Omental fibroma combined with right indirect inguinal hernia masquerades as a scrotal tumor: A case report

BACKGROUND The most common causes of scrotal enlargement in patients include primary tumor of the scrotum,inflammation,hydrocele of the tunica vaginalis,and indirect inguinal hernia;scrotal enlargement caused by external tumors of the scrotum is rare.The patient had both a greater omentum tumor and an inguinal hernia,and the tumor protruded into the scrotum through the hernia sac,which is even rarer.Moreover,omental tumors are mostly metastatic,and primary omental fibroma is rare.CASE SUMMARY Here,we report a rare case of a 25-year-old young man with scrotal enlargement and pain for 3 months.Preoperative examination and multidisciplinary discu-ssions considered intra-abdominal tumor displacement and inguinal hernia,and intraoperative exploration confirmed that the greater omentum tumor protruded into the scrotum.Therefore,tumor resection and tension-free inguinal hernia repair were performed.The final diagnosis was benign fibroma of the greater omentum accompanied by an indirect inguinal hernia.CONCLUSION This unusual presentation of a common inguinal hernia disease illustrates the necessity of performing detailed history taking,physical examination,and imaging before surgery.

Open Scrotal Trauma Complicated by Testicular Evisceration: An Unusual Injury after a Brawl in 2 Cases

Background: Scrotal trauma is a rare injury, and can compromise reproductive function. If in closed trauma, a morphological assessment of the lesion is usually necessary before treatment, in open trauma otherwise, namely in the case of testicular evisceration, surgical exploration is the rule. Objective: To present the management of open scrotal trauma. Case Presentation: These were two adults aged 42 and 63, admitted for post-traumatic testicular evisceration. One of the patients presented with signs of infection due to a diagnosis delay. Management consisted on surgical exploration, with scrotal debridement and testicular reintegration. The evolution was favourable. Conclusion: Open scrotal trauma is a rare lesion that can cause testicular evisceration. It requires surgical exploration, which should be systematic.

Analysis of the Application and Effect of Homemade Medical Scrotal Support Shorts

Objective:To design and manufacture medical scrotal support shorts for patients with enlarged scrotum and observe its application and effect.Methods:40 patients with enlarged scrotum admitted to the basic surgery department from February 2021 to March 2023 were selected and divided into a test group and a control group according to their time of admission,with the test group using scrotal support shorts and the control group using ordinary shorts without scrotal support pockets or diapers.Results:The complication rate of skin injury in the scrotum and the surrounding inguinal area of the patients in the test group was significantly lower than that of the control group(P<0.01).The medical cost covered by patients in the test group was significantly lower than that of the control group(P<0.01)and the hospitalization satisfaction of the patients in the test group was significantly higher than that of the control group(P<0.01).The difference in the therapeutic effect of the test groups was statistically significant when compared with the control group(P<0.05).Conclusion:Homemade medical scrotal support shorts reduced the local enlargement of the scrotum and bleeding,but also protected the scrotum and the surrounding skin to prevent secondary injuries.The process of patient care was simple and promoted their recovery.The length of hospitalization was also decreased,the burden of health care costs was reduced,and the overall comfort and satisfaction of the patient was improved.

Scrotal Trauma in a Motorcycle Accident Leading to a Partial Orchidectomy: Case Report

Scrotal trauma in motorcycle accidents (STMA) is a rare entity in the literature. In general, trauma to the genitals is not life-threatening. However, STMA can cause rupture of the testis with consequences that can lead to alteration of sexuality and reproduction. We present an STMA case managed in a rural hospital where various types of injuries arise from motorcycle accidents. A 20-year-old man without any previous pathology presented in our hospital with a swollen painful scrotum. One week prior to presentation, the patient with a speeding motorbike drove over a speed bump, and the frame of his motorcycle broke into two halves, violently striking his genitals and causing scrotal trauma. After examination and investigation, patient has consented to scrotal exploration which was carried out. A partial left orchidectomy was performed and the right testicle was healthy. The evolution was favorable and the patient was discharged on the 5th postoperative day. Prognosis at 6 months was good. It is possible that genital trauma related to motorcycle accidents will become more frequent in the future. This underscores the importance of educating motorcyclists to respect the Highway Code;and making practitioners aware of the risk of serious injury in the event of acute scrotal trauma.

Reconstruction of Scrotal and Perineal Defects in Fournier’s Gangrene

Fournier’s gangrene described in 1883 by Jean Alfred Fournier, still poses ethiopathogenic, evolutive and therapeutic problems. This is a therapeutic emergency;early diagnosis, medical and surgical treatments contribute to reducing mortality rate. Tissue defect engendered by infection and/or by its excision requires morphological and functional reconstruction. The choice of the reconstruction technique depends on several parameters: early or delayed coverage, the size of the defect, the local capital skin and the patient’s general condition. Through this study involving 95 cases of scrotal and perineal gangrene treated at the National Center of Burns and Plastic Surgery of Ibn Rochd University Hospital of Casablanca over a period of 10 years (2004-2014), we report our approach in the surgical management of defect secondary to Fournier’s gangrene.

Success of acupuncture treatment in patients with initially low sperm output is associated with a decrease in scrotal skin temperature

Poor spermatogenesis in patients with inflammation of the genital tract is associated with scrotal hyperthermia.These patients can benefit from acupuncture treatment.We conducted a study to verify whether the influence of acupuncture treatment on sperm output in patients with low sperm density is associated with a decrease in scrotal temperature.The experimental group included 39 men who were referred for acupuncture owing to low sperm output.The control group,which comprised 18 normal fertile men,was used to define a threshold(30.5℃)above which scrotal skin temperature was considered to be high.Accordingly,34 of the 39 participants in the experimental group initially had high scrotal skin temperature;the other five had normal values.Scrotal skin temperature and sperm concentration were measured before and after acupuncture treatment.The five patients with initially normal scrotal temperatures were not affected by the acupuncture treatment.Following treatment,17 of the 34 patients with hyperthermia,all of whom had genital tract inflammation,had normal scrotal skin temperature;in 15 of these 17 patients,sperm count was increased.In the remaining 17 men with scrotal hyperthermia,neither scrotal skin temperature nor sperm concentration was affected by the treatment.About 90%of the latter patients suffered from high gonadotropins or mixed etiological factors.Low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia,and,consequently,acupuncture treatment is recommended for these men.

Antegrade scrotal sclerotherapy and varicocele

Antegrade scrotal sclerotherapy is a simple and easy technique for the treatment of varicocele. The success rate varies between 87% and 95%. The initial reflux grade and the number of collateral vessels of the spermatic vein are the most important factors to predict the outcome of the technique. The postoperative complication rate is about 7% and the common ones are scrotal hematoma and epididymo-orchitis of slight severity. Testicular athrophy is a rare event (0.6%). This technique offers a considerable cost reduction compared to other therapeutic options currently available for varicocele.

Unilateral congenital scrotal agenesis with ipsilateral cryptorchidism: A case report

BACKGROUND Congenital scrotal agenesis(CSA)is very rare.There are 11 cases of congenital scrotal agenesis or absence reported in the literature,most of which are bilateral and accompanied by cryptorchidism.Only two cases of which are unilateral scrotal agenesis and not accompanied by cryptorchidism.This is the first reported case of unilateral scrotal agenesis with cryptorchidism and scrotoplasty.CASE SUMMARY A 2-year-old boy was admitted to our hospital with left cryptorchidism and ipsilateral CSA.An innovative method was used in the patient where a scrotal skin pedicle from the right part of scrotal skin was transplanted to the left side.At the same time,descent orchiopexy was performed.At the 4-mo follow-up,the left testicle was located in the scrotum and the size and shape were normal.CONCLUSION For unilateral CSA with ipsilateral cryptorchidism,contralateral scrotal pedicle transplantation and descent orchiopexy appear to be a successful surgical option.

Exogenous gonadotropin releasing hormone (GnRH) modulates scrotal and testicular biometrics, libido, endocrinological and heamatological profiles in Ganjam goat under humid tropical coastal ecosystem of Odisha

Objective:To assess the effect of exogenous gonadotropin releasing hormone(GnRH)in libido,scrotal and testicular biometrics,endocrinological and heamatological profiles of Ganjam goat buck during winter and pre-monsoon seasons.Methods:Forty eight healty Ganjam goat bucks of 3-4 years old were equally divided into the control and treatment groups.The control group received distilled water as placebo,while the treatment group received GnRH injection(4μg Buserelin acetate/mL)once a week for four months.Body weight,scrotal circumference and testicular parameters(testicular volume,testicular weight and testis index),endocrinological profiles[follicle stimulating hormone(FSH),luteinizing hormone(LH),and testosterone],sex behavioural profiles(libido score,mating ability score,and sex behavioural score)and heamatological profiles(red blood cells,white blood cells,haemoglobin,and packed cell volume)were estimated.Results:The libido,scrotal and testicular biometrics,and endocrinological profiles significantly differed between the control and GnRH-treated bucks within and between the seasons within the two groups(P<0.05).Body weight,scrotal circumference,testicular volume,testicular weight,testis index,FSH,LH,testosterone,libido score,mating ability score,sex behavioural score,red blood cells,haemoglobin and packed cell volume were significantly higher in the GnRH-treated bucks compared to the control bucks in pre-monsoon and winter seasons(P<0.05).Body weight,scrotal circumference,testicular volume,testicular weight,testis index,FSH,LH,testosterone,libido score,mating ability score,sex behavioural score,red blood cell counts(in treatment),and haemoglobin were significantly higher in pre-monsoon compared to winter season in the experimental groups(P<0.05).The white blood cell counts neither differed between seasons nor between the two groups.Conclusions:Exogenous GnRH supplementation and pre-monsoon season have higher beneficial effects in improvement of endocrinological profiles with cascading beneficial effects on scrotal circumference,testicular volume,testicular weight,and sex behavioural profiles,which in turn will improve the sperm production and its cryo-survivability and fertility rate in Ganjam goat.

Tobacco Exposed Buccal Mucosa Graft—A Potential Carcinogen for Scrotal Cancer

Squamous cell carcinoma of scrotum is not common. It was the first cancer directly associated with a specific occupation i.e. chimney sweeps. We report a case of squamous cell carcinoma of scrotum developed in a patient of stricture urethra with multiple perineal urinary fistulas treated with lay open urethra with buccal mucosal graft. Tobacco exposed buccal mucosa graft can act as a carcinogen for scrotal cancer in patients with multiple fistula and poor hygiene.

Scrotal Skin Metastases of Renal Cell Carcinoma: A Case Report

Cutaneous metastasis from renal cell carcinoma is believed to be rare. We present a 66-year-old man operated for kidney cancer 20 years ago and has consulted for a scrotal lesion that had started 20 days. The physical examination revealed an erythematous lesion. A biopsy of the scrotal skin was made. We found a scrotal metastasis of renal cell carcinoma.

Scrotal Filariasis, the Importance of Filarial Dance Sign in Scrotal Ultrasound

Objective: To study the value of the filarial dance sign as a diagnostic sign in scrotal ultrasonography in human Bancroftian filariasis. Methods: We studied 3 patients with scrotal pain, with high-resolution ultrasonography (HRUS) of scrotum including power and color Doppler study. All patients underwent peripheral blood smear. Results: Multiple cystic spaces containing motile echogenic twisted tubular structures were observed in the 3 patients. Peripheral blood smears in the 3 patients confirmed the presence of microfilaria. Mild hydrocele in two patients. Conclusions: HRUS is a useful technique for diagnosing scrotal filariasis in symptomatic patients and is very useful in the follow-up treatment.

Ram sperm motility after intermittent scrotal insulation evaluated by manual and computer-assisted methods

Aim:To study whether additional measurements of motility characteristics of spermatozoa by computer assisted semen analysis(CASA)were more sensitive indicators of reduced semen quality than estimates of percentages of motile,rapid or progressive cells.Methods:Intermittent scrotal insulation was applied to 6 rams for 16 h per day for 21 days or to 2 of these for 12 h per day for 28 days in the following year.Semen was collected and evaluated by CASA immediately and either frozen or stored at 30℃ or 5℃ before re-evaluation.Results:Intermittent scrotal insulation caused falls in the percentage of motile,progressive and rapid sperm,as did freezing-thawing and storage at 30℃ or 5℃.Motility characteristics(amplitude of lateral head displacement,mean path velocity,mean progressive velocity and curvilinear velocity),as determined by CASA fell only when the percentage of motile sperm was already reduced.Freezing and thawing or liquid storage of the semen from insulated rams caused a greater fall in the percentage of motile and rapid sperm than control semen,but only affected the motility characteristics when the percentage of motile sperm was already reduced.Conclusion:Intermittent scrotal insulation affected not only the motility of the freshly collected sperm,but also theft ability to withstand the additional stress of storage.The additional data on motility characteristics obtained by CASA appeared to be no more a sensitive indicator than the percentage of motile cells of reductions in semen quality.(Asian J Andro12006 Jul;8:411-418)

Choked Inguino-Scrotal Hernia and Fistulising in the Scrotum at the Hospital Somine DOLO of Mopti:A Clinical Observation

We report a case of grave and rare surgical complications nowadays, which calls out to us on the necessity of a bigger raising sensitization on the coverage of the constrictions hernial at the adult. It is about a case of right inguino-scrotal hernia choked secondarily complicated with a scrotal coecostomie at a 64-year-old man. The delay in the care was in touch with a traditional treatment but also in the poverty of the patient which was a needy the total care of which was assured by the social services department of the hospital. The perioperative exploration found a cecostomy the mucous membrane of which was inverted in the opening of the stoma, an ulceration of the peristomial scrotum with a normal macroscopic aspect of the testicle homolateral. The care was made at single time: parage and scrotal suture more resection segmental of the coecum followed by an anastomosis ileocolic terminoterminal and a cure of the hernia according to Shouldice. The operating suites were simple with ablation of the threads to operating J12 comment and the liberation of the patient the next day. The clinical evolution was satisfactory with a backward movement of 4 years.

高频超声联合超声造影对阴囊肿块良恶性的鉴别价值

目的探究高频超声联合超声造影对阴囊肿块良恶性的鉴别价值,为临床诊治提供参考。方法选取2020年1月至2023年12月郑州大学第一附属医院收治的94例阴囊肿块患者作为研究对象,经病理检查结果分为恶性病变组54例和良性病变组40例,以病理检查结果为金标准,分析高频超声联合超声造影对阴囊肿块良恶性的鉴别价值。结果恶性病变组患者的阴囊肿块长径、短径分别为(5.67±2.85)cm、(3.73±2.04)cm,明显长于良性病变组的(3.84±2.56)cm、(2.31±1.45)cm,恶性病变组患者阴囊肿块位于睾丸位置的比例为96.30%,明显高于良性病变组的35.00%,差异均有统计学意义(P<0.05);高频超声、超声造影诊断阴囊肿块良恶性的准确率分别为75.53%(71/94)、77.66%(73/94),两种诊断方式联合的准确率为94.68%(89/94),明显高于两者单独诊断,差异有统计学意义(P<0.05);良、恶性阴囊肿块的形态、钙化、内部回声、血流比较,差异均有统计学意义(P<0.05),但边界和回声分布比较差异均无统计学意义(P>0.05);良、恶性阴囊肿块的增强强度、增强均匀度、造影剂进入与消退方式、增强形式比较,差异均有统计学意义(P<0.05);阴囊肿块良性病变平均渡越时间为(28.04±8.65)s,明显短于恶性病变的(49.21±15.29)s,开始增强时间为(20.53±7.17)s,明显晚于恶性病变的(17.14±4.91)s,差异均有统计学意义(P<0.05);阴囊肿块良性病变的峰值强度为(50.17±8.64)dB,明显高于恶性病变的(45.41±4.31)dB,AUC值、上升支斜率分别为(1043.82±304.25)mm^(2)、(0.21±0.17)dB/s,明显低于恶性病变的(1400.59±340.08)mm^(2)、(0.90±0.20)dB/s,差异均有统计学意义(P<0.05)。结论高频超声联合超声造影应用于阴囊肿块良恶性鉴别的准确率较高,不同病变性质阴囊肿块的高频超声、超声造影表现有明显差异。

福尼尔坏疽负压清创治疗并阴囊重建一例

福尼尔(Fournier)坏疽是一种罕见且进展迅速的生殖器和会阴组织坏死性筋膜炎,该病起病急、病程短、发展快,严重者向盆腔和下腹壁蔓延,病死率高,为泌尿生殖系统的急重症之一。早期治疗是防治Fournier坏疽的关键。Fournier坏疽治疗有清创后缝合、重建和负压吸引等治疗方式。本病例通过VSD负压吸引以及局部清创缝合,应用常规抗生素的方式进行治疗,效果显著,预后良好。

Antegrade scrotal sclerotherapy of internal spermatic veins for varicocele treatment： technique, complications, and results

Varicocele repair is mainly indicated in young adult patients with clinical palpable varicocele and abnormal semen parameters. Varicocele treatment is associated with a significant improvement in sperm concentration, motility, morphology, and pregnancy rate. Antegrade scrotal sclerotherapy （ASS） represented one of the main alternatives to the traditional inguinal or suprainguinal surgical ligation. This article reviews the use of ASS for varicocele treatment. We provide a brief overview of the history of the procedure and present our methods used in ASS. In addition, we review complication and success of ASS, including our own retrospective data of treating 674 patients over the last 17 years. Herein, we analyzed step by step the ASS technique and described our results with an original modified technique with a long follow-up. Between December 1997 and December 2014, we performed 674 ASS. Mean operative time was 14 min （range 9 to 50 min）. No significant intraoperative complications were reported. Within 90 days from the procedure, postoperative complications were recorded in overall 49 （7.2%） patients. No major complications were recorded. A persistent/recurrent varicocele was detected in 40 （5.9%） cases. In 32/40 （80%） cases, patients showed preoperative grade III varicoceles. In patients with a low sperm number before surgery, sperm count improved from 13 x 106 to 21 x 106 m1-1 （P〈 0.001）. The median value of the percentage of progressive motile forms at 1 h improved from 25% to 45% （P 〈 0.001）. Percentage of normal forms increased from 17% before surgery to 35% 1 year after the procedure （P 〈 0.001）. In the subgroup of the 168 infertile patients, 52 （31%） fathered offspring at a 12-month-minimum follow-up. Therefore, ASS is an effective minimal invasive treatment for varicocele with low recurrence/persistence rate.

超声造影联合彩色多普勒超声鉴别诊断阴囊肿块的临床价值

目的探究超声造影结合彩色多普勒超声鉴别诊断阴囊肿块的临床价值。方法选取2019年3月至2022年3月福建省武夷山市立医院和福建省立医院接诊的80例阴囊肿块患者作为研究对象,患者均于术前进行彩色多普勒超声检查、超声造影检查,以手术病理检查结果为金标准,比较彩色多普勒超声检查、超声造影检查及联合检查的诊断效能。结果手术病理检查结果显示,良性肿块20例,恶性肿块60例。联合检查对阴囊肿块诊断的准确度、特异度均高于彩色多普勒超声检查、超声造影检查,差异有统计学意义(P<0.05)。良性肿块与恶性肿块的形态、边界、回声分布比较差异无统计学意义;良性肿块未见内部血流信号占比高于恶性肿块,差异有统计学意义(P<0.05)。良性肿块造影剂增强强度高、不均匀、增强方式快/同步、消退方式缓慢占比低于恶性肿块,差异均有统计学意义(P<0.05)。结论超声造影联合彩色多普勒超声诊断价值更高,可准确鉴别肿块良恶性质,以指导后续治疗。

Testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children aged<3 years:10-year experience with 1034 cases

This study was performed to summarize our clinical experience with testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children.This study included 1034 children with palpable cryptorchidism from March 2009 to March 2019.A scrotal stria incision was used to perform testicular descent and fixation.Overall,1020 children successfully underwent surgical testicular descent and fixation through a scrotal stria incision,and 14 patients underwent conversion to inguinal incision surgery.All patients were discharged 1-2 days after the operation.During hospitalization and follow-up,55 patients developed complicationsy including 10 patients with testicular retraction,7 with poor healing of the incision,and 38 with a scrotal hematoma.No patients developed testicular atrophy,an in direct ingui nal hernia,or a hydrocoele.Testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children is safe and feasible in well-selected cases.This method has the advantages of no scarring and a good cosmetic effect.

Management of end-stage erectile dysfunction and stress urinary incontinence after radical prostatectomy by simultaneous dual implantation using a single trans-scrotal incision： surgical technique and outcomes

Stress urinary incontinence （SUI） and end-stage erectile dysfunction （ED） after radical prostatectomy （RP） can decrease a patient＇s quality of life （QoL）. We describe a surgical technique involving scrotal incision for simultaneous dual implantation of an artificial urinary sphincter （AUS） and an inflatable penile prosthesis （IPP）. Patients with moderate to severe SUI （〉3 pads per day） and end-stage ED following RP were selected for dual implantation. An upper transverse scrotal incision was made, followed by bulbar urethra dissection and AUS cuff placement. Through the same incision, the corpora cavernosa was exposed, and an IPP positioned. Followed by extraperitoneal reservoirs placement and pumps introduced in the scrotum. Short-term, intra- and post-operative complications; continence status and erectile function; and patient satisfaction and QoL were recorded. A total of 32 patients underwent dual implantation. Early AUS-related complications were： AUS reservoir migration and urethral erosion. One case of distal corporal extrusion occurred. No prosthetic infection was reported. Over 96% of patients were socially the continent （≤1 pad per day） and 〉95% had sufficient erections for intercourse. Limitations of the study were the small number of patients, the lack of the control group using a perineal approach for AUS placement and only a 12 months follow-up. IPP and AUS dual implantation using a single scrotal incision technique is a safe and effective option in patients with SUI and ED after RP. Further studies on larger numbers of patients are warranted.