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Article
Excision of the Tunica Vaginalis as New Modality for Adult Hydrocelectomy
قص الغلالة الغمدية كتقنية جديدة لأستئصال القيلة المائية لدى البالغين

Author: Abdul Razzaq Al-Salman عبدالرزاق السلمان
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2012 Volume: 9 Issue: 4 Pages: 728-734
Publisher: Babylon University جامعة بابل

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Abstract

Abstract The present article, describe a new surgical technique for hydrocele. This technique involves total excision of tunica vaginalis sac. This surgical method was different from that of the standard operative procedures-Jabouley's and Lord's. Our technique required no suture material in thin tunica vaginalis sac and running suturing for this with thick sac .Thus the technique appeared to be simple and safe, and minimize the postoperative scrotal and testicular swelling ,which is the most troublesome problem following the standard operative procedures. even when carried out by junior surgeon.

الخلاصة تصف الدراسة الحالية تقنية جديدة لعلاج القيلة المائية لدى البالغين وهذه التقنية تتضمن القص الكلي لكيس الغلالة الغمدية وهي طريقة جراحية تختلف عن الطرق الجراحية الشائعة (طريقتي جابولي و لورد). حيث هذه التقنية لا تحتاج الى استخدام الخياطة للغلالة الغمدية الرقيقة وباستخدام خياطة مستمرة لكيس الغلالة الغمدية السميكة لذلك تظهر هذه الطريقة بسيطة وآمنة ومع نسبة ضئيلة من تورم الخصية وكيس الصفن بعد العملية (والذي يعتبر من اهم المشاكل التي تواجه المريض بعد عمليات استئصال القيلة بالطرق الشائعة) حتى ولو تم اجراءها من قبل الأطباء الجدد.


Article
Sub- Inguinal Varicocelectomy in the Treatment of Infertile Males with Varicoceles

Author: Murtadha M.S.Majeed Al-Musafer
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 323-327
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Varicocele is an abnormal dilatation of pampiniform plexus within the spermatic cord. Varicoceles are present in 15% of the normal male population and in up to 35-40% of patients with infertility. In approximately 70-81% of patients with secondary infertility, a varicocele is an underlying cause. It is a disease of puberty and is only rarely detected in boys less than ten years of age.OBJECTIVE:Is to evaluate the sub inguinal approach of varicocelectomy in infertile males with grade II and III varicoceles.METHODS:A total of 150 patients were included in the study from 2004 to May 2010. Their ages ranged from 18 to 42 years. Fifty patients (33.3%) had grade II while 100 (66.6%) patients had grade III varicoceles. All the patients had history of more than one year infertility (ranging from 14 to 36 months) and all of them were sexually competent. Physical examination was performed with no apparent other clinical cause of infertility. Although varicoceles were diagnosed primarily by physical examination, color Doppler ultrasound was done for further documentation of the patient's condition. Only patients with grade II and grade III primary varicoceles were included in the study with exclusion of those with grade I varicoceles. Seminal fluid analysis and hormonal assay were done for all patients. Any patient with sperm concentration below 10 millions / milliliter was also excluded. Sub inguinal varicocelectomy was done for each patient. The operative time ranged from 20-25 minutes. The patients were followed for one year.RESULTS:The overall pregnancy rate at one year was 66, 6 % .The time from the operation till pregnancy was ranged from 4 to 12 months. Ten patients ( 6.6% ) developed recurrence , 2 patients ( 1.3% ) developed scrotal pain for 3 weeks postoperatively and then disappeared , and only 4 patients ( 2.6 % ) developed hydrocele .CONCLUSION:Whereas most male infertility surgeons now use the microsurgical approach, varicocele repairs can be achieved with successful results and minimal complications without microsurgery as long as they are carefully performed. Although microscopic sub inguinal varicocelectomy is better than non microscopic one, the later can be done successfully with shorter operative time


Article
Prophylaxis of Hydrocele after Varicocelectomy

Authors: Hussein Oudah Al-Jasmawy --- Adel Ibraheem Muhi --- Ali Abdulhaleem Kadhim
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2015 Volume: 12 Issue: 3 Pages: 792-796
Publisher: Babylon University جامعة بابل

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Abstract

Hydrocele comes on the top of complications after surgical repair of varicocele.To evaluate the efficacy of selective vein ligation procedure by the aid of loupe optical magnification with creation of a window in tunica vaginalis to prevent the formation of hydrocele after varicocelectomy.Two hundred patients with varicocele treated were analyzed. A study is applied on two patient groups, of each one hundred patient. Group 1: Conventional procedures for varicocele, without use of optical magnification including: Paloma, inguinal mass ligation and subinguinal selective ligation, and a group 2; underwent subinguinal selective varicocelectomy with the aid of optical magnifications and completed by creation of a window in tunica vaginalis. Hydrocele, as a complication following varicocelectomy, is reduced from 15% in group 1 to 3% in group 2.By theaid of optical magnification with creation a window in tunica vaginalis,a significant decrease in incidence of post varicocelectomy hydrocele in group 2 was found. So this procedure seems effective and we recommend its addition to the standard procedures of varicocelectomy.


Article
EFFECT OF HYDROCELECTOMY ON TESTICULAR SIZE IN ADULT PATIENTS WITH UNILATERAL IDIOPATHIC HYDROCELE (HYDROCELECTOMY & TESTICULAR SIZE)
تاثیر عمیلة رفع القیلة المائیة علي حجم الخصیة للمرضى البالغین المصابین بقیلة مائیة احادیة الجانب مجھولة السبب

Author: Mohammed Abd Kadhim محمد عبد كاظم
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2008 Volume: 6 Issue: 3 Pages: 91-98
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background: The testes are paired organs that lie within the scrotal sac which is subdivided into two compartments by the scrotal septum,and supported by the tunica vaginalis, which is formed of 2 layers. In most normal subjects,small amount of fluid (1-2mL) can be seen within the leaves of the tunica vaginalis. Hydrocele is exist when an excessive amount of fluid is present. Hydrocele is divided into congenital & acquired. Virtually all hydroceles are congenital in neonates and infants, whereas most of the acquired causes of hydrocele are idiopathic. Other causes of acquired hydrocele include: infection, tumors, trauma, and torsion and trradiation therapy. Hydrocele is the most common cause of painless scrotal swelling.Objective: to determine whether there is an effect of hydrocelectomy on testicular size in adult patients with unilateral idiopathic hydrocele.Patients and Methods: This prospective study was done in the ultrasound unit of ALkadhimyia teaching hospital from the period of July 2006 to November 2007. Thirty three patients with a mean age of 35.8 years who had unilateral idiopathic hydrocele and who underwent unilateral hydrocelectomy were included in the study. The ultrasound examination was done in the supine position & included the preoperative evaluation of the hydrocele, & assessment of the testicular volume of the involved and uninvolved sides before and after surgery. Calculating the testicular volume from the formula: volume = length × width × depth × 0.52.Results: a statistically significant differences in the testicular volumes between the normal side (mean ± SD, 18.42± 2.02 mL) and the side with the hydrocele (23.23± 2.31 mL) before surgery (p < 0.001), and in the volumes in the side with the hydrocele before (23.23± 2.31 mL) and after (17.77± 2.22 mL) surgery (p <0.001). No such difference in volume was seen in the normal side before (18.42± 2.02 mL)and after (18.46± 2.05 mL) surgery (p =0.200). Also no significant difference in the testicular volumes of the normal side (18.46± 2.05 mL) and the side with hydrocele (17.77± 2.22 mL) after surgery (p = 0.150). The mean reduction in volume in the testis with the hydrocele after hydrocelectomy was 23.22%.Conclusions: There is an association between the development of an idiopathic hydrocele and testicular size. We believe that the increment in the volume is due to an increase in the impedance to venous and lymphatic flow. Surgeons should be aware that there is a decrease in testicular volume after hydrocelectomy so they do not misdiagnose this change as post-operative trauma or atrophy often in correlation with clinical symptoms, clinical examination & assessment.

خلفية الدراسة: ان الخصيتين هما أعضاء مزدوجة توجد داخل كيس الصفن و الذي ينقسم الى جزئين بوساطة حاجز كيس الصفن. مثبتتان بواسطة الغلالة الغمدية و التي تتكون من طبقتين. في معظم الاشخاص توجد كمية قليلة من المادة السائلة (حوالي 1-2 مل) بين طيات الغلالة الغمدية.القيلة المائية تتكون من تجمع كمية كبيرة من السوائل. تقسم القيلة المائية الى نوعين: متوارثة و مكتسبة. ان الغالبية العظمى لحالات القيلة المائية تكون متوارثة في الاطفال وحديثي الولادة ، بينما القيلة المكتسبة تكون في الغالب مجهولة السبب. الاسباب الاخرى للقيلة المائية المكتسبة هي: الالتهاب، الاورام، الشدة الخارجية، التواء الخصية و التعرض للاشعاع. القيلة المائية هي السبب الاكثر شيوعا لانتفاخ كيس الصفن غير المصحوب بالم.هدف الدراسة: هو تحديد تاثير عميلة رفع القيلة المائية على حجم الخصية للمرضى البالغين المصابين بقيلة مائية احادية الجانب مجهولة السبب.المرضى و طرق العمل: هذه الدراسة المستقبلية اجريت في وحدة السونار لمستشفى الكاظمية التعليمي للفترة من تموز 2006 لغاية تشرين الثاني 2007 تضمنت الدراسة 33 مريضا بمعدل عمر 8و35 سنة و الذين يعانون من قيلة مائية احادية الجانب مجهولة السبب والذين اجريت لهم عملية رفع القيلة المائية. تم اجراء فحص السونار في وضع الاستلقاء على الظهر وتضمن الفحص تقييم القيلة المائية و قياس حجم الخصية للجهة المصابة و الجهة السليمة قبل و بعد العملية. تم حساب حجم الخصية من المعادلة التالية: الحجم=الطولxالعرضxالعمقx 0.52.النتائـج: كان هنال فرقا احصائيا مهما لحجم الخصية بين الجهة السليمة و الجهة المصابة بالقيلة المائية قبل العملية (p < 0.001) و بين الجهة المصابة بالقيلة المائية قبل و بعد العملية (p < 0.001). لم يكن هذا الفرق موجودا في الجهة السليمة قبل و بعد العملية (p = 0.200). ايضا لم يكن هناك فرق احصائي مهم لحجم الخصية بين الجهة السليمة و الجهة المصابة بعد العملية (p = 0.150). كان معدل النقص في حجم الخصية للجهة المصابة بالقيلة المائية بعد العملية هو 22و23%.الاستنتاجات: وجود علاقة بين تكون القيلة المائية و حجم الخصية قبل و بعد العملية. نعتقد ان الزيادة في حجم الخصية هو وجود مقاومة للتدفق الوريدي و اللمفاوي. يجب ان يدرك الجراحون ان هناك تناقص في حجم الخصية بعد العملية وان لا يشخصوا ذلك بصفة ضرر ناتج عن العملية او ضمور في الخصية متوافقا مع مقارنة الاعراض و الفحص السريري.مفتاح الكلمات: عملية رفع القيلة المائية، حجم الخصية، قيلة مائية مجهولة السبب.

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