Can volumetric measurement be used in the selection of treatment for inguinoscrotal hernias?

Objective: Inguinoscrotal hernias are often qualified subjectively as big, giant, scrotal, etc. In order to classify this type of hernia, objective criteria are needed. For this purpose, we aimed to introduce a scrotal volume measurement-based classification system and propose a corresponding surgical plan (open or laparoscopic surgery, anterior or posterior repair) based on volumetric data.

Material and Methods: Between October 2012 and October 2013, 30 consecutive male patients with a mean age of 59.5 years (range: 36 to 82 years) presenting with unilateral ISH were included in this retrospective study. Physical measurements in the upright position and computerized tomography measurements using the Valsalva maneuver were obtained from all patients.

Results: Of the 30 patients, 26 patients had scrotal volumes less than 1000 mL, two patients had SVs between 1001 and 2000 mL, one patient had an SV between 2001 and 3000 mL, and one patient had an SV greater than 3000 mL. Laparoscopic total extraperitoneal repair was performed in patients with scrotal volumes inferior to 1000 mL. In three patients with scrotal volumes between 1000 and 3000 mL, an open posterior approach was used. In one patient with a scrotal volume superior to 3000 mL, no surgical intervention was performed due to the patient's cardiac comorbidity.

Conclusion: By establishing a common language among surgeons, we believe that the volumetric measurement-based scrotal hernia classification system proposed in this study will lead to further studies on the subject.