A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair
Identifieur interne : 005A76 ( Main/Exploration ); précédent : 005A75; suivant : 005A77A Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair
Auteurs : Joaquim Nor Es [Brésil] ; Gerusa Dreyer [Brésil]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2010.
Descripteurs français
- KwdFr :
- MESH :
- anatomopathologie : Filariose lymphatique, Hydrocèle, Lymphangiectasie.
- Adulte, Animaux, Filariose lymphatique, Humains, Hydrocèle, Loi du khi-deux, Mâle, Récidive, Wuchereria bancrofti, Études cas-témoins.
English descriptors
- KwdEn :
- MESH :
Abstract
Chronic hydrocele is the most common manifestation of bancroftian filariasis, an endemic disease in 80 countries. In a prospective study, we evaluated the occurrence of intrascrotal lymphangiectasia, gross appearance/consistency of the testis, and the efficacy of complete excision of hydrocele sac in patients living in a bancroftian filariasis endemic area who underwent hydrocelectomy at the Center for Teaching, Research and Tertiary Referral for Bancroftian Filariasis (NEPAF).
A total of 968 patients with uni- or bilateral filarial hydrocele (Group-1) and a Comparison Group (CG) of 218 patients from the same area who already had undergone hydrocele-sac-sparing hydrocelectomy elsewhere were enrolled at NEPAF. Twenty-eight patients from the Comparison Group with hydrocele recurrence were re-operated on at NEPAF and constitute Group-2. In Group-1 a total of 1,128 hydrocelectomies were performed (mean patient age of 30.3yr and mean follow-up of 8.6yr [range 5.3–12]). The hydrocele recurrence rates in Group-1 and in the Comparison Group (mean age of 31.5 yr) were 0.3%, and 19.3%, respectively (p<0,001). There was no hydrocele recurrence in Group-2 (mean patient age of 25.1yr and mean follow-up of 6yr [range 5–6.9]). Per surgically leaking or leak-prone dilated lymphatic vessels were seen in the inner or outer surface of the hydrocele sac wall or in surrounding tissue, particularly in the retrotesticular area, in 30.9% and in 46.3% of patients in Group-1 and Group-2, respectively (p = 0.081). The testicles were abnormal in shape, volume, and consistency in 203/1,128 (18%) and 10/28 (35.7%) of patients from Group-1 and Group-2, respectively (p = 0,025).
Lymph fluid from ruptured dilated lymphatic vessels is an important component of chronic filarial hydrocele fluid that threatens the integrity of the testis in an adult population living in bancroftian filariasis endemic areas. To avoid hydrocele recurrence the authors advise complete excision of hydrocele sac and when identified, leaking or leak-prone dilated lymphatic vessels should be sutured or excised.
Url:
DOI: 10.1371/journal.pntd.0000695
PubMed: 20532225
PubMed Central: 2879368
Affiliations:
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Mechanism for Chronic Filarial Hydrocele with Implications for Its Surgical Repair</title><author><name sortKey="Nor Es, Joaquim" sort="Nor Es, Joaquim" uniqKey="Nor Es J" first="Joaquim" last="Nor Es">Joaquim Nor Es</name><affiliation wicri:level="2"><nlm:aff id="aff1"><addr-line>Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil</addr-line></nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Departamento de Cirurgia, Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, Pernambuco</wicri:regionArea><placeName><region type="state">Pernambuco</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2"><addr-line>Núcleo de Ensino, Pesquisa e Assistência em Filariose (NEPAF), Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil</addr-line></nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Núcleo de Ensino, Pesquisa e 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Brazil</addr-line></nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Núcleo de Ensino, Pesquisa e Assistência em Filariose (NEPAF), Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco</wicri:regionArea><placeName><region type="state">Pernambuco</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3"><addr-line>Organização Não governamental Amaury Coutinho para Doenças Endêmicas e Tropicais, Recife, Pernambuco, Brazil</addr-line></nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Organização Não governamental Amaury Coutinho para Doenças Endêmicas e Tropicais, Recife, Pernambuco</wicri:regionArea><placeName><region type="state">Pernambuco</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff4"><addr-line>Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ), Recife, Pernambuco, Brazil</addr-line></nlm:aff><country xml:lang="fr">Brésil</country><wicri:regionArea>Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ), Recife, Pernambuco</wicri:regionArea><placeName><region type="state">Pernambuco</region></placeName></affiliation></author></analytic><series><title level="j">PLoS Neglected Tropical Diseases</title><idno type="ISSN">1935-2727</idno><idno type="eISSN">1935-2735</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Animals</term><term>Case-Control Studies</term><term>Chi-Square Distribution</term><term>Elephantiasis, Filarial (pathology)</term><term>Elephantiasis, Filarial (surgery)</term><term>Humans</term><term>Lymphangiectasis (pathology)</term><term>Male</term><term>Recurrence</term><term>Testicular Hydrocele (pathology)</term><term>Testicular Hydrocele (surgery)</term><term>Wuchereria bancrofti</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Animaux</term><term>Filariose lymphatique ()</term><term>Filariose lymphatique (anatomopathologie)</term><term>Humains</term><term>Hydrocèle ()</term><term>Hydrocèle (anatomopathologie)</term><term>Loi du khi-deux</term><term>Lymphangiectasie (anatomopathologie)</term><term>Mâle</term><term>Récidive</term><term>Wuchereria bancrofti</term><term>Études cas-témoins</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Filariose lymphatique</term><term>Hydrocèle</term><term>Lymphangiectasie</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Elephantiasis, Filarial</term><term>Lymphangiectasis</term><term>Testicular Hydrocele</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Elephantiasis, Filarial</term><term>Testicular Hydrocele</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Animals</term><term>Case-Control Studies</term><term>Chi-Square Distribution</term><term>Humans</term><term>Male</term><term>Recurrence</term><term>Wuchereria bancrofti</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Animaux</term><term>Filariose lymphatique</term><term>Humains</term><term>Hydrocèle</term><term>Loi du khi-deux</term><term>Mâle</term><term>Récidive</term><term>Wuchereria bancrofti</term><term>Études cas-témoins</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Chronic hydrocele is the most common manifestation of bancroftian filariasis, an endemic disease in 80 countries. In a prospective study, we evaluated the occurrence of intrascrotal lymphangiectasia, gross appearance/consistency of the testis, and the efficacy of complete excision of hydrocele sac in patients living in a bancroftian filariasis endemic area who underwent hydrocelectomy at the Center for Teaching, Research and Tertiary Referral for Bancroftian Filariasis (NEPAF).</p></sec><sec><title>Methodology/Principal Findings</title><p>A total of 968 patients with uni- or bilateral filarial hydrocele (Group-1) and a Comparison Group (CG) of 218 patients from the same area who already had undergone hydrocele-sac-sparing hydrocelectomy elsewhere were enrolled at NEPAF. Twenty-eight patients from the Comparison Group with hydrocele recurrence were re-operated on at NEPAF and constitute Group-2. In Group-1 a total of 1,128 hydrocelectomies were performed (mean patient age of 30.3yr and mean follow-up of 8.6yr [range 5.3–12]). The hydrocele recurrence rates in Group-1 and in the Comparison Group (mean age of 31.5 yr) were 0.3%, and 19.3%, respectively (p<0,001). There was no hydrocele recurrence in Group-2 (mean patient age of 25.1yr and mean follow-up of 6yr [range 5–6.9]). Per surgically leaking or leak-prone dilated lymphatic vessels were seen in the inner or outer surface of the hydrocele sac wall or in surrounding tissue, particularly in the retrotesticular area, in 30.9% and in 46.3% of patients in Group-1 and Group-2, respectively (p = 0.081). The testicles were abnormal in shape, volume, and consistency in 203/1,128 (18%) and 10/28 (35.7%) of patients from Group-1 and Group-2, respectively (p = 0,025).</p></sec><sec><title>Conclusions/Significance</title><p>Lymph fluid from ruptured dilated lymphatic vessels is an important component of chronic filarial hydrocele fluid that threatens the integrity of the testis in an adult population living in bancroftian filariasis endemic areas. To avoid hydrocele recurrence the authors advise complete excision of hydrocele sac and when identified, leaking or leak-prone dilated lymphatic vessels should be sutured or excised.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Michael, E" uniqKey="Michael E">E Michael</name></author><author><name sortKey="Bundy, Dap" uniqKey="Bundy D">DAP Bundy</name></author><author><name sortKey="Grenfell, Bt" uniqKey="Grenfell B">BT Grenfell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thambugala, Rl" uniqKey="Thambugala R">RL Thambugala</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gratama, S" uniqKey="Gratama S">S Gratama</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wijers, Djb" uniqKey="Wijers D">DJB Wijers</name></author></analytic></biblStruct><biblStruct><analytic><author><name 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Möller</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Brésil</li></country><region><li>Pernambuco</li></region></list><tree><country name="Brésil"><region name="Pernambuco"><name sortKey="Nor Es, Joaquim" sort="Nor Es, Joaquim" uniqKey="Nor Es J" first="Joaquim" last="Nor Es">Joaquim Nor Es</name></region><name sortKey="Dreyer, Gerusa" sort="Dreyer, Gerusa" uniqKey="Dreyer G" first="Gerusa" last="Dreyer">Gerusa Dreyer</name><name sortKey="Dreyer, Gerusa" sort="Dreyer, Gerusa" uniqKey="Dreyer G" first="Gerusa" last="Dreyer">Gerusa Dreyer</name><name sortKey="Dreyer, Gerusa" sort="Dreyer, Gerusa" uniqKey="Dreyer G" first="Gerusa" last="Dreyer">Gerusa Dreyer</name><name sortKey="Nor Es, Joaquim" sort="Nor Es, Joaquim" uniqKey="Nor Es J" first="Joaquim" last="Nor Es">Joaquim Nor Es</name><name sortKey="Nor Es, Joaquim" sort="Nor Es, Joaquim" uniqKey="Nor Es J" first="Joaquim" last="Nor Es">Joaquim Nor 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