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Medicine Nov 2023Transverse testicular ectopia (TTE) is a rare congenital malformation with a high rate of misdiagnosis and mistreatment before operation, which cannot be diagnosed even... (Review)
Review
RATIONALE
Transverse testicular ectopia (TTE) is a rare congenital malformation with a high rate of misdiagnosis and mistreatment before operation, which cannot be diagnosed even during operation due to lack of knowledge.
PATIENT CONCERNS
Two patients with ectopic testes who were misdiagnosed as right inguinal hernia for the first time and underwent surgery. The "ovary" and "testicle" like structures was seen in the right inguinal region during the first operation. After being transferred to our hospital for laparoscopic surgery, it was found that the left spermatic cord and testis were transversely transverted to the right, the left testis was fixed at the right inner ring, and agglomerated soft tissue could be seen in the right inguinal canal, which was suspected to be Muller tube.
DIAGNOSES
Based on preoperative images and intraoperative findings, both cases were diagnosed with Transverse testicular ectopia (TTE). The postoperative pathology report for the second patient revealed the presence of an in situ spermatogenic cell tumor in the ectopic testis.
INTERVENTIONS
Preperitoneal tension-free repair of right inguinal hernia and resection of left cryptorchidism were performed on the 2 patients.
OUTCOMES
Postoperative pathology of the first patient confirmed that the resected specimens contained tubal-like and uterine-like structures. The postoperative pathology of the second patient showed that the resected tissue consists of immature testis, epididymis, uterus and seminal vesicle glands, in which an in situ spermatogenic tumor could be seen in the testicular tissue. Postoperative diagnosis: left transversal testicular ectopia and right indirect inguinal hernia.
LESSONS
The clinical misdiagnosis and mistreatment rate of TTE is very high. Once the patients with cryptorchidism complicated with inguinal hernia are found in clinic, the possibility of the disease must be considered. For the patients whose cryptorchidism does not descend into the ipsilateral scrotum and it is difficult to diagnose, laparoscopy can be used for both diagnosis and treatment. If a patient has both inguinal hernia and cryptorchidism, it is crucial to rule out a diagnosis of TTE to prevent misdiagnosis and inappropriate treatment.
Topics: Humans; Male; Cryptorchidism; Diagnostic Errors; Hernia, Inguinal; Neoplasms; Testis
PubMed: 37933018
DOI: 10.1097/MD.0000000000035850 -
Urology Research & Practice Sep 2023Scrotal tumors of nerve origin are extremely rare and occur mostly in the extratesticular tissues of scrotum, such as the spermatic cord and epididymis. A systematic...
Scrotal tumors of nerve origin are extremely rare and occur mostly in the extratesticular tissues of scrotum, such as the spermatic cord and epididymis. A systematic search of the literature in PubMed, Medline, and Google Scholar databases concerning intrascrotal nerve tumors was performed by 2 independent investigators. The systematic search retrieved 45 male adults, with a mean age of included patients at 43.9 ± 18.8 years. The majority of nerve tumors were extra-testicular (86.7%), and only 13.3% originated from the testis. Out of that, 51.1% of neoplasms were histologically proved as schwannomas, 44.4% as neurofibromatosis, and 4.4% as malignant peripheral nerve sheath tumors. The majority of patients presented with atypical symptoms such as scrotal swelling (51.1%), while only 4.4% of patients were asymptomatic. Ultrasonography is the diagnostic modality of choice (97.2%) for the detection of primary lesion, while magnetic resonance imaging and computed tomography comprise supplementary diagnostic tools. Surgical excision of the mass was the preferred type of surgery performed (75.6%), whereas orchiectomy was performed only in 22.2% of patients. Intrascrotal tumors of nerve origin are extremely rare neoplasms that present mainly in middle-aged males. Increased clinical suspicion is required for accurate diagnosis of this rare entity.
PubMed: 37877874
DOI: 10.5152/tud.2023.23050 -
Acta Cirurgica Brasileira 2023To evaluate the viability of the porcine vas deferens as a realistic microsurgical training model for vasectomy reversal.
PURPOSE
To evaluate the viability of the porcine vas deferens as a realistic microsurgical training model for vasectomy reversal.
METHODS
The model uses swine testicles (vas deferent), which are usually discarded in large street markets since they are not part of Brazilian cuisine. The spermatic cord was carefully dissected, and the vas deferens were isolated, measuring 10 cm in length. A paper quadrilateral with 5 cm2 was built to delimit the surgical training field. The objective of the model is to simulate only the microsurgical step when the vas deferens are already isolated. The parameters analyzed were: feasibility for reproducing the technique, patency before and after performing the vasovasostomy, cost of the model, ease of acquisition, ease of handling, execution time, and model reproducibility.
RESULTS
The simulator presented low cost. All models made were viable with a texture similar to human, with positive patency obtained in 100% of the procedures. The internal and external diameters of the vas deferens varied between 0.2-0.4 mm and 2-3 mm, respectively, with a mean length of 9 ± 1.2 cm. The total procedure time was 43.28 ± 3.22 minutes.
CONCLUSIONS
The realistic model presented proved to be viable for carrying out vasectomy reversal training, due to its low cost, easy acquisition, and easy handling, and providing similar tissue characteristics to humans.
Topics: Humans; Male; Animals; Swine; Vasovasostomy; Reproducibility of Results; Testis; Spermatic Cord; Brazil
PubMed: 37646762
DOI: 10.1590/acb383023 -
Actas Urologicas Espanolas Jun 2024Different degrees of testicular torsion result in varying degrees of testicular damage, which influences treatment options and outcomes. Therefore, establishing a...
INTRODUCTION AND OBJECTIVES
Different degrees of testicular torsion result in varying degrees of testicular damage, which influences treatment options and outcomes. Therefore, establishing a testicular torsion model with different degrees is necessary for clinical diagnosis.
MATERIALS AND METHODS
Rabbits were randomly divided into four groups and their spermatic cords were twisted at 0 °, 180 °, 360 °, and 720 °, respectively. Color Doppler flow imaging (CDFI) were performed to evaluate the blood supply in testicles. The twisted testicles were surgically removed at six hours post-operation and were evaluated by morphological observation and Hematoxylin and Eosin staining.
RESULTS
CDFI signals were gradually decreased as the degree of testicular torsion increased, and scores of CDFI in the 360 ° and 720 ° groups were significantly decreased at postoperative six hours compared to pre-surgery. Compared to the sham, the testicle in the 180 ° group exhibited slight congestion, whereas the testicles in the 360 ° and 720 ° groups were dark red in color and had severe congestion and unrecognizable vessels. Hematoxylin and Eosin staining showed mild spermatogenic cell reduction and testicular interstitial hemorrhage in the 180 ° group. In the 360 ° and 720 ° groups, disordered seminiferous tubules, shed spermatogenic cells in tubules, inflammatory cell infiltration, and severe hemorrhage were found. In comparison with the sham, interstitial hemorrhage scores in the 360 ° and 720 ° groups were significantly higher, and scores of germinal epithelial cell thickness in the three testicular torsion groups were significantly decreased.
CONCLUSIONS
Collectively, we successfully constructed a testicular torsion model with different degrees in rabbits.
PubMed: 38885741
DOI: 10.1016/j.acuroe.2024.05.017 -
The Journal of Urology Jan 2024We sought to determine if the addition of liposomal bupivacaine to bupivacaine hydrochloride improves opioid-free rate and postoperative pain scores among children... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness of Liposomal Bupivacaine With Bupivacaine Hydrochloride vs Bupivacaine Hydrochloride Alone as a Local Anesthetic for Children Undergoing Ambulatory Urologic Surgery: The Baby ORIOLES Randomized Clinical Trial.
PURPOSE
We sought to determine if the addition of liposomal bupivacaine to bupivacaine hydrochloride improves opioid-free rate and postoperative pain scores among children undergoing ambulatory urologic surgery.
MATERIALS AND METHODS
A prospective, phase 3, single-blinded, single-center randomized trial with superiority design was conducted in children 6 to 18 years undergoing ambulatory urologic procedures between October 2021 and April 2023. Patients were randomized 1:1 to receive dorsal penile nerve block (penile procedures) or incisional infiltration with spermatic cord block (inguinal/scrotal procedures) with weight-based liposomal bupivacaine plus bupivacaine hydrochloride or bupivacaine hydrochloride alone. The primary outcome was opioid-free rate at 48 hours. Secondary outcomes included parents' postoperative pain measure scores, numerical pain scale scores, and weight-based opioid utilization at 48 hours and 10 to 14 days.
RESULTS
We randomized 104 participants, with > 98% (102/104) with complete follow-up data at 48 hours and 10 to 14 days. At interim analysis, there was no significant difference in opioid-free rate at 48 hours between arms (60% in the intervention vs 62% in the control group; estimated difference in proportion -1.9% [95% CI, -20%-16%]; = .8). We observed no increased odds of patients being opioid-free at 48 hours with the intervention compared to the control group (OR 0.96 [95% CI 0.41-2.3]; = .9). The trial met the predetermined futility threshold for early stopping. There was no difference in parents' postoperative pain measure scores, numerical pain scale scores, or opioid utilization at 48 hours or 10 to 14 days. No difference in adverse events was observed.
CONCLUSIONS
The addition of liposomal bupivacaine to bupivacaine hydrochloride did not significantly improve opioid-sparing effect or postoperative pain compared with bupivacaine hydrochloride alone among children ≥ 6 years undergoing ambulatory urologic surgery.
Topics: Adolescent; Child; Humans; Male; Analgesics, Opioid; Anesthetics, Local; Bupivacaine; Liposomes; Pain, Postoperative; Prospective Studies
PubMed: 37871332
DOI: 10.1097/JU.0000000000003764 -
European Review For Medical and... Nov 2023The present research aimed to study the possible protective effects of Silymarin on testicular I/R injury in a rat model evaluated through histopathology and biochemical...
OBJECTIVE
The present research aimed to study the possible protective effects of Silymarin on testicular I/R injury in a rat model evaluated through histopathology and biochemical parameters.
MATERIALS AND METHODS
This research investigated the impact of Silymarin on IR damage in male Wistar albino rats. Animals were divided into three groups: group 1 (sham), group 2 (IR), and group 3 (IR+Silymarin).
RESULTS
There were no notable differences in the levels of malondialdehyde (MDA), myeloperoxidase (MPO), and glutathione (GSH) across the three groups (p=0.260, p=0.486 and p=0.803, respectively). Contrarily, the total antioxidant status (TAS) levels exhibited significant variations between groups (p=0.001). The total oxidant status (TOS) levels also differed significantly between groups (p=0.004). The tissue evaluations uncovered substantial differences in the Johnson score, which is used to gauge testicular damage. A distinct contrast was seen between Group 1 and Group 2, and also between Group 2 and Group 3, with an all-encompassing p-value lower than 0.01. The same significant disparities were found for the percentages of Bax and Annexin V immunostaining (p<0.01 for each), reflecting the inflammation and apoptosis brought about by ischemia-reperfusion and the protective effects of the treatment.
CONCLUSIONS
The outcomes of the current investigation showed that Silymarin could be a valuable agent for reducing testicular tissue damage following I/R injury.
Topics: Humans; Rats; Male; Animals; Spermatic Cord Torsion; Rats, Wistar; Silymarin; Oxidative Stress; Reperfusion Injury; Testis; Antioxidants; Glutathione; Malondialdehyde
PubMed: 37975368
DOI: 10.26355/eurrev_202311_34319 -
Cureus Oct 2023Hydrocele represents a commonly encountered pathological condition characterized by the development of scrotal swelling. In contrast, spermatic cord hydrocele is a...
Hydrocele represents a commonly encountered pathological condition characterized by the development of scrotal swelling. In contrast, spermatic cord hydrocele is a relatively rare condition that arises from the abnormal closure of the processus vaginalis. This condition entails the accumulation of fluid within the spermatic cord, and although hydrocele itself is a frequently observed ailment affecting roughly 100 out of 100,000 men, encysted hydrocele of the spermatic cord is a seldom-seen variant. Furthermore, it is noteworthy that spermatic cord hydrocele tends to be more prevalent in the pediatric population compared to adults. In our clinical practice, a patient presented with swelling localized to the right hemi-scrotum and was initially diagnosed as suffering from a chronic right-sided hydrocele of the tunica vaginalis. However, during the surgical intervention, the true nature of the condition became evident, as it was determined to be an encysted hydrocele of the cord. This case report chronicles the diagnostic journey surrounding hydrocele, highlighting the distinction in surgical management between encysted hydrocele and vaginal hydrocele of the testis.
PubMed: 38022017
DOI: 10.7759/cureus.47782 -
Georgian Medical News Oct 2023The Lichtenstein method revolutionized the treatment of inguinal hernias. But this method is accompanied by serious complications, as evidenced by the publications of...
The Lichtenstein method revolutionized the treatment of inguinal hernias. But this method is accompanied by serious complications, as evidenced by the publications of recent years. Such complications include the development of fibrous changes in the scrotum, deejaculation, obstructive azoospermia, oligospermia. Therefore, in the treatment of inguinal hernia, the so-called isolation methods are becoming more and more relevant, which implies complete isolation from the rope mesh and does not affect spermatogenesis. Aim of the study - to compare the morphological parameters of sperm before and after hernia surgery in the groups that underwent modeled herniaplasty by Lichtenstein's method and with spermatic cord isolation from a mesh by Gvenetadze. 16 male rabbits aged 12 months ± 3 months, weighing 3.5 ± 0.5 kg were included in the study. Of these, 8 (50%) underwent hernioplasty by Lichtenstein's method, and 8 (50%) - with complete isolation of Bagirak. Gvenetadze's method. Rabbits were divided into two groups. The first group: 8 rabbits, which underwent Lichtenstein's hernia surgery. The second group: 8 rabbits, which underwent hernioplasty with complete isolation of the sacrum using the Gvenetadze method. In both groups, a spermomorphocytological study was performed 2 days before the operation and 3 months and 6 months after the operation. The study included a complete spermomorphocytological examination by studying the following sperm parameters: sperm volume, color, turbidity, ejaculatory time, stickiness, odor, PH, number of spermatozoa in 1 ml, number of spermatozoa in the whole ejaculate, live spermatozoa, motile spermatozoa, progressive motile spermatozoa, Normal morphological of permatozoites Molds, leukocytes, erythrocytes, lipoid bodies, spermagglutination, fungi, bacteria, mucus. Semen were collected 2 days before surgery, 3 months after surgery, and 6 months after surgery. The sperm was obtained using the so-called "artificial vagina". Our study showed that inguinal hernia repair with spermatic cord isolation does not affect spermatogenesis.
Topics: Female; Animals; Male; Rabbits; Hernia, Inguinal; Semen; Surgical Mesh; Spermatogenesis; Herniorrhaphy; Treatment Outcome; Recurrence
PubMed: 38096521
DOI: No ID Found -
Cureus Dec 2023Background Testicular torsion is a serious condition that requires immediate medical attention. It occurs when the spermatic cord, which carries blood to the testicles,...
Background Testicular torsion is a serious condition that requires immediate medical attention. It occurs when the spermatic cord, which carries blood to the testicles, twists, reducing blood flow and oxygen to the testicle. This can lead to tissue death and loss of the testis if not treated promptly. It is important to seek medical attention immediately when symptoms of testicular torsion arise, as prompt treatment can help prevent permanent damage to the testicle. This study aimed to explore the level of knowledge about testicular torsion among the general population in the Kingdom of Saudi Arabia. Methodology A descriptive cross-sectional study was conducted using a convenience sample recruited from the general population who fulfilled the inclusion criteria. The data were collected from participants using an electronic pre-structured questionnaire. The researchers developed the questionnaire through expert consultation and after an intensive literature review. The questionnaire was reviewed by a panel of three experts for validation and applicability. After a pilot study, the reliability coefficient (Cronbach's alpha) was 0.74. The data were analyzed using SSPS version 25 (IBM Corp., Armonk, NY, USA) and presented as percentages and frequencies. Chi-square and logistic regression were conducted. P-values ≤0.05 were considered statistically significant. Results A total of 732 participants were recruited, most of whom were male (486, 66.4%), with ages ranging between 18 and 30 years (452, 61.7%). Regarding testicular torsion knowledge, more than half of the participants had good knowledge (406, 55.5%) and knew about the signs, symptoms, and risk factors of testicular torsion. There was a statistically significant relationship between age and knowledge (p < 0.001) and an insignificant relationship between sex and knowledge (p > 0.05). Conclusions The study participants were found to have good knowledge. Fortunately, most participants knew that testicular torsion is an emergency and they must immediately visit the hospital. With further awareness programs, the overall knowledge level can be improved.
PubMed: 38283529
DOI: 10.7759/cureus.51194