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International Journal of Urology :... Jun 2016Testicular torsion is a common urological emergency among adolescent boys and young men. Rotation of the testis and twisting of the spermatic cord rapidly leads to... (Review)
Review
Testicular torsion is a common urological emergency among adolescent boys and young men. Rotation of the testis and twisting of the spermatic cord rapidly leads to ischemia, resulting in a loss of germ cells. Thus, prompt diagnosis and urgent surgical intervention are required, but the subsequent release of the torsion induces reperfusion injury, which causes further damage to the ischemic testis. Testicular torsion-detorsion (ischemia-reperfusion) injury triggers the generation of reactive oxygen species, pro-inflammatory cytokines, neutrophil recruitment, lipid peroxidation, anoxia and apoptosis, which carry a significant risk of subsequent infertility. Previously, the effects of numerous pharmacological agents and treatments have been evaluated to prevent testicular ischemia-reperfusion injury in animal models. We propose a new treatment, especially postconditioning, to prevent adverse effects of ischemia-reperfusion injury after testicular torsion-detorsion.
Topics: Animals; Humans; Ischemic Postconditioning; Male; Rats, Sprague-Dawley; Reperfusion Injury; Spermatic Cord; Spermatic Cord Torsion; Testis
PubMed: 27217335
DOI: 10.1111/iju.13110 -
Cancer Management and Research 2021The metastasis of gastric cancer to the testis or spermatic cord is very rare; however, simultaneous testicular and spermatic cord metastases are even rarer. Here, we...
The metastasis of gastric cancer to the testis or spermatic cord is very rare; however, simultaneous testicular and spermatic cord metastases are even rarer. Here, we report an unusual case of a 54-year-old male patient who had undergone radical gastrectomy for gastric adenocarcinoma more than two years before. He complained of palpable painful masses in the right scrotum and inguinal area occurring for more than half a year. Enhanced computed tomography (CT) separately showed an enhanced soft tissue mass in the right testicular and spermatic cord areas. Therefore, a right radical orchiectomy was conducted. The pathology was consistent with the metastases of gastric adenocarcinoma.
PubMed: 33654434
DOI: 10.2147/CMAR.S286909 -
Annals of Saudi Medicine 2020Inflammatory myofibroblastic tumor (IMT) is a neoplasm of intermediate biological potential. Few cases of spermatic cord IMT have been reported in the literature.... (Review)
Review
Inflammatory myofibroblastic tumor (IMT) is a neoplasm of intermediate biological potential. Few cases of spermatic cord IMT have been reported in the literature. Inflammatory myofibroblastic tumor is a consequence of the proliferation of fibroblasts and inflammatory cells. Despite its benign nature, the tumor often clinically mimics intrascrotal malignancy and usually remains undiagnosed preoperatively. The diagnosis of spermatic IMT is difficult preoperatively due to the non-specific findings. Therefore, if testicular tumors cannot be precisely excluded, radical orchiectomy should be performed for the diagnosis and treatment. However, it mainly occurs in children and young adults; spermatic IMT may also be seen among elderly men. Here, we report two cases of inflammatory myofibroblastic tumor involving the spermatic cord. SIMILAR CASES PUBLISHED: There are seven cases entitled "inflammatory myofibroblastic tumor of spermatic cord" in the literature. In our study we present two cases that had a spermatic cord IMT. Furthermore, one of these cases was 82 years of age and is the oldest patient presented in the literature.
Topics: Aged, 80 and over; Genital Neoplasms, Male; Humans; Male; Middle Aged; Neoplasms, Muscle Tissue; Spermatic Cord
PubMed: 32027518
DOI: 10.5144/0256-4947.2020.66 -
Frontiers in Surgery 2022Anastomosing hemangioma (AH) is a rare vascular tumor and occurs in various organs. It is difficult to distinguish AH from malignant tumors even through multimodal...
BACKGROUND
Anastomosing hemangioma (AH) is a rare vascular tumor and occurs in various organs. It is difficult to distinguish AH from malignant tumors even through multimodal imaging examination. AH located in the inguinal region is even rare. We present the diagnosis and treatment of a patient with spermatic cord AH in detail and conduct a literature review.
CASE REPORT
An 84-year-old Chinese man had swelling pain in his right scrotum. A hard and fixed mass was palpable in the right inguinal region. Preoperative radiological examination considered it a neurogenic or vascular tumor. Malignant soft tissue sarcoma could not be excluded. He underwent radical inguinal right orchiectomy under intraspinal anesthesia. The diagnosis of spermatic cord AH was confirmed by pathological examination. The patient recovered uneventfully and remained disease-free during an 18-month follow-up.
CONCLUSION
Spermatic cord AH is quite rare and could be misdiagnosed as a malignant tumor. Pathological evidence might be necessary. The optimal choice of treatment should be determined through a comprehensive assessment of both tumor and patient factors.
PubMed: 35937604
DOI: 10.3389/fsurg.2022.930160 -
The Archives of Bone and Joint Surgery Oct 2015Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. Anterior acetabular surgery also includes...
BACKGROUND
Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. Anterior acetabular surgery also includes fixation through an ilioinguinal or Stoppa approach. These exposures risk injury to the spermatic cord and accompanying genital branch of the genitofemoral nerve. The primary aim of this study was to identify the distance between the midline and the spermatic cords in adult male cadaveric specimens. The secondary aim was to determine spermatic cord diameters and measure the distance between the spermatic cord and implant during instrumentation of a retrograde superior pubic ramus medullary screw.
METHODS
Extended Pfannenstiel and Stoppa approaches were performed on 18 embalmed male cadavers bilaterally. Spermatic cord characteristics were recorded and a number of measurements were performed to determine the distance of implants and the midline from the spermatic cord.
RESULTS
The average distance between the midline and spermatic cords was 34.2 mm. The average distance between the spermatic cord and implant was 18.2 mm. Eleven of the thirty-six dissections had abnormalities including cord lipomas and inguinal hernias. The average cord diameter was 18.6 mm. The average cord diameter in those with abnormalities was 24.9 mm and 16 mm in those without abnormalities, this difference was statistically significant.
DISCUSSION
Due to the proximity of the spermatic cord, the surgeon should either formally expose the cord or limit lateral dissection from the midline during Pfannenstiel and Stoppa exposures. Similarly, the surgeon should use soft-tissue sleeves and oscillating drills to avoid injury to the contralateral spermatic cord during the insertion of retrograde superior pubic ramus medullary screws.
PubMed: 26550592
DOI: No ID Found -
Urology Oct 2021To examine the utility of a modified spermatic cord block (MSCB) that targets known contributors to refractory chronic scrotal content pain (CSCP) at predicting...
OBJECTIVE
To examine the utility of a modified spermatic cord block (MSCB) that targets known contributors to refractory chronic scrotal content pain (CSCP) at predicting postoperative pain relief following a microscopic spermatic cord denervation (MSCD).
METHODS
A MSCB was performed in all patients with refractory CSCP. This was performed by injecting anesthetic circumferentially around the vas deferens and over the external ring. Patients with >50% pain reduction were offered MSCD. Baseline, post-block, and postoperative pain was assessed. Age, prior groin surgery, and post-block pain free period were recorded. A multivariate linear regression model was used to determine predictors of surgical success.
RESULTS
Fifty-two patients underwent a MSCB. Forty-six (88%) had an adequate response and underwent MSCD. All patients saw improvement in pain postoperatively with an average reduction of 80% (4 < 50%; 7 50-69%; 35 ≥ 70%). On multivariate linear regression analysis, pain reduction following MSCD was an independent predictor of postoperative improvement (P < 0.001). No other factors, including post-block pain free period or prior surgery predicted success.
CONCLUSIONS
The described MSCB can be utilized as an independent predictor of success following MSCD. Post-block pain free period was not associated with postoperative pain level. The MSCB may help identify candidates for MSCD that would be missed with the traditional block.
Topics: Adult; Aged; Chronic Pain; Denervation; Humans; Male; Microsurgery; Middle Aged; Preoperative Period; Prognosis; Retrospective Studies; Scrotum; Spermatic Cord; Treatment Outcome; Young Adult
PubMed: 33961892
DOI: 10.1016/j.urology.2021.04.033 -
The Journal of Urology Sep 2021The primary aim of our study was to evaluate relief of chronic scrotal content pain after a series of spermatic cord blocks with a combination of local anesthetic and a...
PURPOSE
The primary aim of our study was to evaluate relief of chronic scrotal content pain after a series of spermatic cord blocks with a combination of local anesthetic and a steroid. Secondary aims were to assess factors associated with a positive response and complications.
MATERIALS AND METHODS
We performed a retrospective chart review of patients who underwent spermatic cord block series for chronic scrotal content pain at our practice between 2012 and 2019. Pain scores were compared before and after treatment using an 11-point numerical pain rating scale. We performed univariate analysis to assess differences between responders and nonresponders, and the relationship between symptom duration and response was analyzed by rank-order correlation.
RESULTS
We included 44 men with chronic scrotal content pain present for a median duration of 24 months who underwent a spermatic cord block series. At a median followup of 16 months, 31 patients (70.5%) experienced sustained relief, including 9 patients (20.5%) with complete resolution of pain. There were no differences between responders and nonresponders in terms of symptom duration, perceived etiology, or previous treatments, and there was no association between response and duration of pain. Minor complications occurred in 5 cases (11.4%).
CONCLUSIONS
Spermatic cord block series is a safe, minimally invasive treatment for men with refractory chronic scrotal content pain. Response to cord block series appears to be independent of symptom duration, perceived etiology or prior medical and surgical treatments. Future studies should be conducted to evaluate long-term durability and predictors of success.
Topics: Adult; Aged; Anesthetics, Local; Chronic Pain; Glucocorticoids; Humans; Male; Middle Aged; Nerve Block; Pain Measurement; Retrospective Studies; Scrotum; Spermatic Cord; Testicular Diseases; Treatment Outcome; Young Adult
PubMed: 33872052
DOI: 10.1097/JU.0000000000001777 -
Hernia : the Journal of Hernias and... Oct 2021Cord lipomas can clinically resemble groin hernias and missed cord lipomas can potentially result in persistent symptoms. However, no international guideline exists...
PURPOSE
Cord lipomas can clinically resemble groin hernias and missed cord lipomas can potentially result in persistent symptoms. However, no international guideline exists concerning the management of cord lipomas found during inguinal hernia surgery. This study aimed to gain insight into how surgeons typically manage cord lipomas found during inguinal hernia surgery.
METHODS
A questionnaire was sent to all general surgeons in Denmark performing unsupervised laparoscopic inguinal hernia repair and Lichtenstein repair. The survey contained questions about demographic details and questions about how surgeons would handle cord lipomas. The questionnaire was created by the research team and face-validated on general surgeons.
RESULTS
A total of 58 surgeons (60%) responded to the questionnaire. The majority agreed that cord lipomas should not be left untouched. During laparoscopic repairs, 53% of the surgeons recommended that cord lipomas should be resected and removed if the anatomical circumstances allowed it. During Lichtenstein repair, the surgeons recommended that cord lipomas should always be resected and removed (49%) or that resection should depend on the size of the lipoma (44%).
CONCLUSION
When asking surgeons about their preferred handling of cord lipomas, they answered that the management of cord lipomas found during inguinal hernia surgery depends on anatomical circumstances such as the pedicle appearance, the lipoma mobility, and its size. If the cord lipoma is left untouched, the patients' hernia resembling symptoms could persist, why the surgeons predominantly preferred to resect and remove cord lipomas.
Topics: Hernia, Inguinal; Herniorrhaphy; Humans; Laparoscopy; Lipoma; Male; Spermatic Cord; Surveys and Questionnaires
PubMed: 33993347
DOI: 10.1007/s10029-021-02425-5 -
Minerva Pediatrics Jun 2023
Topics: Infant, Newborn; Male; Humans; Spermatic Cord Torsion; Testis; Orchiectomy
PubMed: 36757016
DOI: 10.23736/S2724-5276.23.07168-9 -
Cureus Nov 2021Spermatic cord cancer is a rare entity. Among malignant tumors of the spermatic cord, liposarcomas are the most common type, often presenting as painless slow-growing...
Spermatic cord cancer is a rare entity. Among malignant tumors of the spermatic cord, liposarcomas are the most common type, often presenting as painless slow-growing masses usually in the fifth and sixth decades of life; they can be misdiagnosed as inguinal hernia or hydrocele. Radical orchiectomy with wide local soft tissue resection is an accepted standard of care for spermatic cord liposarcoma and has been curative in some cases. There is no definitive role for other treatment modalities such as chemotherapy, retroperitoneal lymph node dissection (RPLND), and radiotherapy. We present a case of liposarcoma of the spermatic cord managed with radical orchiectomy, wide local excision, and was followed up without disease recurrence. We also engage in a review of the literature on the role of systemic chemotherapy and radiotherapy in preventing locoregional recurrence after primary surgery. A combination of surgery and postoperative radiotherapy is effective in preventing locoregional spread. Data from case reports support this strategy in certain histologic subtypes or when margins are positive after primary surgery. A follow-up period of up to a decade after surgery is recommended.
PubMed: 34917443
DOI: 10.7759/cureus.19567