The application of scrotoscope-assisted minimally invasive excision for epididymal mass: an initial report

Background Traditional open excision of epididymal mass is a non-minimal invasive treatment and brings relatively more postoperative discomfort and complications. To solve this problem, we apply scrotoscope to treat epididymal mass and 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. The primary outcomes included general information, intraoperative data and postoperative data. Results 174 patients underwent SA and other 79 underwent OE. Demographic data was similar between the two groups. Compared with OE surgery, SA could significantly shorten operating time (19.4 ± 4.1 vs 53.8 ± 12.9 minutes), reduce blood loss (5.3 ± 1.5 vs 21.3 ± 5.6 mL) and downsize the operative incision (1.5 ± 0.3 cm vs 4.5 ± 0.8 cm). Additionally, postoperative complications were significantly less occurred in SA group than those in OE (15.5 % vs 21.5%). Patients in SA group had a significant higher overall satisfaction score (94.8 ± 3.7 vs 91.7 ± 4.9) than that in OE group. Conclusion SA is emerging as a novel and effective option with promising perspectives for epididymal mass therapy.

Symptomatic Nephroptosis of the Transplant: First Report of Diagnostic Workup and Successful Minimal-Invasive Treatment

The symptomatic nephroptosis of a kidney transplant is a rare and potentially fatal complication and requires fast diagnosis and treatment. In this report, we describe a case in which intermittent symptomatic hydronephrosis and an increase of the creatinine levels were the leading symptoms of nephroptosis. Moreover, we describe the diagnostic procedures and the successful minimal-invasive treatment. To our knowledge, this is the first report of a symptomatic transplant nephroptosis with consecutive intermittent hydronephrosis and without complications of perfusion solved with a minimal-invasive approach.

Spiculectomy and Orthonyxia for Ingrown Toenails in Patients at Risk; Prospective Observational Cohort Study

Background: Ingrown toenails (unguis incarnatus) are common in persons with Diabetes Mellitus (DM) and Peripheral Arterial Disease (PAD). Minimal invasive treatment of ingrown toenails with spiculectomy and/or orthonyxia might be a promising treatment option. Aim: The aim of this study was to evaluate the efficacy and safety of minimal invasive treatment spiculectomy and orthonyxia Design/Setting: Prospective observational cohort study in an outpatient podiatric clinic Method: Eighty-eight patients with unguis incarnatus were included. Primary outcomes were post-procedural complication rate (infection and hemorrhage), and duration of pain. Patient satisfaction during and after treatment procedure was evaluated. Results: Healing was achieved in 80/88 (90.9%) persons; non-DM group 28/32 (87.5%) vs DM group 51/56 (91.1%); median healing time (21 [14, 42] days) and median treatment time; (56 [30, 86] days) were comparable between the non-DM and the DM groups. (Sixty-four patients (72.7%) had a significant pain reduction within 0-2 days. Median reduction of the VAS score after the first treatment was 2.0 points [0.0, 6.0] (non-DM group 3.5[1.0, 6.0]; DM group 2.0[0.0, 5.0] (p=0.0117)). Forty-eight (94, 4%) patients, 31(96.9%) non-DM group vs 53(94.6%) DM group (p=0.534)) had no limitations in daily activities by the affected toe after 14 days. There were no treatment-related complications like bleeding or infection. Conclusion: Spiculectomy and orthonyxia resulted in a high patient satisfaction. Five of 88 patients needed referral for a partial nail resection. This treatment seems to be very suiTable for persons with a high risk for foot ulcerations.

Management of Pilonidal sinus by partial sinus excision along with Ksharsutra ligation

Pilonidal sinus is a disease of a midline pit situated in mid gluteal cleft at post anal region associated with hairs. Continued sitting, obesity, hairy part, family history which increases the risk of diseases. The prevalence rate in males is more (Male & Female ration 3:1) and incidence is about 26 per 100,000 population. The treatment of pilonidal sinus includes excision and primary closure, excision with reconstructed flap technique etc. In Ayurveda pilonidal sinus is correlated with Nadivrana and it can be considered under shalyaj Nadivrana and Shushruta has explained Shastrakarma with intervention of ksharsutra as one of the treatment of Nadivrana (sinus) excision. In this case study, a case of pilonidal sinus, 21yr / Male patient diagnosed and treated successfully with integrated approach i.e. partial sinus excision adjuvant to Ksharsutra therapy. Partial sinus excision followed by Ksharsutra ligation in the remaining intact tract was performed under local anaesthesia, Patient was asked to attend surgical OPD for dressing on alternate days, and Seitz bath with lukewarm water was advocated before dressing. The Ksharsutra was changed weekly for 3 sitting. To reduce pain, inflammation and control infection, Analgesic,anti-inflammatory and oral antibiotic drug were also prescribed for 5 days. Observation revealed that sinus- track cut through and healed by 4 weeks. Patient was under observation for period of one year to check for recurrence. This innovative partial sinus excision along with Ksharsutra ligation under local anesthesia, proved an effective ,time conserving and non-recurrent, minimal invasive treatment alternative for pilonidal management.