Preliminary experiences in the treatment of adult testicular hydrocele with scrotoscopy combined with bipolar plasma resection

doi:10.3877/cma.j.issn.1674-3253.2025.05.014

Abstract

Abstract:

Objective

To compare the clinical effects of scrotoscopy and traditional surgical methods in the treatment of adult testicular hydrocele.

Methods

A retrospective analysis was conducted on the data of 38 patients diagnosed with adult testicular hydrocele in the Second People's Hospital of Honghe Autonomous Prefecture from July 2017 to May 2024. According to the surgical methods, they were divided into two groups: 21 cases in the scrotoscopy group (endoscopic group), and endoscopic-assisted treatment was performed using a 1.5 cm small incision at the lower pole of the scrotum in the lithotomy position combined with plasma electrocision equipment; 17 cases in the tunica vaginalis eversion group (traditional group), and the tunica vaginalis eversion was performed through the scrotal incision in the supine position. The operation time, blood loss, postoperative hospital stay, and complications of the two groups were compared.

Results

All operations were successfully completed. Comparing the operation time [(35±8) min vs (69±20) min, P<0.05], blood loss [(1.8±1.2) ml vs (11.5±2.3) ml, P<0.05], hospital stay [(4.4±0.7) d vs (9.4±1.5) d, P<0.05], surgical scar [(1.1±0.3) cm vs (8.1±1.9) cm, P<0.05], total postoperative complication rate (19.0% vs 58.8%, P=0.018) of the two groups, it was found that the endoscopic group had obvious advantages.

Conclusion

As a minimally invasive treatment method, scrotoscopy has the advantages of less trauma, quick recovery, and aesthetic scars in the treatment of adult testicular hydrocele. It is a safe and effective treatment method.

Key words: Testis, Hydrocele, Scrotoscope, Resection, Tunica vaginalis eversion, Minimally invasive surgery

Jun Ma, Yong Xu, Jiangang Yang, Quan Yang, Zheng Zhao, Xu Jiang, Lishi Ma, Xiurong Cheng, Wencui Dou. Preliminary experiences in the treatment of adult testicular hydrocele with scrotoscopy combined with bipolar plasma resection[J]. Chinese Journal of Endourology(Electronic Edition), 2025, 19(05): 633-638.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2025.05.014

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2025/V19/I05/633

Figures/Tables 3

References 33

[1]	刘继红. 男科手术学[M].北京: 北京科学技术出版社, 2006,194-200.
[2]	Keller AK, Howard MM, Jensen JB. Complications after scrotal surgery-still a major issue?[J]. Scand J Urol, 2021, 55(5): 404-407. DOI: 10.1080/21681805.2021.1884131.
[3]	孙颖浩.吴阶平泌尿外科学[M].北京: 人民卫生出版社, 2019, 1822-1823.
[4]	黄健, 张旭. 中国泌尿外科和男科疾病诊断治疗指南: 2022版[M].北京:科学出版社, 2022, 982-983.
[5]	许云峰, 蒋海燕, 胡慧勇, 等. 高频彩超对小儿阴囊急症的诊断及鉴别诊断价值[J]. 中华男科学杂志, 2016, 22(11): 996-1000. DOI: 10.13263/j.cnki.nja.2016.11.007.
[6]	Low LS, Nair SM, Davies AJW, et al. Aspiration and sclerotherapy of hydroceles and spermatoceles/epididymal cysts with 100% alcohol[J]. ANZ J Surg, 2020, 90(1-2): 57-61. DOI: 10.1111/ans.15467.
[7]	Ho GT, Ball RA, Schuessler W, et al. Efficacy of endoscopic hydrocele ablation[J]. J Endourol, 1993, 7(1): 71-74. DOI: 10.1089/end.1993.7.71.
[8]	尹焯, 杨金瑞, 王钊, 等. 阴囊镜在睾丸附睾疾病诊断与治疗中的应用[J]. 北京大学学报(医学版), 2015, 47(4): 648-652. DOI: 10.3969/j.issn.1671-167X.2015.04.020.
[9]	张亚龙, 高继学, 张烨. 急性睾丸扭转30例临床诊治体会及相关文献复习[J]. 中国性科学, 2017, 26(12): 5-7. DOI: 10.3969/j.issn.1672-1993.2017.12.001.
[10]	班永光, 栾钦花, 刘伟, 等. 鞘膜外型睾丸扭转的超声诊断价值探讨[J]．中国超声医学杂志, 2021, 37(8): 954-956. DOI: 10.3969/j.issn.1002-0101.2021.08.036.
[11]	Yan B, Wei YB, Yin Z, et al. Minimal hydrocelectomy with the aid of scrotoscope: a ten-year experience[J]. Int Braz J Urol, 2014, 40(3): 384-389. DOI: 10.1590/S1677-5538.IBJU.2014.03.13.
[12]	曹彬, 王军, 郭晖, 等. 腹腔镜联合经阴囊小切口治疗特殊小儿鞘膜积液[J]. 中国微创外科杂志, 2020, 20(10): 911-914. DOI: 10.3969/j.issn.1009-6604.2020.10.011.
[13]	熊磊，陶荣镇，王杜渐，等.阴囊镜辅助小切口睾丸鞘膜切除术在睾丸鞘膜积液治疗中的应用[J]．现代泌尿外科杂志，2023，28(9):780-784. DOI: 10.3969/j.issn.1009-8291.2023.09.010.
[14]	孙玉芳, 罗添华, 张旭辉, 等.腹腔镜技术在腹阴囊鞘膜积液诊治中的应用[J].中华泌尿外科杂志, 2021, 42(12): 935-936. DOI: 10.3760/cma.j.cn112330-20200302-00146.
[15]	张玲玲, 刘华建, 桂萌, 等.腹腔镜囊肿开窗联合鞘状突结扎治疗儿童腹阴囊鞘膜积液的疗效分析[J]. 腹腔镜外科杂志，2024，29(3)：222-230. DOI:10.13499/j.cnki.fqjwkzz.2024.03.222.
[16]	Lei J, Luo C, Zhang Y, et al. A comparison of a novel endoscopic "Su-Wang technique" with the open "Jaboulay's procedure" for the surgical treatment of adult primary vaginal hydrocele[J]. Sci Rep, 2019, 9: 9152. DOI: 10.1038/s41598-019-45229-5.
[17]	杨彪, 赵春利. 阴囊镜的发展现状与应用[J]. 医学综述, 2020, 26(23): 4724-4727, 4733. DOI: 10.3969/j.issn.1006-2084.2020.23.027.
[18]	Gerris J, Camp C, Neuten J, et al. Scrotal endoscopy in male infertility[J]. Lancet, 1988, 331(8594): 1102. DOI: 10.1016/s0140-6736(88)91915-0.
[19]	Wang Z, Wei YB, Yin Z, et al. Diagnosis and management of scrotal superficial angiomyxoma with the aid of a scrotoscope: case report and literature review[J]. Clin Genitourin Cancer, 2015, 13(4): e311-e313. DOI: 10.1016/j.clgc.2014.11.009.
[20]	Yang JR, Wei YB, Yan B, et al. Comparison between open epididymal cystectomy and minimal resection of epididymal cysts using a scrotoscope: a clinical trial for the evaluation of a new surgical technique[J]. Urology, 2015, 85(6): 1510-1514. DOI: 10.1016/j.urology.2015.03.003.
[21]	Shafik A. The scrotoscope. A new instrument for examining the scrotal contents[J]. Br J Urol, 1990, 65(2): 209-210. DOI: 10.1111/j.1464-410x.1990.tb14702.x.
[22]	杨金瑞. 阴囊镜手术学[M]. 北京: 人民卫生出版社, 2016,126-132.
[23]	李峰, 将小强, 钱卫良, 等.内镜技术在阴囊疾病中的研究[J].浙江创伤外科, 2021, 26(10): 879-880. DOI: 10.3969/j.issn.1009-7147.2021.05.035.
[24]	徐乐, 黎灿强, 邱敏捷, 等. 阴囊镜在39例睾丸附睾疾病诊治中的应用[J]. 中华男科学杂志, 2020, 26(2): 134-138. DOI: 10.13263/j.cnki.nja.2020.02.007.
[25]	曾振华, 唐建生, 王栋洋, 等. 阴囊镜手术治疗附睾肿块的疗效[J]. 中国现代医师, 2021, 59(4): 50-53.
[26]	杨增士, 叶宁, 卓红兵, 等.阴囊镜用于诊断睾丸扭转及治疗附睾囊肿（附19例病例报告）[J].世界最新医学信息文摘, 2021, 21(48): 258-259. DOI: 10.3969/j.issn.1671-3141.2021.48.121.
[27]	郭景阳，古德强，张彦桥，等. 4.8 F可视肾镜治疗睾丸鞘膜积液的初步探讨[J].中华男科学杂志，2021, 27(3): 274-276. DOI: 10.13263/j.cnki.nja.2021.03.014.
[28]	李冬明, 崔振宇, 郭景阳, 等.可视穿刺肾镜在成人睾丸鞘膜积液治疗中的初步应用[J]. 中国内镜杂志, 2022, 28(2): 77-81. DOI: 10.12235/E20210340.
[29]	王思成, 贾斌, 樊体武. 层面外科理念下的一种全新的睾丸鞘膜翻转切除术15例经验[J]. 现代泌尿外科杂志, 2024, 29(4): 359-362.
[30]	陈大勇, 郭宏志, 李权.鞘膜切除术与鞘膜翻转术治疗儿童睾丸鞘膜积液疗效比较[J].四川解剖学杂志, 2022, 30(4): 27-30. DOI: 10.3969/j.issn.1005-1457.2022.04.009.
[31]	刘春晓. 实用经尿道手术学[M]. 北京: 人民卫生出版社, 2011, 8-17.
[32]	钱利强, 周荷妹, 王刚, 等. 腹腔镜完全腹膜外腹股沟疝修补术治疗阴囊疝的临床疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(1): 90-92.
[33]	娜菲沙·沙木西丁, 艾科热木·开赛尔江, 王雅琦, 等. 先天性腹壁缺损患儿的发病机制及创新治疗[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(4): 468-475. DOI: 10.3877/cma.j.issn.1673-5250.2024.04.015.

组别	例数	年龄[岁，(±s)]	合并高血压(例)	合并糖尿病(例)	合并陈旧性脑梗(例)	合并冠心病(例)	合并肺气肿(例)	积液最大径[cm，(±s)]	侧别(例)		术前低分子肝素钙桥接治疗(例)	术前控制血压治疗(例)
组别	例数	年龄[岁，(±s)]	合并高血压(例)	合并糖尿病(例)	合并陈旧性脑梗(例)	合并冠心病(例)	合并肺气肿(例)	积液最大径[cm，(±s)]	左侧	右侧	术前低分子肝素钙桥接治疗(例)	术前控制血压治疗(例)
内镜组	21	61±7	5	3	1	1	1	11.3±3.9	10	11	2	2
传统组	17	63±8	7	1	2	1	0	12.2±3.9	11	6	3	2
统计值		t=-0.711	-	-	-	-	-	t=-0.706	-		-	-
P值		0.481	0.370	0.612	0.577	>0.999	>0.999	0.485	0.342		0.640	>0.999

组别	例数	年龄[岁，(±s)]	合并高血压(例)	合并糖尿病(例)	合并陈旧性脑梗(例)	合并冠心病(例)	合并肺气肿(例)	积液最大径[cm，(±s)]	侧别(例)		术前低分子肝素钙桥接治疗(例)	术前控制血压治疗(例)
组别	例数	年龄[岁，(±s)]	合并高血压(例)	合并糖尿病(例)	合并陈旧性脑梗(例)	合并冠心病(例)	合并肺气肿(例)	积液最大径[cm，(±s)]	左侧	右侧	术前低分子肝素钙桥接治疗(例)	术前控制血压治疗(例)
内镜组	21	61±7	5	3	1	1	1	11.3±3.9	10	11	2	2
传统组	17	63±8	7	1	2	1	0	12.2±3.9	11	6	3	2
统计值		t=-0.711	-	-	-	-	-	t=-0.706	-		-	-
P值		0.481	0.370	0.612	0.577	>0.999	>0.999	0.485	0.342		0.640	>0.999

	例数	手术时间[min，(±s)]	出血量[mL，(±s)]	住院时间[d，(±s)]	手术疤痕[cm，(±s)]	术后并发症(例)	术后复发(例)
内镜组	21	35±8	1.76±1.2	4.4±0.7	1.1±0.3	4	0
传统组	17	69±19	11.5±2.3	9.4±1.5	8.1±1.9	10	0
统计值		t=-6.869	t=-15.440	t=-13.331	t=-16.732	-	-
P值		<0.001	<0.001	<0.001	<0.001	0.018	-

	例数	手术时间[min，(±s)]	出血量[mL，(±s)]	住院时间[d，(±s)]	手术疤痕[cm，(±s)]	术后并发症(例)	术后复发(例)
内镜组	21	35±8	1.76±1.2	4.4±0.7	1.1±0.3	4	0
传统组	17	69±19	11.5±2.3	9.4±1.5	8.1±1.9	10	0
统计值		t=-6.869	t=-15.440	t=-13.331	t=-16.732	-	-
P值		<0.001	<0.001	<0.001	<0.001	0.018	-

Please choose a citation manager

Content to export