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Journal of the College of Physicians... Apr 2022Paratesticular liposarcoma (PLS) is a rare type of genitourinary malignancy in the spermatic cord presenting as scrotal swelling. In this case study, we report an...
Paratesticular liposarcoma (PLS) is a rare type of genitourinary malignancy in the spermatic cord presenting as scrotal swelling. In this case study, we report an 82-year male who presented with prolonged left scrotal swelling and pain that did not respond to analgesic treatment for one week. His ultrasound confirmed increased fluid content in the left scrotal compartment in the form of septated hydrocele, and hydrocelectomy was planned. During the operation, infected fluid was drained. The testicle and surrounding tissues were infected; hence, left orchiectomy was performed. The pathological examination revealed a dedifferentiated liposarcoma. To our knowledge, this is the first report of liposarcoma of the spermatic cord with hydrocele in the literature. Key Words: Liposarcoma, Spermatic cord, Scrotal swelling, Hydrocele.
Topics: Genital Neoplasms, Male; Humans; Liposarcoma; Male; Orchiectomy; Scrotum; Spermatic Cord
PubMed: 35632994
DOI: 10.29271/jcpsp.2022.Supp1.S1 -
Urologia Internationalis 2022Testicular torsion is a serious surgical emergency of children. Prompt recognition and exclusion of other acute scrotal causes are essential for avoiding testicular...
INTRODUCTION
Testicular torsion is a serious surgical emergency of children. Prompt recognition and exclusion of other acute scrotal causes are essential for avoiding testicular loss. The aim of this study was to evaluate 10 years of experience with testicular torsion, point out our pitfalls in diagnosis and management, determine our likelihood of performing orchiectomy for potentially reversible injury.
MATERIAL AND METHOD
Records of patients operated for testicular torsion in the last decade were reviewed retrospectively. Clinical findings, symptoms, type of surgery, accuracy of radiological evaluation, and the outcome were analyzed. Orchiectomy specimens were reevaluated and histologically graded to determine the existence of previously undetermined low-grade injury.
RESULTS
In total, 107 children were operated for testicular torsion. Presentation included pain 96 (89.7%), scrotal swelling 48 (44.8%). Doppler ultrasonography was performed in 96 patients with false-negative results in 26 (27%). Testicular salvage occurred in 65 (60.7%) patients of which 6 (9.2%) developed subsequent testicular atrophy. Forty-two (33.9%) patients were treated with orchiectomy and histologic reevaluation, and grading of the specimens revealed 4 (9.7%) low-grade injury which indicates a potential of reversible injury. Seventeen (13.7%) patients had normal testicular anatomy in surgery.
CONCLUSION
Surgical exploration is mandated in case of clinical suspicion for testicular torsion even with a normal flow Doppler ultrasound. Macroscopic evaluation does not always correlate with microscopic findings, and a decision according to it may result in excision of potentially viable testis. Further studies are required to determine the actual risk of contralateral autoimmune damage and increase the rate testicular salvageability after testicular torsion.
Topics: Child; Male; Humans; Spermatic Cord Torsion; Retrospective Studies; Treatment Outcome; Orchiectomy; Testis
PubMed: 36063809
DOI: 10.1159/000525264 -
Urology Jan 2021To demonstrate the safety and efficacy of testis-sparing surgery (TSS) in 2 specific circumstances: small, nonpalpable masses suspected to be benign and masses...
OBJECTIVE
To demonstrate the safety and efficacy of testis-sparing surgery (TSS) in 2 specific circumstances: small, nonpalpable masses suspected to be benign and masses suspicious for germ cell tumor in a solitary or functionally solitary testicle or bilateral disease.
METHODS
Our institutional review board-approved testicular cancer registry was reviewed for men who underwent inguinal exploration with intent for TSS (2013-2020). The attempted TSS and completed TSS groups were evaluated for differences using Student's t test for normally-distributed variables, chi-squared and Fisher's exact tests for proportions, and Wilcoxon rank-sum test for nonparametric variables.
RESULTS
TSS was attempted in 28 patients and completed in 14. TSS was completed only if intraoperative frozen section demonstrated benign disease, except for 1 patient with stage I seminoma and solitary testicle. Sensitivity and specificity of frozen section analysis was 100% and 93%, respectively. There were no significant differences in demographics between attempted vs completed TSS cohorts. Median tumor size was significantly smaller in the completed TSS cohort (1.0 cm vs 1.7 cm, P = .03). In patients with unilateral masses without history of testis cancer, the testis was successfully spared in 9 of 22 cases (41%). In patients with bilateral disease or germ cell tumor in solitary testis, the testis was spared in 5 of 6 cases (83%). At a median follow up of 12.2 months, all patients were alive, and 27 of 28 had no evidence of disease (96%).
CONCLUSION
TSS is safe and effective for small, benign masses and in the setting of bilateral disease or tumor in a solitary testis.
Topics: Adult; Disease-Free Survival; Follow-Up Studies; Humans; Male; Neoplasm Recurrence, Local; Neoplasms, Germ Cell and Embryonal; Orchiectomy; Organ Sparing Treatments; Prospective Studies; Registries; Retrospective Studies; Testicular Neoplasms; Testis; Tumor Burden
PubMed: 33137349
DOI: 10.1016/j.urology.2020.10.031 -
Cirugia Pediatrica : Organo Oficial de... Jan 2021Orchiectomy is the most widely used surgical technique in testicular tumors (TT). However, according to tumor size, tumor markers, and histology, tumorectomy can be...
OBJECTIVES
Orchiectomy is the most widely used surgical technique in testicular tumors (TT). However, according to tumor size, tumor markers, and histology, tumorectomy can be considered as the technique of choice, since these tumors are mostly benign. We present our experience with conservative surgery.
MATERIAL AND METHODS
A retrospective study of 21 TT cases in 19 patients under 14 years of age treated in our healthcare facility from 1998 to 2018 was carried out. The following variables were analyzed: age, laterality, histological type, evolution, presence or absence of recurrence, and ultrasound and analytical follow-up. The therapeutic attitude used was reviewed while assessing the possibility of testicular preservation in selected patients.
RESULTS
Conservative surgery was performed in 9 TT cases in 7 patients (2 bilateral cases). Mean age was 6 years (0-13 years). 86% of cases started as an asymptomatic scrotal mass. No significant differences were found in terms of laterality. Tumor markers were negative before and after surgery, except in an infant with high alpha-fetoprotein, which was normalized in the postoperative period. The histological study diagnosed 7 stromal TTs (three Leydig cell stromal TTs, one bilateral Sertoli cell stromal TT, one hamartoma, and one fibroma) and 2 germ cell TTs (bilateral epidermoid cyst). Evolution was favorable in all cases, without clinical or ultrasound recurrence.
CONCLUSIONS
Conservative surgery of the testicular parenchyma using tumorectomy can be the first therapeutic option in benign tumors and in selected patients with bilateral tumor, since it allows future hormonal and reproductive function to be preserved.
Topics: Child; Humans; Male; Neoplasm Recurrence, Local; Orchiectomy; Retrospective Studies; Testicular Neoplasms
PubMed: 33507639
DOI: No ID Found -
International Journal of Surgery... Dec 2023Testis-sparing surgery (TSS) is a safe treatment for patients with benign testicular tumors. Presently, assessments for evaluating the suitability of TSS are poorly...
BACKGROUND
Testis-sparing surgery (TSS) is a safe treatment for patients with benign testicular tumors. Presently, assessments for evaluating the suitability of TSS are poorly standardized, partially because testicular anatomical elements cannot be quantitatively described.
MATERIALS AND METHODS
The authors developed a scoring method known as the SAVE testis-sparing score based on four critical and accessible anatomical features of a testicular tumor. The SAVE score ranges from 0 to 8 and is divided into four risk classes ( low , medium , high , and extremely high ) to evaluate the feasibility of TSS, wherein low-risk indicates high feasibility and vice versa. This study included 444 testicular tumor patients from eight centers. Among them, 216 patients (model group: 151 patients, validation group: 65 patients) were included in the modeling analysis, and the other 228 patients from children's centers were included in the proportion analysis. Using retrospective data, patient characteristics associated with surgical methods were identified. Furthermore, a multivariate logistic regression model was built quantify the associations between these characteristics and the surgery method. The receiver operator characteristic curve was used to evaluate the classification efficiency of SAVE.
RESULTS
The SAVE testis-sparing score includes size (tumor size as maximal diameter), available testicular tissue volume, volume ratio of the tumor to the testis, and the exophytic / endophytic properties of the tumor. The SAVE scoring system accurately classified the suitability of TSS based on the complexity of benign testicular tumors.
CONCLUSION
The SAVE score is a reproducible and robust tool for quantitatively describing the anatomical characteristics of benign testicular tumors and guide the preoperative evaluation of TSS.
Topics: Male; Child; Humans; Retrospective Studies; Orchiectomy; Organ Sparing Treatments; Testicular Neoplasms
PubMed: 37738014
DOI: 10.1097/JS9.0000000000000752 -
Minerva Pediatrics Jun 2023
Topics: Infant, Newborn; Male; Humans; Spermatic Cord Torsion; Testis; Orchiectomy
PubMed: 36757016
DOI: 10.23736/S2724-5276.23.07168-9 -
The Veterinary Record Aug 2019Treatment of inflammation and pain management is an important topic in the welfare of pigs. It is very difficult for veterinary practitioners to choose the most... (Review)
Review
OBJECTIVE
Treatment of inflammation and pain management is an important topic in the welfare of pigs. It is very difficult for veterinary practitioners to choose the most appropriate product for a certain problem. This review aims to summarise and discuss the characteristics of different non-steroidal anti-inflammatory drugs (NSAIDs), as well as paracetamol and metamizole, available for pigs in the European Union.
METHODS
The databases Pubmed, Google Scholar, CliniPharm CliniTox and European Medicines Agency were searched. Relevant terms (eg,'meloxicam', 'fever', 'swine', 'pig', 'inflammation', 'castration', 'pain') were used to search for original articles, reviews and books. Only peer-reviewed articles were used. References from studies were also analysed in order to find additional relevant studies.
CONCLUSION
Studies which have investigated the efficacy of NSAIDs for different conditions, using different treatment regimens, are scarce. Most studies focused on the efficacy of NSAID-related pain alleviation in piglet castration, as well as the anti-inflammatory potential of NSAIDs in experimental inflammation models. Little research has been carried out on the use of metamizole, tolfenamic acid, paracetamol and sodium salicylate and their effect in pigs.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Inflammation; Orchiectomy; Pain; Pain Management; Swine
PubMed: 31040220
DOI: 10.1136/vr.105170 -
Pediatric Emergency Care Oct 2023Factors associated with testicular torsion (TT) and consequent orchiectomy in patients presenting to pediatric emergency departments (PEDs) with scrotal pain (SP) are...
OBJECTIVE
Factors associated with testicular torsion (TT) and consequent orchiectomy in patients presenting to pediatric emergency departments (PEDs) with scrotal pain (SP) are not well described. We report the factors predicting TT and consequent orchiectomy in children with SP.
METHODS
The data on patients (aged ≤18 years) who presented with SP to PEDs at 4 branches of the Chang Gung Hospital through 10 years were analyzed.
RESULTS
In all, 256 pediatric patients presented with SP. Their mean age was 11.60 ± 4.61 years and 72.7% (n = 186) were aged 10 to 18 years. The pain was left-sided in 54.7% (n = 140) and the interval between SP onset and PED arrival was 22.45 ± 31.27 hours. Overall, 84 (32.8%) patients needed surgery and 72 (28.1%) had TT. Of the patients with TT, 28 (38.9%) patients needed an orchiectomy. After analysis, TT and consequent orchiectomy were associated with a longer interval between SP onset and PED arrival, absent of testicular ultrasonic blood flow, interval between SP onset and surgery of more than 24 hours, and a high degree of TT. None of them experienced recurrent SP symptoms or TT again.
CONCLUSIONS
The rate of TT in patients presenting to PEDs with an SP was 28.1%, and 38.9% of the patients with TT needed an orchiectomy. Early diagnosis and intervention helped to prevent subsequent orchiectomy in pediatric patients with TT.
Topics: Male; Child; Humans; Adolescent; Spermatic Cord Torsion; Orchiectomy; Retrospective Studies; Testis; Pain
PubMed: 37624776
DOI: 10.1097/PEC.0000000000003037 -
Journal of Pediatric Surgery Aug 2022Testicular torsion is a pediatric surgical emergency, and prompt diagnosis and treatment is imperative. During the COVID-19 pandemic, pediatric patients with symptoms of... (Observational Study)
Observational Study
BACKGROUND
Testicular torsion is a pediatric surgical emergency, and prompt diagnosis and treatment is imperative. During the COVID-19 pandemic, pediatric patients with symptoms of testicular torsion may be reluctant to seek medical care which increases the likelihood of delayed presentation and the need for an orchiectomy. This observational study sought to determine whether there was a higher number of testicular torsion cases during COVID-19.
METHODS
As the first patient with COVID-19 was admitted to our facility on March 6, 2020, we identified male children ages 1-18 years with testicular torsion between March 1-December 31, 2020 (during COVID-19) compared to the same time period between 2015 and 2019 (prior to COVID-19). All patients were evaluated at our Institution's Emergency Department by a pediatric urologist.
RESULTS
There were 38 cases of testicular torsion between March 1-December 31, 2020 compared to 15.8 cases on average during the same 10-month period between 2015 and 2019 (a total of 79 cases). There was a statistically significant increase in testicular torsion cases during the COVID-19 pandemic compared to equivalent time periods in 2015-2019 (38 vs. 15.8, p = 0.05). Patients with testicular torsion during the COVID-19 pandemic were younger, had a longer duration of symptoms, and had a higher number of orchiectomies (although not statistically significant).
CONCLUSION
During the COVID-19 pandemic, an escalation in testicular torsion cases was observed. Timely assessment, diagnosis, and surgery are crucial to prevent testicular loss and potential infertility in the future. Further evaluation is needed to elucidate the surge in testicular torsion and possible mechanisms.
Topics: Adolescent; COVID-19; Child; Child, Preschool; Humans; Infant; Male; Orchiectomy; Pandemics; Retrospective Studies; Spermatic Cord Torsion
PubMed: 34392971
DOI: 10.1016/j.jpedsurg.2021.07.008 -
Journal of Pediatric Urology Aug 2022The literature reported an increased avoidance of the Emergency Department (ED) during COrona VIrus Disease 19 (COVID-19) pandemic, causing a subsequent increase of...
INTRODUCTION
The literature reported an increased avoidance of the Emergency Department (ED) during COrona VIrus Disease 19 (COVID-19) pandemic, causing a subsequent increase of morbidity and mortality for acute conditions. Testicular torsion is a surgical emergency, which can lead to the loss of the affected testicle if a delayed treatment occurs. As testicular loss is time-related, outcome was hypothesized to be negatively affected by the pandemic.
OBJECTIVE
The aim is to investigate whether presentation, treatment and outcomes of children with testicular torsion were delayed during COVID-19.
STUDY DESIGN
Medical records of pediatric patients operated for testicular torsion of six Paediatric Surgical Units in Northern Italy between January 2019 and December 2020 were retrospectively reviewed. Patients were divided as for ones treated during (dC) or before the pandemic (pC). To reflect possible seasonality, related to lockdown restrictions, winter and summer calendar blocks were also analysed. For all cohorts, demographic data, pre-operative evaluation, operative notes and post-operative outcomes were reviewed. Primary outcomes were referral time, time from diagnosis to surgery and ischemic time, while secondary outcomes were orchiectomy and atrophy rates. Statistic was conducted as appropriate.
RESULTS
A total of 188 patients with acute testicular torsion were included in the study period, 89 in the pre-COVID-19 (pC) period and 99 during COVID-19 (dC). Time from symptom onset to the access to the Emergency Department (T1) was not different among the two populations (pC: 5,5 h, dC: 6 h, p 0.374), and similarly time from diagnosis to surgery (pC: 2,5 h, dC: 2,5 h, p 0.970) and ischemic time (pC: 8,2 h, dC: 10 h, p 0.655). T1 was <6 h in 46/99 patients (46%) pC and 45/89 patients (51%) dC (p = 0.88, Fisher's exact test). Subgroup analysis accounting for different lockdown measures, confirm the absence of any difference. Orchiectomies rate was 23% (23/99) dC and 21% (19/89) pC (p = 0.861, Fisher's exact test) and rate of post-operative atrophy was 9% dC (7/76) and 14% pC (10/70), p = 0,44, Fisher's exact test.
DISCUSSION
Despite worldwide pediatric ED accesses reduction, we reported that neither ischemic time nor the long-term outcomes in children with testicular torsion increased during the COVID-19 pandemic. In the available literature, few studies investigated the topic and are controversial on the results. Similarly to our findings, some studies found that timing and orchiectomy rates were not significantly different during the pandemic, while others reported a correlation to pandemic seasonality. Furthermore, in the recent pediatric literature it has been reported a delayed testicular torsion diagnosis due to shame in informing parents. Strengths of this study are the large numerosity, its multicentric design and a long study period. Its main limitation is being retrospective.
CONCLUSIONS
We reported our large cohort from one of the most heavily COVID-19-affected regions, finding that referral, intra-hospital protocols and ischemic time in testicular torsion were not increased during to the pandemic, as well as orchiectomy rate and atrophy.
Topics: Male; Child; Humans; Spermatic Cord Torsion; Retrospective Studies; Pandemics; COVID-19; Communicable Disease Control; Orchiectomy; Atrophy
PubMed: 35842391
DOI: 10.1016/j.jpurol.2022.06.010