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What Do These Ultrasound Findings Indicate?
Question: Hi there, My Name is Dr XXXXXXX XXXX, currently working in Medical Insurance Department. I have one case which I need to discuss with Urologist.
This case is of 43 years old married man. He has 4 children before. He is now complaining of umbilical swelling and swelling in left testis. etiology was given by the member is lifting heavy weight.
Ultrasound was done which showed:
• There is a clear defect in the abdominal fascia at the umbilicus with a 2.49 cm gap.
• The hernia sac reaches through the subcutaneous fat to the skin level.
• There is omentum within the sac which cannot be reduced. Around the omentum there is evidence of free fluid as sign of incarceration.
• No bowel loops or other organs detected in the sac.
• The left testicle is significantly smaller than the right.
• There is dilatation of the entire plexus pampiniform up to 1cm in diameter.
• No hydrocele and no evidence of inguinal hernia. The findings are of varicocele Grade 2.
As the member was not complaining of any pain, only swelling. we have asked the doctor to confirm the testicular volume of the member. As per the Radiologist, Right testis volume is 16.5 cc and left testis volume is 18.0 cc.
Our concern in this case, there is no significant change in testicular volume, and the member is 43 years old. there is no signs of secondary infertility. Varicocelectomy will not be treatment option for this patient.
May I request you to please give us your expert opinion on this case if the patient really in need of varicocelectomy. it will be beneficial for me also if you can provide me also any International Guidelines or supportive article. it will help me to expand my knowledge on Urology and on future similar case.
Thanks and Best Regards.
Dr. XXXXXXX XXXX
This case is of 43 years old married man. He has 4 children before. He is now complaining of umbilical swelling and swelling in left testis. etiology was given by the member is lifting heavy weight.
Ultrasound was done which showed:
• There is a clear defect in the abdominal fascia at the umbilicus with a 2.49 cm gap.
• The hernia sac reaches through the subcutaneous fat to the skin level.
• There is omentum within the sac which cannot be reduced. Around the omentum there is evidence of free fluid as sign of incarceration.
• No bowel loops or other organs detected in the sac.
• The left testicle is significantly smaller than the right.
• There is dilatation of the entire plexus pampiniform up to 1cm in diameter.
• No hydrocele and no evidence of inguinal hernia. The findings are of varicocele Grade 2.
As the member was not complaining of any pain, only swelling. we have asked the doctor to confirm the testicular volume of the member. As per the Radiologist, Right testis volume is 16.5 cc and left testis volume is 18.0 cc.
Our concern in this case, there is no significant change in testicular volume, and the member is 43 years old. there is no signs of secondary infertility. Varicocelectomy will not be treatment option for this patient.
May I request you to please give us your expert opinion on this case if the patient really in need of varicocelectomy. it will be beneficial for me also if you can provide me also any International Guidelines or supportive article. it will help me to expand my knowledge on Urology and on future similar case.
Thanks and Best Regards.
Dr. XXXXXXX XXXX
Brief Answer:
Read detail answer bellow.
Detailed Answer:
Hello
Thanks for query.
The ultrasound findings of the patient that you have posted suggest that he has
1) Umbilical Hernia with Omentum as it's content .In such situation there is high risk of it getting it into Obstruction and land into emergency.In such situation it is always safe to get operated and to do hernia repair with mesh.
2) As regards lump in Left testicle it is detected to be due to grade 2 Varicocele .As he has 4 kids there is no doubt that he is fertile.
Surgery in this case can be advised only if he has severe pain due to Varicocele or when all the medical management fails to give desired results in terms of pain relief.
Hope I have answered your query .Please feel free to ask if you have more questions .I shall be happy to help you.
Thanking you with Regards.
Dr.Patil.
Read detail answer bellow.
Detailed Answer:
Hello
Thanks for query.
The ultrasound findings of the patient that you have posted suggest that he has
1) Umbilical Hernia with Omentum as it's content .In such situation there is high risk of it getting it into Obstruction and land into emergency.In such situation it is always safe to get operated and to do hernia repair with mesh.
2) As regards lump in Left testicle it is detected to be due to grade 2 Varicocele .As he has 4 kids there is no doubt that he is fertile.
Surgery in this case can be advised only if he has severe pain due to Varicocele or when all the medical management fails to give desired results in terms of pain relief.
Hope I have answered your query .Please feel free to ask if you have more questions .I shall be happy to help you.
Thanking you with Regards.
Dr.Patil.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Dr XXXXXXX
Thank you for your answer.
Please advise in which cases Varicocelectomy is indicated? is it necessary to know about the testicular volume and semen analysis report in a case of fertile man. how much will be the testicular volume indicates Varicocelectomy.
May I request you to please advise some International guidelines on indication of Varicocelectomy.
Thank you for your answer.
Please advise in which cases Varicocelectomy is indicated? is it necessary to know about the testicular volume and semen analysis report in a case of fertile man. how much will be the testicular volume indicates Varicocelectomy.
May I request you to please advise some International guidelines on indication of Varicocelectomy.
Brief Answer:
Cases where Varicocelectomy is indicated.
Detailed Answer:
hello
Thanks for follow up.
There is no relation between the volume of the testis and Varicocele .One can have normal testicular function even with grade 3 Varicocele .
Varicocelectomy surgery is advised that to with a guarded opinion of improvement in sperm count in case of infertility and not otherwise .There are no proven scientific data to suggest the relation between testicular function and Varicocele .As such it is very difficult to establish testicular function in isolated or individual testis . Surgery for Varicocele is advised in following circumstances
1) Patient is infertile
2) Severe pain in testicle .
Thanks and Regards.
Dr.Patil.
Cases where Varicocelectomy is indicated.
Detailed Answer:
hello
Thanks for follow up.
There is no relation between the volume of the testis and Varicocele .One can have normal testicular function even with grade 3 Varicocele .
Varicocelectomy surgery is advised that to with a guarded opinion of improvement in sperm count in case of infertility and not otherwise .There are no proven scientific data to suggest the relation between testicular function and Varicocele .As such it is very difficult to establish testicular function in isolated or individual testis . Surgery for Varicocele is advised in following circumstances
1) Patient is infertile
2) Severe pain in testicle .
Thanks and Regards.
Dr.Patil.
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Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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