4 Months After Hydrocele Surgery Testicle Starting to Swell Again
Int Neurourol J. 2012 Mar; sixteen(1): 51–53.
Persistent Genital Swelling after Hydrocele Ligation in a Patient Receiving Continuous Convalescent Peritoneal Dialysis
Bo Sung Shin
Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
Dominicus-Ouck Kim
Department of Urology, Chonnam National University Medical Schoolhouse, Gwangju, Korea.
In Sang Hwang
Department of Urology, Chonnam National University Medical Schoolhouse, Gwangju, Korea.
European union Chang Hwang
Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
Kyung Jin Ohn
Section of Urology, Chonnam National University Medical School, Gwangju, Korea.
Received 2011 Mar 2; Accepted 2012 Feb xx.
Abstract
We written report a case of genital swelling in a patient receiving continuous ambulatory peritoneal dialysis. A physical examination did not place any defect. Ultrasonography revealed a large hydrocele, and surgical repair brought resolution of the genital swelling. Ii months later, nonetheless, the genital swelling had recurred and was not improved until peritoneal dialysis was replaced by hemodialysis 3 months subsequently.
Keywords: Peritoneal dialysis, Ballocks, Testicular hydrocele
Continuous ambulatory peritoneal dialysis is an accepted treatment of stop-stage renal affliction. In properly selected patients, this method is suitable with minimal complications. Genital edema is a distressing complication that occurs in 4 to 10% of patients on continuous convalescent peritoneal dialysis. It tin can be caused by fluid leakage from a processus vaginalis and also past extravasation of dialysate from the catheter into surrounding tissues [ane]. We report a case of persistent genital edema later on surgical ligation of a processus vaginalis. To resolve the edema, the peritoneal dialysis was somewhen changed to hemodialysis.
CASE REPORT
A 53-twelvemonth-onetime man with cease-stage renal affliction was referred for urological evaluation of massive scrotal edema of 1 month duration. Continuous convalescent peritoneal dialysis had been performed for the preceding 8 months. The patient had no trauma, hematuria, or pain and no signs of overhydration. Blood urea nitrogen and serum creatinine levels were 71.one and xiii.three, respectively. Potassium was slightly elevated. On concrete examination, the abdomen was soft and nontender. The peritoneal catheter was functioning normally. Both the scrotum and the penis were swollen and nontender (Fig. 1). The scrotum transmitted low-cal. Ultrasonography was performed to exclude an inguinal hernia. On ultrasonography, patency betwixt the peritoneal cavity and the correct inguinal canal was revealed and there was a large hydrocele (Fig. 2). All the same, there was no sign of bowel hernia. Peritoneal dialysis was temporarily replaced by hemodialysis to allow the edema to subside. Surgical repair was done. During the operation, the inguinal sac was found and high ligation was performed. The patient had consummate resolution and returned to ambulatory treatment uneventfully at i month afterward the operation. All the same, the patient revisited the dispensary for recurrent scrotal and penile swelling at two months after the performance. Although we tried intermittent peritoneal dialysis with a low dialysate volume, the genital edema was resolved only after hemodialysis was performed nigh 3 months after.
Scrotal edema including swelling of the unabridged penis.
Scrotal ultrasound written report showing a hydrocele and scrotal wall edema.
Discussion
Continuous ambulatory peritoneal dialysis is increasing equally a common handling for end-phase renal illness. Genital edema is a distressing complexity that occurs in four to 10% of patients on continuous ambulatory peritoneal dialysis [2,3]. The incidence of a patent processus vaginalis at autopsy of male cadavers ranges from 15 to 37% [4]. In nearly patients, the genital edema is caused past leakage of fluid through the patent processus vaginalis as a upshot of increased pressure level. During dialysis, fluid enters the sac then leaks out into the surrounding tissues, which eventually results in edema as a result of the increased hydrostatic pressure exceeding the osmotic pressure level of the dialysate. Also, genital edema can result from extravasation of dialysate from the catheter site into the surrounding tissues or from a tear in a hernia sac or processus vaginalis. Abraham et al. [ii] reported a series of patients receiving continuous ambulatory peritoneal dialysis in whom genital swelling developed. One major cause of genital swelling was found to be a break in a processus vaginalis. In our case, an disregarded tear in a processus vaginalis may exist the explanation for the associated penile and generalized genital swelling. Scrotal ultrasound may reveal a simple large hydrocele, but a unproblematic hydrocelectomy would be an inadequate handling. Peritoneograms, abdominal scintigraphy with 99mtechetium, and computed tomography (CT) scanning could be used for correct localization and accurate diagnosis [3,5]. Of these methods, CT scanning is the most useful tool and allows precise localization of the peritoneal defect [1]. In our example, the patient revisited the clinic for recurrent scrotal and penile swelling at 2 months after the operation. The genital edema was resolved merely after hemodialysis was performed 3 months later.
This report calls attention to a persistent manifestation of genital swelling even after hydrocele ligation that should be included in the differential diagnosis of combined processus vaginalis tears or defects other than patent processus vaginalis. Besides, the occurrence of generalized genital swelling including penile swelling in a patient receiving continuous ambulatory peritoneal dialysis suggests the existence of not simply a patent vaginalis, merely also a tear in a processus or hernia sac. Accurate localization of the defect leading to the genital edema is crucial. Our feel suggests that the persistent genital swelling afterwards a hydrocele ligation in patients receiving continuous ambulatory peritoneal dialysis can exist improved with a rapid change from peritoneal dialysis to hemodialysis.
Footnotes
No potential conflict of involvement relevant to this commodity was reported.
References
1. Capelouto CC, DeWolf WC. Genital swelling secondary to leakage from continuous convalescent peritoneal dialysis: computerized tomography diagnosis. J Urol. 1993;150:196–198. [PubMed] [Google Scholar]
2. Abraham G, Blake PG, Mathews RE, Bargman JM, Izatt Due south, Oreopoulos DG. Genital swelling as a surgical complication of continuous ambulatory peritoneal dialysis. Surg Gynecol Obstet. 1990;170:306–308. [PubMed] [Google Scholar]
3. Kopecky RT, Funk MM, Kreitzer PR. Localized genital edema in patients undergoing continuous ambulatory peritoneal dialysis. J Urol. 1985;134:880–884. [PubMed] [Google Scholar]
4. Woolley MM. Ravitch MM, Welch KJ, Benson CD, Aberdeen E, Randolph JG. Pediatric surgery. third ed. Chicago: Twelvemonth Book Medical Publishers; 1979. Inguinal hernia; pp. 815–825. [Google Scholar]
v. Ziegelbaum M, Kovach C, Siegel Due south. The use of 99mtechnetium in the diagnosis of patent processus vaginalis. J Urol. 1988;139:599–600. [PubMed] [Google Scholar]
Articles from International Neurourology Journal are provided here courtesy of Korean Continence Order
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321405/
0 Response to "4 Months After Hydrocele Surgery Testicle Starting to Swell Again"
Post a Comment