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Progres En Urologie : Journal de... Feb 2022Spermatic cord torsion is a frequent urological emergency that mostly concerns teenagers and young adults. This study aimed to determine the clinical and surgical...
TORSAFUF - Surgical exploration for torsion of spermatic cord suspicion and risk factors for unnecessary surgery: Results of a French nationwide retrospective study on 2940 patients.
BACKGROUNDS
Spermatic cord torsion is a frequent urological emergency that mostly concerns teenagers and young adults. This study aimed to determine the clinical and surgical characteristics of young adults who had scrotal exploration for suspected spermatic cord torsion and to identify clinical risk factors associated with needless scrotal exploration.
METHODS
We retrospectively collected national data from patients aged 12years and older who underwent a surgical exploration for suspicion of torsion of the spermatic cord between 2005 and 2019 in 17 hospitals. We analyzed demographics, surgical and postoperative characteristics in our population. We compared the cohort according to the intraoperative diagnosis of torsion or not.
RESULTS
In total, 2940 had surgical exploration: 1802 (61.3%) patients had torsion of the spermatic cord and 1138 (38.7%) had another diagnosis. In multivariate analysis, age (OR: 1.04; 95% CI: 1.01-1.06; P=0.005), medical history of cryptorchism (OR: 4.14; 95% CI: 1.05-16.31; P=0.042) and VAS pain score (OR: 0.91; 95% CI: 0.83-0.98; P=0.018) were risk factors significantly associated with unnecessary surgical exploration. The rate of complications in the 90days after surgery was 11% in the "torsion" group, and 9.7% in the "non-torsion" group (P=0.28).
CONCLUSION
Scrotal exploration without intraoperative diagnosis of torsion was performed in 40% of our cohort. VAS pain score and cryptorchism history can help for the diagnosis but scrotal exploration remains the way to diagnose spermatic cord torsion and should be performed on the slightest suspicion, even after 24hours of symptoms, as the chances for testicular salvage remains around 50%.
Topics: Adolescent; Child; Humans; Male; Retrospective Studies; Risk Factors; Scrotum; Spermatic Cord; Spermatic Cord Torsion; Unnecessary Procedures; Young Adult
PubMed: 34920923
DOI: 10.1016/j.purol.2021.10.011 -
Radiographics : a Review Publication of... 2022A wide range of benign and malignant processes can affect the spermatic cord (SC). Familiarity with and recognition of the characteristic imaging features of these...
A wide range of benign and malignant processes can affect the spermatic cord (SC). Familiarity with and recognition of the characteristic imaging features of these entities are imperative for accurate diagnosis and optimal clinical care. While some SC diseases are self-limiting, others can result in infertility and potentially life-threatening infection or bleeding if they are left untreated. Therefore, correct diagnosis is important for life-saving treatment and preservation of fertility. Disorders including anomalies of the vas deferens and the processus vaginalis, arterial and venous diseases (torsion of the SC and varicoceles), infection, trauma, and neoplasms are the most pertinent entities with which radiologists should be familiar when assessing the SC. Knowing what to expect in a patient who has undergone SC interventions is imperative. US has a fundamental role in the initial examination of patients who present with symptoms that indicate abnormalities of the SC, such as suspected posttraumatic testicular retraction or SC torsion. Other imaging techniques including abdominal and pelvic MRI and CT have their own importance. For correct interpretation of the findings and to establish an accurate diagnosis, it is crucial to have a thorough knowledge of the anatomy, the utility and limitations of various imaging modalities, optimal imaging and scanning techniques, and the imaging features of various benign and malignant pathologic conditions that can involve the SC. RSNA, 2022.
Topics: Humans; Inguinal Canal; Magnetic Resonance Imaging; Male; Spermatic Cord; Spermatic Cord Torsion; Testicular Diseases
PubMed: 35394888
DOI: 10.1148/rg.210161 -
European Journal of Emergency Medicine... Jun 2016The acute scrotum is a challenging condition for the treating emergency physician requiring consideration of a number of possible diagnoses including testicular torsion.... (Review)
Review
The acute scrotum is a challenging condition for the treating emergency physician requiring consideration of a number of possible diagnoses including testicular torsion. Prompt recognition of torsion and exclusion of other causes may lead to organ salvage, avoiding the devastating functional and psychological issues of testicular loss and minimizing unnecessary exploratory surgeries. This review aims to familiarize the reader with the latest management strategies for the acute scrotum, discusses key points in diagnosis and management and evaluates the strengths and drawbacks of history and clinical examination from an emergency perspective. It outlines the types and mechanisms of testicular torsion, and examines the current and possible future roles of labwork and radiological imaging in diagnosis. Emergency departments should be wary of younger males presenting with the acute scrotum.
Topics: Acute Disease; Emergency Service, Hospital; Humans; Male; Physical Examination; Scrotum; Spermatic Cord Torsion
PubMed: 26267075
DOI: 10.1097/MEJ.0000000000000303 -
The Journal of Dermatology Nov 2020
Topics: Humans; Male; Spermatic Cord; Tuberculosis, Cutaneous
PubMed: 32783197
DOI: 10.1111/1346-8138.15540 -
Safety and efficacy of intensity-modulated radiotherapy in the management of spermatic cord sarcoma.Cancer Radiotherapie : Journal de La... Feb 2017Spermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide...
PURPOSE
Spermatic cord sarcoma is a rare disease, which management remains controversial due to the lack of guidelines. The standard therapeutic approach is surgical: wide soft-tissue resection with radical inguinal orchidectomy, The diagnosis is made during the analysis of the specimen. The high rate of local recurrence indicates adjuvant radiotherapy of the tumor bed. The aim of this series is to determine the efficacy and safety of postoperative intensity-modulated radiotherapy for spermatic cord sarcomas.
PATIENTS AND METHODS
Our series included five consecutive cases of spermatic cord sarcoma treated between 2011 and 2014. The indications for radiotherapy were: R1 status after initial surgery, R1 status after wide en bloc resection and orchiectomy, high French federation of cancer centers (FNCLCC) grade, tumor size over 5cm, tumor resection during surgery.
RESULTS
Median age at diagnosis was 66years (range 46-84years). Median follow-up was 18months (range 6-28months). Four patients had repeat surgery after incomplete removal. All surgeries were orchidectomy with primary ligation of testicular vessels. One patient did not have an in sano margin after the second surgical procedure. The median tumor size was 60mm (range 30-150mm). No recurrence was observed during the follow-up.
CONCLUSION
No grade 4 toxicities were reported and the most frequent acute toxicity was dermatitis. No recurrence was reported after adjuvant intensity-modulated radiotherapy. The treatment is feasible and well tolerated and seems to provide encouraging results regarding locoregional control of the disease. Dynamic or rotational intensity-modulated radiotherapy is now recommended to decrease acute toxicities while improving the efficacy of this approach.
Topics: Aged; Aged, 80 and over; Follow-Up Studies; Genital Neoplasms, Male; Humans; Leiomyosarcoma; Liposarcoma; Male; Middle Aged; Neoplasm Recurrence, Local; Orchiectomy; Organs at Risk; Radiodermatitis; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Reoperation; Retrospective Studies; Spermatic Cord; Treatment Outcome
PubMed: 28041814
DOI: 10.1016/j.canrad.2016.07.102 -
European Journal of Surgical Oncology :... Jul 2023To evaluate the outcomes of adult patients with spermatic cord sarcoma (SCS).
PURPOSE
To evaluate the outcomes of adult patients with spermatic cord sarcoma (SCS).
METHODS
All consecutive patients with SCS managed by the French Sarcoma Group from 1980 to 2017 were analysed retrospectively. Multivariate analysis (MVA) was used to identify independent correlates of overall survival (OS), metastasis-free survival (MFS), and local relapse-free survival (LRFS).
RESULTS
A total of 224 patients were recorded. The median age was 65.1 years. Forty-one (20.1%) SCSs were discovered unexpectedly during inguinal hernia surgery. The most common subtypes were liposarcoma (LPS) (73%) and leiomyosarcoma (LMS) (12.5%). The initial treatment was surgery for 218 (97.3%) patients. Forty-two patients (18.8%) received radiotherapy, 17 patients (7.6%) received chemotherapy. The median follow-up was 5.1 years. The median OS was 13.9 years. In MVA, OS decreased significantly with histology (HR, well-differentiated LPS versus others = 0.096; p = 0.0224), high grade (HR, 3 versus 1-2 = 2.7; p = 0.0111), previous cancer and metastasis at diagnosis (HR = 6.8; p = 0.0006). The five-year MFS was 85.9% [95% CI: 79.3-90.6]. In MVA, significant factors associated with MFS were LMS subtype (HR = 4.517; p < 10-4) and grade 3 (HR = 3.664; p < 10-3). The five-year LRFS survival rate was 67.9% [95% CI: 59.6-74.9]. In MVA, significant factors associated with local relapse were margins and wide reresection (WRR) after incomplete resection. OS was not significantly different between patients with initial R0/R1 resection and R2 patients who underwent WRR.
CONCLUSIONS
Unplanned surgery affected 20.1% of SCSs. A nonreducible painless inguinal lump should suggest a sarcoma. WRR with R0 resection achieved similar OS to patients with correct surgery upfront.
Topics: Male; Adult; Humans; Aged; Prognosis; Spermatic Cord; Retrospective Studies; Lipopolysaccharides; Neoplasm Recurrence, Local; Sarcoma; Liposarcoma; Leiomyosarcoma; Soft Tissue Neoplasms
PubMed: 36868941
DOI: 10.1016/j.ejso.2023.02.013 -
Current management of liposarcoma of the spermatic cord: A case report and review of the literature.Molecular and Clinical Oncology Mar 2017Liposarcomas of the spermatic cord, a rare cause of an inguinal mass, may closely mimic inguinal hernias on clinical examination. However, these tumors require a...
Liposarcomas of the spermatic cord, a rare cause of an inguinal mass, may closely mimic inguinal hernias on clinical examination. However, these tumors require a different surgical approach and treatment plan; therefore, intraoperative diagnosis might complicate patient management. We report the case of a 63-year-old man who presented with a mobile mass in the inguinal canal consistent with an inguinal hernia. The patient was subsequently diagnosed with a liposarcoma of the spermatic cord and successfully treated with extensive local resection, including radical orchiectomy and en bloc resection of the mass and associated cord structures. No adjuvant therapy was deemed necessary, and the patient remained asymptomatic and disease-free 10 years after surgery. The details of this case are presented, along with a review and discussion of the currently available data regarding the diagnosis and management of this challenging condition.
PubMed: 28451429
DOI: 10.3892/mco.2017.1157 -
Injury Feb 2022Distances between anatomic landmarks and anatomic structures at risk are often underestimated by surgeons.
BACKGROUND
Distances between anatomic landmarks and anatomic structures at risk are often underestimated by surgeons.
PURPOSE
The goal of the study was to evaluate the distances between anatomic landmarks and the spermatic cord in case of anterior plating of the symphysis.
METHODS
A total of 25 pelves (50 hemipelves) of male embalmed cadavers were dissected. A 5-hole 3.5mm locking compression plate (Synthes GmbH) was fixed from directly anterior on the symphysis. Measurements were taken 1) distance between the tips of both pubic tubercles, 2) horizontal interval between the lateral border of the plate and the medial margin of the SC (bilateral), 3) distances between the medial border of the SC and the tip of the pubic tubercle (bilateral), 4) distances between the medial border of the SC and the lateral basis of the pubic tubercle (bilateral).
RESULTS
The distance between the pubic tubercles was 60.3mm in average (SD: 5.7). The interval between the lateral border of the plate and the medial margin of the SC was on average 4.5mm (SD: 1.9) on the right and 4.7mm (SD: 2.6) on the left side. The distance between the tip of the pubic tubercle and the medial border of the SC was in average 11.2mm (SD: 2.7) on the right, and 11.0mm (SD: 2.7) on the left side. The average distance between the medial border of the SC and the lateral basis of the pubic tubercle was 8.1mm (SD: 2.4) on the right and 8.2 mm (SD: 2.4) on the left side.
CONCLUSION
The SC is at risk not only during dissection but also during anterior plating of the symphysis, because of its close relation to the SC.
CLINICAL RELEVANCE
Average distances between the palpable pubic tubercle and the SC are below one finger breadth (as reference).
Topics: Bone Plates; Fracture Fixation, Internal; Humans; Male; Pubic Bone; Pubic Symphysis; Spermatic Cord
PubMed: 34620470
DOI: 10.1016/j.injury.2021.09.045 -
Journal of Pediatric Urology Feb 2022
Topics: Humans; Male; Spermatic Cord Torsion; Testis; Xanthophylls
PubMed: 34776362
DOI: 10.1016/j.jpurol.2021.10.019 -
Indian Journal of Pediatrics Mar 2022
Topics: Female; Humans; Male; Pregnancy; Spermatic Cord Torsion; Testis
PubMed: 34435326
DOI: 10.1007/s12098-021-03920-4