BACKGROUND Hydrocelectomy is the gold standard for the treatment of hydrocele,but it often causes complications after surgery,including hematoma,infection,persistent swelling,hydrocele recurrence,and chronic pain. In ...BACKGROUND Hydrocelectomy is the gold standard for the treatment of hydrocele,but it often causes complications after surgery,including hematoma,infection,persistent swelling,hydrocele recurrence,and chronic pain. In recent years,several methods for minimally invasive treatment of hydrocele have been introduced,but they all have limitations. Herein,we introduce a new method of individualized minimally invasive treatment for hydrocele.AIM To present a new method for the treatment of adult testicular hydrocele.METHODS Fifty-two adult patients with idiopathic testicular hydrocele were included. The key point of this procedure was that the scope of the resection of the sheath of the tunica vaginalis was determined according to the maximum diameter(d) of the effusion measured by ultrasound and the maximum diameter of the portion of the sheath pulled out of the scrotum was approximately πd/2. The surgical procedure consisted of a 2-cm incision in the anterior wall of the scrotum,drainage of the effusion,and dissection of part of the sheath of the tunica vaginalis. After the sheath was peeled away to the predetermined target extent,the pulled-out sheath was removed. The intraoperative findings and postoperative complications were analyzed.RESULTS All patients were successfully treated with a median operation time of 18 min.The median maximum diameter of the effusion on ultrasound was 3.5 cm,and the median maximum diameter of the resected sheath was 5.5 cm. Complications occurred in four(7.7%) patients: two(3.8%) cases of mild scrotal edema,one(1.9%) case of scrotal hematoma,and one(1.9%) case of wound infection. All of the complications were grade I-II. Recurrent hydrocele,chronic scrotal pain,and testicular atrophy were not observed during a median follow-up of 12 mo.CONCLUSION We report a new technique for individualized treatment of testicular hydrocele,which is quantitative and minimally invasive and yields good outcomes. Further study is warranted to verify its potential value in clinical practice.展开更多
BACKGROUND Renal papillary necrosis(RPN)is a rare disease.It is difficult to distinguish RPN with urinary tract obstruction from upper urinary tract occupying lesions.We reported a case of RPN and made a definite diag...BACKGROUND Renal papillary necrosis(RPN)is a rare disease.It is difficult to distinguish RPN with urinary tract obstruction from upper urinary tract occupying lesions.We reported a case of RPN and made a definite diagnosis largely based upon its endoscopic characteristics.CASE SUMMARY A 75-year-old woman presented with right flank pain,visible hematuria and a body temperature greater than 39℃.Laboratory investigations revealed leukocytosis with 12.7×10/L white blood cells and 93.6%neutrophils.Blood creatinine was 333 umol/L.Ultrasonography showed hydronephrosis of the right kidney and a right distal ureteric lesion.After urgent placement of right ureteral double J stent and treatment with antibiotics,the patient’s symptoms and the blood abnormalities improved rapidly.Computed tomography urography showed the presence of multiple occupying lesions in the right pelvis.The endoscopic ureteroscopy revealed that renal papillary necrosis and the subsequent migration of sloughed papillae into the upper ureter and calyces.The sloughed papillae appeared like“cottons”,which were whitish,soft,and irregularly-shaped without blood supply.In addition,the necrotic and sloughed renal papillae were removed by flexible ureteroscopy to prevent further obstruction.Pathological examination found that infarcted renal papillae were associated with inflammatory exudation.Three months after discharge,follow-up computed tomography urography showed no obvious lesions in the renal pelvis.CONCLUSION This case revealed the endoscopic features of RPN.In addition,flexible ureteroscopy proves to be vital in diagnosis and treatment of RPN.展开更多
基金Supported by the Joint Funds for Innovation of Science and Technology,Fujian Province,No.2017Y9064
文摘BACKGROUND Hydrocelectomy is the gold standard for the treatment of hydrocele,but it often causes complications after surgery,including hematoma,infection,persistent swelling,hydrocele recurrence,and chronic pain. In recent years,several methods for minimally invasive treatment of hydrocele have been introduced,but they all have limitations. Herein,we introduce a new method of individualized minimally invasive treatment for hydrocele.AIM To present a new method for the treatment of adult testicular hydrocele.METHODS Fifty-two adult patients with idiopathic testicular hydrocele were included. The key point of this procedure was that the scope of the resection of the sheath of the tunica vaginalis was determined according to the maximum diameter(d) of the effusion measured by ultrasound and the maximum diameter of the portion of the sheath pulled out of the scrotum was approximately πd/2. The surgical procedure consisted of a 2-cm incision in the anterior wall of the scrotum,drainage of the effusion,and dissection of part of the sheath of the tunica vaginalis. After the sheath was peeled away to the predetermined target extent,the pulled-out sheath was removed. The intraoperative findings and postoperative complications were analyzed.RESULTS All patients were successfully treated with a median operation time of 18 min.The median maximum diameter of the effusion on ultrasound was 3.5 cm,and the median maximum diameter of the resected sheath was 5.5 cm. Complications occurred in four(7.7%) patients: two(3.8%) cases of mild scrotal edema,one(1.9%) case of scrotal hematoma,and one(1.9%) case of wound infection. All of the complications were grade I-II. Recurrent hydrocele,chronic scrotal pain,and testicular atrophy were not observed during a median follow-up of 12 mo.CONCLUSION We report a new technique for individualized treatment of testicular hydrocele,which is quantitative and minimally invasive and yields good outcomes. Further study is warranted to verify its potential value in clinical practice.
文摘BACKGROUND Renal papillary necrosis(RPN)is a rare disease.It is difficult to distinguish RPN with urinary tract obstruction from upper urinary tract occupying lesions.We reported a case of RPN and made a definite diagnosis largely based upon its endoscopic characteristics.CASE SUMMARY A 75-year-old woman presented with right flank pain,visible hematuria and a body temperature greater than 39℃.Laboratory investigations revealed leukocytosis with 12.7×10/L white blood cells and 93.6%neutrophils.Blood creatinine was 333 umol/L.Ultrasonography showed hydronephrosis of the right kidney and a right distal ureteric lesion.After urgent placement of right ureteral double J stent and treatment with antibiotics,the patient’s symptoms and the blood abnormalities improved rapidly.Computed tomography urography showed the presence of multiple occupying lesions in the right pelvis.The endoscopic ureteroscopy revealed that renal papillary necrosis and the subsequent migration of sloughed papillae into the upper ureter and calyces.The sloughed papillae appeared like“cottons”,which were whitish,soft,and irregularly-shaped without blood supply.In addition,the necrotic and sloughed renal papillae were removed by flexible ureteroscopy to prevent further obstruction.Pathological examination found that infarcted renal papillae were associated with inflammatory exudation.Three months after discharge,follow-up computed tomography urography showed no obvious lesions in the renal pelvis.CONCLUSION This case revealed the endoscopic features of RPN.In addition,flexible ureteroscopy proves to be vital in diagnosis and treatment of RPN.
