719 IS PREOPERATIVE ULTRASONOGRAPHY USEFUL TO DETECTING CONTRALATERAL METACHRONOUS COMMUNICATING HYDROCELE OR INGUINAL HERNIA IN BOYS?

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A prospective evaluation of “acute scrotum” by colour-coded duplex sonography: Its value and potential pitfalls in the diagnostic management Altinkilic B.M., Pilatz A., Köhler E.U., Weidner W. University of Giessen, Dept. of Urology and Pediatric Urology, Giessen, Germany Introduction & Objectives: The differential diagnosis of “acute scrotum” is challenging. In case of testicular torsion surgical therapy is required while in hydatid torsion or epididymitis conservative management may be justified. We analyzed the efficacy of colour-coded duplex sonography (CCDS) to improve diagnostics in such cases. Material & Methods: We evaluated the outcome of the standardized diagnostic investigation and therapy in 165 consecutive cases (mean age 15.3 years, 0 to 44) with an acute scrotum. CCDS was performed in all cases to detect intratesticular perfusion. Subsequently, the diagnosis was confirmed by explorative surgery. Results: The following table compares the intra-operative findings with the results of CCDS: INTRAOPERATIVE DIAGNOSIS: Testicular torsion Trauma with test. rupture Hydatid torsion Epididymitis Successful man. detorsion Trauma Hydrocele Varicocele

WITHDRAWN

Pre-operative CCDS: neg., n=99 79 1 11 4 2 1 1 0

Pre-operative CCDS: pos., n=66 0 0 53 10 0 2 0 1

In the 99 patients with negative intratesticular perfusion, testicular torsion was the underlying disease in 79 cases, trauma with rupture in one case. In the remaining 19 cases a decreased testicular perfusion as documented with prior CCDS could not be confirmed by explorative surgery. In all 66 patients with normal intratesticular blood flow pre-operatively, testicular torsion was excluded. Conclusions: CCDS appears to be a useful tool in the pre-operative evaluation of acute scrotum. Nevertheless, it correctly predicted the need for an operation only in 80 of 99 patients (80.8%) in case of missing testicular perfusion. Atrophic or small testis as well as maldescencus may reduce CCDS accuracy. In contrast to this experience, in case of positive intratesticular perfusion as seen with prior CCDS in 66 patients, testicular torsion was not found intra-operatively. Thus, the doctrine to expose the testis in all cases of acute scrotum can not be confirmed by our results. Our data provide clear evidence that operation seems to be unnecessary in case of a definite intratesticular perfusion documented by CCDS.



719

Is preoperative ultrasonography useful to detecting contralateral metachronous communicating hydrocele or inguinal hernia in boys? Seo J.H.1, Kim G.N.1, Kwon T.G.2, Park D.S.3, Hong J.Y.3, Seo Y.J.4, Kim K.H.4 Pochon Cha University, Dept. of Urology, Kyeongsangbukdo, South Korea, Kyungpook National University, Dept. of Urology, Daegu, South Korea, 3 Pochon Cha University, Dept. of Urology, Kyeonggido, South Korea, 4 Dongguk University, Dept. of Urology, Kyeongsangbukdo, South Korea 1

2

Introduction & Objectives: To analyze the value of preoperative ultrasonography (USG) in identification of a contralateral metachronous communicating hydroceles or inguinal hernias in boys. Material & Methods: Between May, 2001 and November, 2007, 309 patients (211 hydrocele and 198 inguinal hernia) with unilateral inguinal hernia or hydrocele, received preoperative USG on both groin was analyzed about recurrence of contralateral metachronous hydrocele or inguinal hernia by retrospective chart review. Results: The mean age was 50.5±37.1 months. Right hydrocele or inguinal hernia was 254 patients, left was 155. Thirty patents (6.7%) were developed in contralateral side metachronously at a median interval of 21.2 months although there was no evidence of contralateral patent processus vaginalis by USG. The contralateral incidence of right hydrocele or inguinal hernia was 19 of 254 (7.5%) and that of left was 11 of 189 (7.1%). There was no significant difference statistically. Conclusions: USG is non-invasive and highly accurate diagnostic tool. But, 6.7% of contralateral hydrocele or inguinal hernia was developed even though USG showed no evidence of contralateral patent processus vaginalis. More accurate diagnostic tool is needed for prevention of contralateral recurrence.

Eur Urol Suppl 2009;8(4):300



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Adolescent varicocele may impair testicular growth durin puberty. Prospective cross-sectional study Pfeiffer D.1, Berger J.2, Tauber R.1, Gross A.1 Asklepios Clinic Barmbek, Dept. of Urology, Hamburg, Germany, University Hospital Hamburg-Eppendorf, Center of Experimental Medicine, Institute of Medical Biometry and Epidemiology, Hamburg, Germany

1 2

Introduction & Objectives: We prospectively assessed in male students in the 4th and 8th forms to see whether varicoceles affect testicular growth. Material & Methods: Ultrasound measurements were done in 700 boys with a left or bilateral varicoceles to define the testicular size according the pubertal stage. 257 children and 287 adolescents with unilateral varicoceles were assessed for testicular size discrepancies in relationship to the varicocele size. The varicocele degree was determined according to the WHO (1993). Venous reflux was proven in upright and supine position by CW-Doppler sonography. The ultrasonographic volume of the testis was calculated with the formula V=8A2/3pL. Results: Rapid testicular growth occurred at puberty. The testicular volume increased from median 0.6 ccm (range, 0.4- 1.0) in children to 8.1 ccm (5.510 ccm) in adolescents. Varicocele-related disceprancies of the testicular size were only detectable in adolescents. By comparing the frequencies and extent of ipsilateral growth failures, significant differences were noted between the varicocele grades (p< 0,0005). Accordingly, volume differentials ³ 15% were associated with the varicocele grade (p< 0,0001). Conclusions: Varicoceles may impair the rapid testicular growth at puberty. The severity of volume loss depends on the varicocele size.