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Radiology Case Reports Dec 2022Spermatic cord abscess is a rare condition usually associated with other genitourinary infections. We present a case of a 49-year-old male with past medical history of...
Spermatic cord abscess is a rare condition usually associated with other genitourinary infections. We present a case of a 49-year-old male with past medical history of uncontrolled diabetes mellitus. He presented with right groin swelling and pain for a week. Ultrasound showed a tubular hyperemic structure extending into the scrotal sac. Computed tomography showed concurrent perinephric abscess and right spermatic cord abscess. The spermatic cord abscess was managed surgically by incision and drainage. To our knowledge, this is the first case report of a patient with spermatic cord abscess and concurrent perinephric abscess. We highlight the clinical importance of familiarity with such a rare condition and the role of imaging in establishing the correct diagnosis while excluding close differentials.
PubMed: 36204416
DOI: 10.1016/j.radcr.2022.09.026 -
Asian Journal of Andrology 2020We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General...
We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General Hospital (Shanghai, China). In this surgical approach, the testis was delivered, and the gubernacular and external cremasteric veins were stripped. In addition, the spermatic cord was delivered downward with continuous double traction away from the external ring. The remaining procedure was similar to the conventional approach. We followed patients for at least 3 months and evaluated postoperative semen parameters, pain symptoms, and complications. We excluded data for 32 men due to inadequate follow-up (<3 months). Of the remaining 254 patients, 73 had oligoasthenospermia, 121 had nonobstructive azoospermia, and 60 had symptomatic varicoceles. Total progressive sperm counts increased in the oligoasthenospermic patients from a median preoperative value of 9.15 × 10 ml to 25.33 × 10 ml (n= 34), and 35.6% (26/73) initially oligoasthenospermic men contributed to unassisted pregnancies. Sperm returned to the ejaculate in 12.4% (15/121) azoospermia patients. In patients with scrotal pain (n = 60), 43 (71.7%) reported complete resolution of pain, 16 (26.7%) reported partial resolution, and 1 (1.7%) reported no change. No patients experienced varicocele recurrence. This double-traction strategy avoids opening the external oblique aponeurosis, and results in less damage and faster recovery. In addition, the stripping strategy eliminates potential damage to the testis caused by the varicose veins. Our results showed that microsurgical subinguinal varicocelectomy using spermatic cord double traction in conjunction with testicular delivery for vein stripping is a safe and effective approach for varicocele repair.
Topics: Adolescent; Adult; Humans; Male; Microsurgery; Middle Aged; Retrospective Studies; Spermatic Cord; Testis; Treatment Outcome; Urogenital Surgical Procedures; Varicocele; Veins; Young Adult
PubMed: 31793442
DOI: 10.4103/aja.aja_118_19 -
International Journal of Surgery Case... 2019Leiomyosarcoma of the spermatic cord is a rare entity. It presents as a firm and painless intrascrotal mass. For diagnosis radiological methods such as ultrasound, CT or...
BACKGROUND
Leiomyosarcoma of the spermatic cord is a rare entity. It presents as a firm and painless intrascrotal mass. For diagnosis radiological methods such as ultrasound, CT or MRI are necessary. Radical orchiectomy is the gold standard of treatment.
CASE DESCRIPTION
We reported a one case of a 66-year-old man that he has suffered from a painless hard mass in the right hemiscrotum since three years. Ultrasound revealed a paratesticular mass. Further workup revealed no distant metastasis before surgery. Right radical orchiectomy was performed, the final pathologic examination showed a leiomyosarcoma of the spermatic cord. The patient remained disease-free twelve-month during follow up after surgery.
DISCUSSION
Leiomyosarcoma of the spermatic cord is a rare condition, it arises from mesenchymal cells of the spermatic cord and occurs mainly in elderly patients. The diagnosis of spermatic cord leiomyosarcoma is difficult if based only on imaging procedures, it is revealed by histological examination post surgery. No treatment protocol has yet been established for paratesticular leiomyosarcoma due to the rarity of the disease. Standard treatment is radical orchidectomy with high ligation of the spermatic cord. The benefit of adjuvant chemotherapy, radiotherapy, and retroperitoneal lymphadenectomy are not well understood and may differ according to the surgeon's preferences.
CONCLUSION
The lack of such cases results in the challenging nature of the diagnosis and treatment of leiomyosarcoma of the spermatic cord. Additional studies are needed to better define optimal management strategies.
PubMed: 30981071
DOI: 10.1016/j.ijscr.2019.04.006 -
Biology of Reproduction Feb 2016Testis cords, embryonic precursors of the seminiferous tubules, are fundamental for testis structure and function. Delay or disruption of testis cord formation could... (Review)
Review
Testis cords, embryonic precursors of the seminiferous tubules, are fundamental for testis structure and function. Delay or disruption of testis cord formation could result in gonadal dysgenesis. Although mechanisms regulating testis cord formation during sex determination have been well-studied, the genes and signaling pathways involving in testis cord maintenance after the cords have formed are not well characterized. It is now clear that the maintenance of cord structure is an active process. In this review, we summarize the recent findings regarding the regulation of testis cord integrity by a series of Sertoli cell transcription factors, including the WT1-SOX8/SOX9-beta-CATENIN-DHH network, GPR56, STIM1, and NR0B1 (also known as DAX1). In particularly, we emphasize the underappreciated role of peritubular myoid cells in testis cord maintenance and their cooperation with Sertoli cells. The regulation of the size, shape, and number of testis cords by Sertoli cell proliferation (e.g., SMAD4, GATA4, and TGF-beta signaling), Leydig cell products (e.g., ACTIVIN A), vascular development (a lesson learned from PDGF signaling), and available gonad space (as observed in Ift144 mutant mice) is also addressed. Further efforts and new genetic models are needed to unveil the gene networks and underlying mechanisms regulating testis cord integrity and morphology after sex determination.
Topics: Animals; Embryonic Development; Male; Mice; Repressor Proteins; SOX9 Transcription Factor; Seminiferous Tubules; Sertoli Cells; Signal Transduction; Spermatic Cord; WT1 Proteins; beta Catenin
PubMed: 26792939
DOI: 10.1095/biolreprod.115.137117 -
World Journal of Urology Dec 2023Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic...
PURPOSE
Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic cord in a large cohort.
METHODS
We performed a retrospective multicenter study (TORSAFUF cohort) of patients with suspected spermatic cord torsion between 2005 and 2019. All patients aged > 12 years who were suspected of having a torsion of the spermatic cord in 14 University Hospitals in France were included (n = 2986). Patients for whom data on pain duration were not available (n = 923) or for whom the final diagnosis was not torsion of the spermatic cord (n = 807) were excluded. The primary outcome was orchiectomy. The secondary outcomes were testicular survival time and the prediction of orchiectomy with the duration of pain.
RESULTS
1266 patients were included with an orchiectomy rate of 12% (150 patients). The mean age was 21.5 years old in the salvage group and 23.7 years old in the orchiectomy group (p = 0.01), respectively. The median time from the onset of pain to surgery was 5.5 (IQR = 5) hours in the salvage group and 51.1 (IQR = 70) hours in the orchiectomy group (p < 0.0001). The risk of orchiectomy increased after a time cut-off of 6 h 30. A delay of 15 h 30 in pain duration was found to predict orchiectomy (sensitivity: 0.81; specificity: 0.87).
CONCLUSIONS
Pain duration can predict the probability of salvaging the testicles and performing orchiectomy. Rapid intervention should be recommended, regardless of the time elapsed from the onset of pain.
Topics: Adult; Humans; Male; Young Adult; Orchiectomy; Orchiopexy; Pain; Retrospective Studies; Spermatic Cord Torsion; Adolescent
PubMed: 37897515
DOI: 10.1007/s00345-023-04671-x -
Frontiers in Surgery 2020A spermatic cord lipoma is found in 20-70% of all inguinal hernia repairs. The clinical picture of an inguinal hernia with bulging and pain but without an actual...
A spermatic cord lipoma is found in 20-70% of all inguinal hernia repairs. The clinical picture of an inguinal hernia with bulging and pain but without an actual indirect hernia sac may become manifest in up to 8% of these cases. Missed spermatic cord lipoma can result in recurrence or pseudo-recurrence. This review presents the relevant literature on this topic. A systematic search of the available literature was performed in February 2020 using Medline, PubMed, Google Scholar, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals and reference lists. Forty-two publications were identified as relevant for this topic. Spermatic cord lipoma seems to originate from preperitoneal fatty tissue within the internal spermatic fascia in topographical proximity to the arteries, veins, lymphatics, nerves, and deferent duct within the spermatic cord. Reliable diagnosis cannot be made clinically, but rather with ultrasound, CT, or MRI. In the absence of a real hernia sac, a spermatic cord lipoma is classified as a lateral inguinal hernia with a defect size <1.5 cm according to the European Hernia Society (EHS LI). Missed or inadequately treated spermatic cord lipoma results in recurrence or pseudo-recurrence. Since spermatic cord lipoma obtains its vascular supply from the preperitoneal space, it can be reduced or resected. Spermatic cord lipoma is a common finding in inguinal hernia repairs and must be properly diagnosed and treated with care respecting the anatomy of the spermatic cord.
PubMed: 32793626
DOI: 10.3389/fsurg.2020.00039 -
Korean Journal of Urology Jan 2015Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete... (Review)
Review
Scrotal pain is a common complaint in a urological practice. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. This article discusses the evaluation and management of several entities of scrotal pain, including testicular torsion, epididymitis, postvasectomy pain, varicocele, and chronic orchialgia.
Topics: Diagnosis, Differential; Epididymitis; Humans; Male; Pain; Pain Management; Pain, Postoperative; Physical Examination; Scrotum; Spermatic Cord Torsion; Testis; Varicocele; Vasectomy
PubMed: 25598931
DOI: 10.4111/kju.2015.56.1.3 -
Veterinary Medicine and Science Sep 2023Orchiectomy with a vas deferens to pampiniform plexus ligation (VPL) is a novel method, and it is unclear how its short-term outcomes compare with the results of a...
BACKGROUND
Orchiectomy with a vas deferens to pampiniform plexus ligation (VPL) is a novel method, and it is unclear how its short-term outcomes compare with the results of a conventional method, spermatic cord ligation (SCL).
OBJECTIVE
To compare the short-term outcomes of SCL and VPL on inflammation, surgery time, bleeding, pain and surgeon satisfaction during canine open orchiectomy.
METHODS
Thirty male crossbred dogs undergoing open orchiectomy were enrolled the study. Dogs were randomly allocated to one of the SCL or VPL groups, with 15 patients in each. In the SCL group, the spermatic cord was ligated using absorbable sutures. The vas deferens, and pampiniform plexus self-tying were performed in the VPL group. Surgery time, bleeding and surgeon satisfaction scores were recorded. Inflammation at the surgical site was assessed using infrared thermal camera over three days, and pain associated with inflammation was scored on the third day.
RESULTS
On Day 3, the average temperature in the SCL group was significantly higher than that of the VPL group, with a mean difference of 4.63°C (95% CI: 2.34-6.93, p < 0.001). Moreover, the surgery time in the VPL group was significantly longer compared to the SCL group, with a mean difference of 1.7 min (95% CI: 0.28-3.11, p = 0.021). The bleeding score was also significantly higher in the VPL group (p = 0.012). On the other hand, surgeon satisfaction and pain scores were not significantly different between groups.
CONCLUSION
Both SCL and VPL methods are safe and effective for orchiectomy in dogs. VPL is comparable in efficacy and safety and has the additional benefit of less inflammation.
Topics: Dogs; Male; Animals; Spermatic Cord; Vas Deferens; Orchiectomy; Prospective Studies; Inflammation; Pain; Dog Diseases
PubMed: 37466009
DOI: 10.1002/vms3.1208 -
Fertility and Sterility Jan 2017Brown JS, Dubin L, Hotchkiss RS. The varicocele as related to fertility. Fertil Steril 1967;18:46-56. "The fact that some men with varicoceles are fertile should not...
Brown JS, Dubin L, Hotchkiss RS. The varicocele as related to fertility. Fertil Steril 1967;18:46-56. "The fact that some men with varicoceles are fertile should not minimize the potentially detrimental role of this abnormality. It would be reasonable to claim that varicocele is uniformly detrimental. One might postulate that a fertile man with a varicocele would have better semen without this condition."
Topics: Fertility; History, 20th Century; Humans; Infertility, Male; Male; Phlebography; Predictive Value of Tests; Risk Factors; Spermatic Cord; Varicocele; Veins
PubMed: 27842996
DOI: 10.1016/j.fertnstert.2016.10.018 -
Urologic Nursing 2017Testicular torsion is a urologic emergency, requiring prompt identification and management. Understanding the risk factors, presentation, and management is essential to... (Review)
Review
Testicular torsion is a urologic emergency, requiring prompt identification and management. Understanding the risk factors, presentation, and management is essential to decrease delays in diagnosis and intervention. This review discusses the prevalence, pathophysiology, management, and outcomes of testicular torsion.
Topics: Age Factors; Disease Management; Humans; Male; Physical Examination; Risk Factors; Spermatic Cord Torsion; Ultrasonography
PubMed: 29240370
DOI: No ID Found