemiscrotal testes proved normal. Moreover, the testis with intact vas deferens showed normal spermatogenesis. In the left scrotum a second resection was performed on the upper end because it had been only partly resected. Histological examination of the resected vasa deferentia confirmed triorchidism with normal spermatogenesis. This condition may be associated with other congenital abnormalities such as anomalous union between the testis and its epididymis, absence of a rete testis and hernia and hydrocele. Urogenital examinations before vasectomy and post vasectomy semen analyses should be done to prevent similar occurrences.
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PMID:Triorchidism with normal spermatogenesis: an unusual cause for failure of vasectomy. 117 4

Controversy exists regarding the role of the epididymis in testicular descent, as epididymal abnormalities have been reported in 36 to 79% of boys with an undescended testis. Although most undescended testes are associated with a patent processus vaginalis, the incidence of epididymal abnormalities in descended testes with a patent processus has not been reported. Epididymal morphology was examined in 81 boys with a hydrocele/hernia without cryptorchidism (90 testes) and 100 children undergoing orchiopexy (115 testes). Boys with an intra-abdominal undescended testis were excluded. Among 48 boys with a hydrocele/hernia 24 (50%) had an epididymal abnormality if the processus was patent and communicated with the testis (complete hernia), compared to 4 of 42 patients (10%) if there was not a communication with the testis (p less than 0.01). Among the 96 children with an undescended testis 68 (71%) had an epididymal abnormality if there was a patent processus, compared to 3 of 19 boys (16%) without a patent processus (p less than 0.01). These data suggest that most epididymal abnormalities probably do not contribute to testicular maldescent.
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PMID:Epididymal anomalies associated with hydrocele/hernia and cryptorchidism: implications regarding testicular descent. 135 42

Ten male goats and five rams were examined from 11 and 15 weeks of age, respectively, for six months to study the ultrasonic appearance of normal testes and epididymides before and after puberty. Five adult rams with lesions of these organs were also examined. A portable, B-mode, real time scanner fitted with a 7.5 MHz, linear array transducer was used. The testis appeared as a homogeneous and moderately echogenic structure with a centrally located mediastinum testis represented by an hyperechogenic line in images taken in the longitudinal plane and by an almost circular spot in transverse images. The testicular capsule and skin were evident as a distinct hyperechogenic line encircling the testicular parenchyma. A thin non-echogenic layer of fluid, presumably between two layers of tunica vaginalis, was observed. The tail of the epididymis was more heterogeneous and less echogenic than the testis. The epididymal head was also less echogenic but homogeneous in texture, and the body of the epididymis was difficult to image. The pampiniform plexus was easily identified as numerous convoluted sonolucent tubular structures. The ultrasonic images of possible cases of epididymitis, spermatocele, testicular cyst and abscess and scrotal hernia are described.
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PMID:B-mode real time ultrasonographic imaging of the testis and epididymis of sheep and goats. 186 75

Inguinal herniorrhaphy is the most common general surgical procedure performed on the neonate or young pediatric patient. The vas deferens and epididymis are vulnerable to damage, including transection during inguinal exploration or hernia repair. Occasionally the surgical pathologist encounters glandular or tubular epithelial-lined structures in hernia sac tissue. Significant medicolegal implications arise when embryonal remnants are mistakenly identified as true vas deferens or epididymis. This study evaluates the incidence and morphology of these embryonal remnants in hernia sacs from patients of The Children's Hospital, Denver, CO. Embryonal remnants were found in 1.5% of 599 hernia sacs from 427 consecutively operated males aged 37 weeks gestation to 19 years. True vas deferens and epididymis were each identified once for an incidence of 0.33%. The remnants resemble either vas deferens or epididymis. The average remnant diameter is 0.17 mm, and did not change significantly with age. Remnants are surrounded by varying amounts of condensed mesenchyme, trichrome-negative for muscle. The testes and vasa differentia from 32 autopsy cases, ranging in age from 26 weeks gestation to 7 years of age, were used to evaluate normal development and morphology of the vas deferens, epididymis and embryonal remnants. The vas deferens is well developed by 26 weeks gestation. The surrounding smooth-muscle coat does not stain with trichrome until 32 weeks gestation. The vas deferens increases in diameter in a linear fashion during gestation, and continues to increase in diameter in the postnatal period. The vas deferens at 4 months of age is 1.2 to 1.4 mm in diameter; this is also the age of highest incidence of bilateral herniorrhaphies and presence of remnants.
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PMID:Embryonal remnants in inguinal hernia sacs. 231 11

Yearling beef bulls were subjected to a breeding soundness examination (BSE) at completion of performance testing programs at 4 locations over 5 years. Of 862 bulls, 80.1% were classified as satisfactory potential breeders, 7.3% as questionable potential breeders, and 12.7% as unsatisfactory potential breeders. Year (P less than 0.01), location (P less than 0.01), and breed (P less than 0.01) affected the percentage of bulls classified as satisfactory; age of the bulls did not affect this percentage. Adjusted mean scrotal circumference (SC) measurements were 31, 33.2, and 34.8 cm for bulls classified as unsatisfactory, questionable, and satisfactory (P less than 0.01), respectively. Of 109 bulls classified as unsatisfactory, 2.8% were so classified because of poor semen quality alone; 41.3% had no ejaculate in 4 separate electroejaculation attempts. Other abnormalities in these 109 bulls included reproductive tract infections (22%), persistent penile frenulum (16.5%), testicular abnormalities (8.3%), fibropapilloma (1.8%), hernia (1.8%), aplastic epididymis (1.8%), penile abnormalities (1.8%), pendulous sheath (0.9%), and eye abnormalities (0.9%). Age had a significant effect on SC in bulls at 3 locations and on percentage of normal cells, primary abnormalities, and secondary abnormalities as well as BSE score at 1 location. Percentage of primary and secondary abnormalities as well as SC were different across years at 2 locations, and percentage of normal and motile cells as well as BSE score were different across years at 1 location. Breed effects were significant for SC, percentage of primary abnormalities, and BSE score at 3 locations and for percentage of normal and motile cells at 1 location.
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PMID:Breeding soundness examination of yearling beef bulls. 319 58

Magnetic resonance (MR) imaging of the scrotum with a high-resolution surface coil was performed in ten healthy volunteers and 20 patients with scrotal abnormalities demonstrated by high-resolution real-time ultrasound (US). Four patients had an abnormal testis (two tumors, one cyst, one testicular atrophy), and 16 patients had extratesticular abnormalities (four hydroceles, five epididymal cysts, one hernia, and six cases of epididymitis). The normal structures of the scrotum were depicted clearly on MR images. In all cases, the tunica albuginea was easily differentiated from the testis and epididymis. MR imaging enabled one to distinguish intratesticular from extratesticular lesions and to determine whether a lesion was solid or cystic. Complicated and simple fluid collections could also be differentiated. In general, MR imaging and US scanning provided similar information. A potential advantage of MR imaging is in the evaluation of patients with painful scrotal lesions that may limit US evaluation.
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PMID:MR imaging of the scrotum with a high-resolution surface coil. 354 97

The site of obstruction was evaluated by seminal vesiculography in 24 cases of azoospermia with normal testicular biopsies. In 21 cases, obstruction was located at the level of the tail of the epididymis; in 2 cases ejaculatory duct was obstructed; and in 1 case the injected dye was arrested at the level of internal inguinal ring, at the site of previous hernia operation. Vesiculogram in 24 obstructed cases and 4 cases of chronic seminal vesiculities without obstruction showed one normal picture, four with catarrhal inflammation, and the rest with chronic interstitial vesiculities. Radiological study of a patient complaining of aspermia showed multiple congenital anomalies. The high incidence of chronic vesiculities and postinflammatory obstruction is attributed to underlying bilharziasis.
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PMID:Diagnostic value of vaso-seminal-vesiculography. 383 76

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

An exact diagnosis of a congenital absence of the testis (monorchism) may be a problem from the clinical (preoperatively) as well as from the surgical (intraoperatively) point of view. Namely, there has not yet been generally accepted clinical and surgical criteria which could contribute to a doubtless verification of this, not so rare, anomaly in children. After an analysis of their numerous patients, the authors conclude that compensatory hypertrophy of only one intrascrotal testis has been proved as a clinical indicator of a monorchism. Finding a normal inguinal canal without a hernia, spermatic blood vessels blindly ending and vas deferens like a cord during the surgery are reliable signs indicating that there is no testis and that further surgical exploration will not succeed in finding a testis. Even only an operative finding of blindly spermatic blood vessels is sufficient for a definite diagnosis of monorchism, but finding only blindly ending vas deferens or epididymis suggests that one should continue to search for the testis. The upper border of surgical exploration, with the aim to detect or exclude a monorchism, is situated at the lower pole of the kidney.
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PMID:[Contribution to the clinical and intraoperative diagnosis of monorchism]. 688 May 36

Glandular inclusions in inguinal hernia sacs are not frequent. We present six cases of inguinal hernia with this finding, which represents an incidence of 2.6% in males and shows a predominance in the prepubertal stage. Five patients showed cryptorchidism and two cases were related to congenital malformations of the single umbilical artery type and 47,XY chromosome disorder with chromosomal marker. The most important differential diagnosis must be made with normal histological structures such as the vas deferens or epididymis. The mean diameter of the inclusions was 0.1988 mm and there was a significant difference in size between the inclusions and the vas deferens, but not the epididymis. Differentiation from the latter is based on the absence of a well-developed muscular coat in the wall of the inclusions. It is important to recognize that these inclusions can occur in hernia sacs because of the clinical and medicolegal implications that arise if they are confused with true epididymis or vas deferens. They may arise from paratesticular embryonal remnants.
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PMID:Glandular inclusions in inguinal hernia sacs: a clinicopathological study of six cases. 785 6


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