PURPOSE: Preoperative ultrasonography (USG) in pediatric inguinal hernia has controversy. In this study, we analyzed the cases of pediatric inguinal hernia with/without preoperative USG and discussed whether USG is necessary. METHODS: We reviewed medical records of 1,441 patients who underwent inguinal hernia repair in Seoul National University Children's Hospital between January 2011 and August 2016 retrospectively. RESULTS: Male were 69.3% and age at operation was 37.8±36.5 months old. There were 150 patients (10.4%) performed USG preoperatively. The department ordered to perform USG included department of surgery (n=71), emergency medicine (n=42), pediatrics (n=26), urology (n=10) and outside hospital (n=1). The reasons of performing USG included evaluation for hernia laterality (n=82), incarceration (n=28), testis (n=15), request of parents (n=14), scrotal mass (n=6) and incidentally found during evaluation for another disease (n=5). Excepting 5 cases of incidental finding, of 145 cases with USG, 12 (8.3%) cases changed the surgical plan; change to bilateral repair from unilateral repair (n=5), emergency operation due to incarceration (n=4) which include 1 salpingo-oophorectomy, 1 open abdomen surgery and 2 hernia repair after reduction of ovary, change to co-operation of orchiopexy (n=2) and change to laparoscopic surgery from open surgery due to herniation of both ovaries into one inguinal canal (n=1). In group without USG (n=1,291), 5 patients (0.4%) had unexpected problems during operation; 2 co-operation of orchiopexy because of transverse testicular ectopia (n=1) and right undescended testis (n=1), 2 hypertrophy of major labia and 1 retroperitoneal lymphangioma at inguinal area misdiagnosed as inguinal hernia. CONCLUSION: It was difficult to interpret the meaning of preoperative USG because not all patients had performed it. In this study, 10.4% of patients performed USG and 8.3% of them changed surgical plan. About 0.4% of patients without preoperative USG would have benefited from it for surgery if they had performed it. Since the percentage is too low, it is unreasonable to conclude that USG has diagnostic utility in inguinal hernia in this study.
Abdomen ; Child ; Cryptorchidism ; Emergencies ; Emergency Medicine ; Female ; Hernia ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Hypertrophy ; Incidental Findings ; Inguinal Canal ; Laparoscopy ; Lymphangioma ; Male ; Medical Records ; Orchiopexy ; Ovary ; Parents ; Pediatrics ; Retrospective Studies ; Seoul ; Testis ; Ultrasonography ; Urology

The present study aimed to investigate the relationship between histopathological subtype and the probability of inguinal lymph node metastasis (ILNM) in patients with penile squamous cell carcinoma (PSCC). The clinical records of 198 consecutive patients with PSCC were analyzed retrospectively. Primary lesions were reevaluated according to the 2016 World Health Organization (WHO) histopathological classification. We retrieved the clinicopathological factors from the medical records including age, clinical lymph node stage, pathological tumor stage, lymphatic invasion, and nerve invasion. Uni- and multivariate logistic regression analyses were used to explore the risk factors of ILNM. Multivariate analyses identified clinical lymph node stage (P = 0.000), pathological tumor stage (P = 0.016), histologic grade (P = 0.000), and risk group of histological subtypes (P = 0.029) as independent predictors for ILNM. Compared with the low-risk group of PSCC subtypes, the intermediate- (HR: 3.66, 95% CI: 1.30-10.37, P = 0.021) and high-risk groups (HR: 28.74, 95% CI: 2.37-348.54, P = 0.008) were significantly associated with ILNM. In conclusion, the histopathological subtype of the primary lesion is a significant predictor for ILNM in patients with PSCC.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/secondary* ; Humans ; Inguinal Canal ; Lymph Nodes/pathology* ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Staging ; Penile Neoplasms/pathology* ; Retrospective Studies ; Risk Factors ; Young Adult

The genitofemoral nerve (GFN) has its unique anatomic characteristics of location, run and function in the male urinary system and its relationship with the ureter, deferens and inguinal region is apt to be ignored in clinical anatomic application. Clinical studies show that GFN is closely correlated with postoperative ureteral complications and pain in the inguinal region after spermatic cord or hernia repair. GFN transplantation can be used in the management of erectile dysfunction caused by cavernous nerve injury. Therefore, GFN played an important role in the clinical application of uroandrology. This review summarizes the advances in the studies of GFN in relation to different diseases in uroandrology.
Erectile Dysfunction ; etiology ; surgery ; Hernia, Inguinal ; surgery ; Humans ; Inguinal Canal ; innervation ; Lumbosacral Plexus ; injuries ; Male ; Pain, Postoperative ; etiology ; Peripheral Nerves ; transplantation ; Postoperative Complications ; etiology ; surgery ; Ureter ; innervation ; surgery ; Urogenital System ; innervation ; Vas Deferens ; innervation

PURPOSE: Laparoscopic hernia repair in children is still controversial. The aim of this study was to report our long-term results of the laparoscopic hernia technique, which is based on the same surgical principles as conventional open herniotomy. METHODS: Five hundred fourteen pediatric patients with inguinal hernia were included in this study under informed consent. All patients underwent a laparoscopic technique of sac transection and intracorporeal ligation. The asymptomatic contralateral inguinal ring was routinely explored and repaired if a patient had patent processus vaginalis on the contralateral side. Patients were prospectively followed for 5 years. Those who were lost to follow-up were excluded from the study. Perioperative complications and recurrences were evaluated. RESULTS: The mean follow-up period was 29 months. Mean operation time was 27.5 minutes. Forty one percent of the patients had contralateral patent processus vaginalis. Only one hernia recurred (0.19%). We had one case of contralateral metachronous hernia (0.21%) during follow-up period. CONCLUSION: The long-term follow-up results of our study revealed that laparoscopic hernia sac transection and ligation can be a safe and effective alternative for conventional herniorraphy.
Child* ; Cohort Studies* ; Follow-Up Studies ; Hernia* ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Informed Consent ; Inguinal Canal ; Laparoscopy ; Ligation* ; Lost to Follow-Up ; Prospective Studies ; Recurrence

Palpable inguinal mass in children should be differentiated from inguinal hernia, hydrocele, lymph node, and tumor. Though using ultrasonography, fatty tumor would be misdiagnosed as incarcerated inguinal hernia containing fatty component. We experienced the huge inguinal lipoblastoma in 5-year-old girl mimicking recurrent incarcerated hernia. Laparoscopic exploration revealed it was not incarcerated hernia but well demarcated bulging mass from abdominal wall. Mass was about 10x4x3 cm and extended from internal inguinal ring to saphenous opening. It was near total excised because of right external iliac vein injury. Pathologically, it was proven as lipoblastoma containing mature adipocyte with lipoblast and fibrous septa. Postoperatively, we noticed a segmental thrombotic occlusion of external iliac vein. After 1 year, she has no symptom related to occluded vessel. The remained lipoblastoma showed no interval change. Even lipoblastoma has a good prognosis with low recurrence rate, we need careful follow-up.
Abdominal Wall ; Adipocytes ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Hernia ; Hernia, Inguinal* ; Humans ; Iliac Vein ; Inguinal Canal ; Lipoblastoma* ; Lipoma ; Lymph Nodes ; Prognosis ; Recurrence ; Ultrasonography

PURPOSE: The purpose of this study is to describe the ultrasonographic findings of ovary-containing hernias of the canal of Nuck. METHODS: This was a retrospective analysis of 22 hernia cases of the canal of Nuck. The following gray scale and color Doppler ultrasonographic features were analyzed: the site and the size of the hernia, the texture of the hernia contents, and the presence or absence of blood flow in the hernia contents. RESULTS: All of the patients had swelling of the right inguinal region (n=10), left inguinal region (n=8), or both (n=2). On ultrasonography, the hernias appeared as either solid masses (n=17) or solid masses containing cysts (n=5). The mean anteroposterior diameter of the hernia sac of the canal of Nuck was 9.1 mm (range, 5 to 18 mm). The mean anteroposterior diameters of the hernia sac were 11.6 mm (range, 7.6 to 18 mm) for hernias containing an ovary, and 8.3 mm (range, 5 to 13 mm) for hernias containing omental fat. During surgery, among the 17 cases with solid-appearing hernia contents on ultrasonography, omental fat was identified in the hernia sac in four cases, but no structure was identified in 13 cases. All five cases that appeared as solid masses containing cysts on ultrasonography contained ovary tissue in the hernia sac. Among the four cases of ovary-containing hernias, color Doppler ultrasonography identified blood flow within the ovary in three cases, but no flow signal was seen in one case of incarcerated hernia. CONCLUSION: Ultrasonography may be helpful for the diagnosis of ovary-containing hernias of the canal of Nuck by detecting solid masses containing small cysts.
Diagnosis* ; Female ; Hernia* ; Humans ; Inguinal Canal ; Ovary ; Retrospective Studies ; Ultrasonography ; Ultrasonography, Doppler, Color

Duplication of vas deferens is a rare congenital anomaly. All previously reported cases of this rare anomaly were identified during procedures such as orchiepexy, inguinal hernia repair, vasectomy, varicocoelectomy, and radical prostatectomy. Here, we report a case of unilateral duplicated vas deferens noted in an adult cadaver during regular dissection for medical students. The right spermatic cord contained 2 separate and completely developed cord-like structures. Both cords communicated separately with the tail of the epididymis. When traced cranially, both traversed the inguinal canal as content of the spermatic cord and finally fused at the level of the deep inguinal ring. No other variations were found in the testis or epididymis, and no variations were seen in the left spermatic cord. In addition, no associated renal abnormalities were noted.
Adult ; Cadaver ; Epididymis ; Hernia, Inguinal ; Humans ; Inguinal Canal ; Male ; Prostatectomy ; Spermatic Cord ; Students, Medical ; Testis ; Vas Deferens ; Vasectomy

Herniation of the appendix into an inguinal canal is known as an Amyand hernia. Due to its nonspecific symptoms, clinical diagnosis is extremely difficult, and an accurate preoperative diagnosis of Amyand hernia with ultrasound (US) and CT is rarely reported. Herein, we reported a typical case of Amyand hernia in a 74-year-old male in which the correct diagnosis was made using inguinal US and contrast-enhanced abdominopelvic CT. US and CT findings of Amyand hernia showed a target-like tubular structure within the inguinal canal.
Aged ; Appendix ; Diagnosis ; Hernia* ; Humans ; Inguinal Canal ; Male ; Ultrasonography*

The Canal of Nuck is the portion of the processus vaginalis within the inguinal canal in women. A hydrocele of the Canal of Nuck is equivalent to an encysted hydrocele of the spermatic cord in men. Little about this rare condition in the adult female patient has been reported in the literature. In this paper, we report on a case of hydrocele of the Canal of Nuck in a 30-year-old female. The diagnosis was made based on sonography and CT, and then confirmed during surgery. Although rare, a hydrocele of the Canal of Nuck must be included in the differential diagnosis of a groin lump in female patients.
Adult ; Diagnosis ; Diagnosis, Differential ; Female ; Groin ; Humans ; Inguinal Canal ; Male ; Spermatic Cord ; Ultrasonography*

The processus vaginalis within the inguinal canal forms the canal of Nuck, which is a homolog of the processus vaginalis in women. Incomplete obliteration of the processus vaginalis causes indirect inguinal hernia or hydrocele of the canal of Nuck, a very rare condition in women. Here, we report 2 cases of hydrocele of the canal of Nuck that were diagnosed with ultrasonography in both cases and magnetic resonance imaging in 1 case to confirm the sonographic diagnosis. High ligation and hydrocelectomy were conducted in both patients. In 1 patient, 14 months later, the occurrence of contralateral inguinal hernia was suspected, but did not require surgery. The other patient had a history of surgery for left inguinal hernia 11 months before the occurrence of right hydrocele of the canal of Nuck. In both cases, the occurrence of an inguinal hernia on the contralateral side was noted.
Female ; Hernia, Inguinal ; Humans ; Inguinal Canal ; Ligation ; Magnetic Resonance Imaging