A PROSPECTIVE STUDY OF HD LAPAROSCOPIC VARICOCELE LIGATION FOR CHRONIC SCROTAL PAIN

Introduction: The prevalence of varicocele is approximately 15% in the general population, and about 2 -10 % of them have chronic scrotal pain. Microsurgical or Laparoscopic testicular vein ligations are preferred surgical options for the patient refractory to conservative therapy. Previous studies have proved the superiority of microscopic surgeries in painful varicocele treatment but the newer HD endo-vision system has improved laparoscopic vision quality signicantly and testicular veins are identied more precisely than ever before. So there is a need to relook the results of laparoscopic varicocele ligation. We have done a prospective observational study to assess patients' perceived changes in scrotal pain scores preand-post HD laparoscopic varicocele ligation. Materials and Methods: This prospective observational study was conducted at a tertiary care referral center. All patients with scrotal pain were evaluated for varicocele between September 2017 and December 2018. Varicocele patients with normal semen count with chronic scrotal pain not responding to conservative therapy were included in the study. The Laparoscopic varicocele ligation surgeries were done by HD endo-vision system under general or spinal anesthesia. Preoperative and post-operative universal pain scores were compared by Student's pair t-test. Result: A total of 34 patients (mean age, 26.2±3.9 years) underwent Laparoscopic varicocele ligation for scrotal pain symptoms. Thirty-two patients (94.11%) reported complete or marked resolution of pain at 3 months follow-up. There was no early or late postoperative complication reported in any study patient. There was a marked improvement in the mean universal pain score, from 5.6 preoperatively to 1.1 postoperatively (p=0.00011). Conclusion: HD Laparoscopic varicocele ligation has a very high success rate with minimal post-operative complications in painful varicocele management.

Diagnosis and management of a scrotal wall mass with the aid of a Scrotoscope: a descriptive observational study

Background and objective: A scrotal wall mass is relatively rare in clinical practice, and very difficult to differentiate from a scrotal content lesion by a physical or ultrasound examination. In this study, we share our experience with the scrotoscope for diagnosing and treating scrotal wall masses. Methods: We retrospectively reviewed all clinical data of scrotal wall mass patients treated by our medical team between June 2015 and July 2019. Diagnostic value was evaluated by comparison with a Doppler ultrasound examination and therapeutic value was evaluated by comparison with traditional surgery. Suspected scrotal tuberculosis or malignant scrotal tumor patients were excluded. Results: Six patients with scrotal wall masses were diagnosed and treated with the scrotoscope. A preoperative ultrasound examination led to an ambiguous or incorrect diagnosis for the origin of the scrotal wall masses in all six cases. The location of all of the masses was confirmed by exploring with the scrotoscope. Three patients were diagnosed with scrotal wall cysts, and one was successfully resected during the procedure; the other two were resected through a small incision. Four scrotal wall solid masses were resected in the other three patients through small incisions after the diagnosis using the scrotoscope. No wound infection, scrotal edema, hematoma, chronic scrotal pain, or injury to the testicles or epididymis were observed. Conclusions: Scrotal wall masses are relatively rare, and it was very difficult to obtain a firm diagnosis of their origin using preoperative ultrasound. The scrotoscope confirmed localization of the tumor, and provided us important information for a minimally invasive resection. Endoscopic resection of a mass can be performed using a scrotoscope.

Diagnosis and Management of Scrotal Wall Mass with the Aid of Scrotoscope: Case Series Report

Background Scrotal wall mass is relatively rare in clinical practice, and very difficult to be differentiated from scrotal content lesions by physical or ultrasound examination. Herein, we would like to share the experiences of scrotoscope in diagnosis and treatment of Scrotal wall masses. Methods Retrospectively reviewed all the clinical data of scrotal wall mass patients treated by our medical team between June 2015 and July 2019. The diagnostic value was evaluated by comparing with Doppler ultrasound examination and the therapeutic value was evaluated by comparing with traditional surgery. Suspected scrotal tuberculosis or malignant scrotal tumor patients were excluded. Results Totally, 6 patients with scrotal wall masses were diagnosed and treated with scrotoscope. Preoperative ultrasound examination leaded to ambiguous or incorrect diagnosis of the origination of scrotal wall masses in all the 6 cases. The location of all the masses was clearly confirmed by scrotoscope exploration. Three patients were diagnosed as scrotal wall cysts, and 1 of them was successfully resected during the procedure, the other 2 were resected through small incision. In the other 3 patients, a total of 4 scrotal wall solid masses were resected through small incision after diagnosis by scrotoscope. There was no wound infection, scrotal edema, hematoma, chronic scrotal pain or injury of testicular or epididymis. Conclusions Scrotal wall masses are relatively rare, and it is very difficult for preoperative ultrasound examination to make a firm diagnosis of its origination. Scrotoscope can confirm the localization of the tumor, and provides us important information for minimally invasive resection. And even in some cases, endoscopic resection of the masses can be performed under scrotoscope.

Etiology of testicular pain 2019: Classification into ten logical subgroups

Background: Testicular pain encompasses a vast medical diagnostic field, with numerous organ and system convergence. Acute testicular pain is a medical emergency that requires accurate evaluation and immediate resolution, whereas chronic testicular pain is enigmatic and requires sound knowledge of the mechanisms of testicular pain and the differential diagnosis. Objective: To review the causes of testicular pain and propose a new etiologic classification consisting of 10 subgroups. Methods: A bibliographic search was carried out utilizing Google and the National Library of Medicine’s PubMed databases to identify original articles and review articles (hard copy or electronic) published on testicular pain, up to March 2020. The search included: MeSH terms: testicular disease (classification, complications, etiology, trauma, microbiology, pathology, pathophysiology, secondary, surgery, treatment) and vasectomy; Non-MeSH terms: acute and chronic orchialgia, scrotalgia, orchidynia, groin pain, epididymalgia, testalgia, chronic testicular pain, chronic scrotal pain syndrome, testicular pain syndrome, epididymal pain syndrome, and post-vasectomy pain syndrome. The initial search produced 625 articles, of which 143 were included in the present review. Results: To better understand testicular pain etiology, 100 possible diagnoses were divided into ten subgroups: infectious, neoplastic, traumatic, torsional, vascular, immunologic, neurologic, pharmacologic, obstructive, and miscellaneous causes. Likewise, treatment can be divided into two main groups, according to therapeutic options: pharmacologic and non-pharmacologic, with the latter subdivided into: noninvasive and the increasingly performed invasive (surgical) alternatives. Conclusions: Testicular pain should be understood as a complex pain syndrome of enigmatic origin. Treatment success depends on the correct identification, from hundreds of possibilities, of the cause of pain. Logical grouping of those possibilities could aid in making the accurate etiologic identification.