P112 INCIDENTAL INGUINAL HERNIA IN MEN

Aim “Ultrasound may contribute to establish the cause of nonspecific groin complaints. However, the risk is diagnosing an incidental inguinal hernia whereas the pain has an alternative cause. Overtreatment is to be prevented. Therefore, the aim of this study is to determine the prevalence of a previously unknown inguinal hernia among working-age men without groin complaints.” Material and Methods “A cross sectional study was conducted in healthy men aged 45-67 years. Men with a Body Mass Index (BMI) > 40, a history of groin complaints, a known inguinal hernia or previous inguinal surgery were excluded. Ultrasound of both groins was performed in supine position with and without a Valsalva manoeuvre by a specialised ultrasound technician in consultation with a radiologist. In all groin ultrasounds showing an inguinal hernia, physical examination was executed by a hernia surgeon.” Results “In the months June and November of 2018, 200 groins of 100 men were analysed. In 16 (16%) men an inguinal hernia was found on groin ultrasound (95% confidence interval [8.8 – 23.2]). In 12 men this was a unilateral inguinal hernia and in 4 men a bilateral inguinal hernia. Ultrasound yielded no other pathology.” Conclusions “In a population of men aged 40-67 years without groin complaints, ultrasound detects an inguinal hernia in 16%. Hence, the probability of wrongly attributing groin complaints to an incidental inguinal hernia, diagnosed on ultrasound, is considerable. ”

Characterization of cerebral cortical endocannabinoid levels in a rat inguinal surgery model using liquid chromatography–tandem mass spectrometry (LC–MS/MS)

Background: The brain endocannabinoid system is believed to play significant roles in anti-nociception, fear response, anxiety, and stress. This study investigated the effects of rat inguinal surgery on the levels of endocannabinoids in the cerebral cortex. Aim: The aim of this study was to investigate the effects of acute post-surgical pain on the levels of endocannabinoids in the cerebral cortex. Methods: Quantitation of endocannabinoids in the rat cerebral cortex was performed by liquid chromatography–tandem mass spectrometry. Results: There was no significant difference in the cerebral cortical levels of anandamide (AEA) and 2-arachidonoylglycerol (2-AG) between the sham and surgery experimental groups. However, there were lateralized differences in the levels of these endocannabinoids between the right and left cerebral cortices irrespective of the two groups. The concentrations of AEA and 2-AG were significantly higher in the right cerebral cortex compared to the contralateral cerebral cortex. Conclusion: Acute post-surgical pain did not induce significant alterations in the cerebral cortical levels of endocannabinoids in this study, but the phenomenon of lateralization of the cerebral cortical AEA and 2-AG levels was observed; this latter finding may be related to the role played by endocannabinoids in fear conditioning.

Bilateral abdominoscrotal hydrocele in childhood

Introduction. Bilateral abdominoscrotal hydrocele is a rare entity in childhood. The etiology of abdominoscrotal hydrocele has not been fully clarified. The diagnosis is based on clinical examination, ultrasound and magnetic resonance imaging. The treatment is surgery. Case outline. This paper presents an eight-month-old boy who was admitted at the department of pediatric surgery due to bilateral swellings in the scrotum area. The changes were first noticed when he was three months old and the diagnosis of bilateral abdominoscrotal hydrocele was confirmed after the scrotum ultrasound examination. When the patient was six and eight months old, the symptoms have significantly increased, the magnetic resonance of the abdomen and the lesser pelvis was performed, and the bilateral abdominoscrotal hydrocele was successfully treated with inguinal surgery. The operative and postoperative course was uneventful. Conclusion. In this paper, we presented a rare form of hydrocele in children, as well as diagnostic evaluation that involved ultrasound and magnetic resonance examination. Surgical treatment by inguinal approach is also presented.

Single penile incision for combined hypospadias and inguinal surgery: A comparative study

Introduction: We sought to compare the surgical outcomes of hypospadias repair with correction of inguinal pathology using a single penile incision vs. conventional approach using two incisions.Methods: This is a retrospective study that reviewed all patients who underwent concurrent surgical repair for both hypospadias and inguinal pathologies between January 2003 and November 2015. Patients were classified into Group A, conventional (inguinal or scrotal and penile incision) approach; or Group B, single penile incision approach. Baseline characteristics, including age, degree of hypospadias, type and laterality of inguinal pathology, operative time, and surgical outcomes, were collected. Between groups, variable comparisons were analyzed using Mann-Whitney U-Test and Fisher-exact test. Statistical significant set at <0.05.Results: Seventy-six patients (Group A: 40; Group B: 36) were eligible for study. Baseline characteristics of both groups were comparable, with no significant statistical difference. Overall meanoperative time for Group A was 139.3 ± 56.2 minutes, while Group B was 107.8 ± 46.7 minutes (Z=2.6; U=470.5; p=0.009). Two patients in Group A and two patients in Group B had testicularascension, all of which also had hypospadias-related complications (p=1.0). Hypospadias-related complications in Group A included seven urethrocutaneous fistulae and two repair dehiscence. Eighturethrocutaneous fistulae, one urethral stricture, and two repair dehiscence occurred in Group B (p=0.448). Surgical outcome appearance in both groups were comparable, with no statisticallysignificant difference (p=0.466).Conclusions: Single penile incision for both hypospadias repair and correction of inguinal pathology is a feasible technique and comparable to the conventional approach, with similar surgical outcomes and shorter overall operative time.

The use of TPA in combination with alcohol in the treatment of the recurrent complex hydrocele

A hydrocele is an abnormal collection of serous fluid in the space between the parietal and visceral layers of the tunica vaginalis. Hydrocele is the most common cause of painless scrotal swelling which affects about 1% of men. Generally, adult hydroceles are idiopathic in origin; however, inguinal surgery, varicocelectomy, infection, trauma and a patent processus vaginalis are each associated with the subsequent development of a hydrocele. Surgical removal of hydroceles is the gold standard of care. However, multiple cases have reported high success rates (ranging from 85% to 96%) using a combination of aspiration and sclerotherapy. We present a case of a patient with recurring complex hydrocele and effective treatment utilizing a combination of thrombolytic therapy, catheter drainage and subsequent alcohol ablation.