-
Sexual Medicine Reviews Oct 2022The management of chronic scrotal pain is long and varied, with historical treatment algorithms typically ending with orchiectomy. Microsurgical denervation of the... (Review)
Review
INTRODUCTION
The management of chronic scrotal pain is long and varied, with historical treatment algorithms typically ending with orchiectomy. Microsurgical denervation of the spermatic cord (MDSC) is a testicle-sparing option for patients who have failed conservative treatment options and over its forty-year history has seen many technical refinements.
OBJECTIVES
To review the history and development of MDSC and discuss the outcomes of different surgical techniques.
METHODS
A literature review using PubMed and Google Scholar was conducted to identify studies pertaining to surgical treatment of CSP, MDSC, and outcomes. Search terms included "chronic," "scrotal pain," "orchialgia," "spermatic cord," "denervation," and "microsurgery."
RESULTS
We included 21 case reports and series since the first seminal paper describing MDSC technique in 1978. Additional studies that challenged existing conventions or described novel techniques are also discussed. The current standard procedure utilizes a subinguinal incision and a surgical microscope. Open, robotic, and laparoscopic approaches to MDSC have been described, but access to minimally invasive instruments may be limited outside of developed nations. Pain reduction following preoperative spermatic cord predicts success of MDSC. Methods for identifying and preserving the testicular and deferential arteries vary depending on surgeon preference but appear to have comparable outcomes. Future developments in MDSC involve targeted denervation, minimizing collateral thermal injury, and alternative techniques to visualize arterial supply.
CONCLUSION
For patients suffering from CSP, MDSC is a well-studied technique that may offer appropriately selected patients' relief. Future investigation comparing targeted vs full MDSC as well as in vivo study of new techniques are needed to continue to improve outcomes.
Topics: Male; Humans; Denervation; Spermatic Cord; Testicular Diseases; Genital Diseases, Male; Pelvic Pain
PubMed: 37051952
DOI: 10.1016/j.sxmr.2021.11.005 -
Emergency Medicine Clinics of North... Nov 2019Scrotal emergencies are rare but potentially life and fertility threatening. This article explains how to diagnose and manage scrotal emergencies such as testicular... (Review)
Review
Scrotal emergencies are rare but potentially life and fertility threatening. This article explains how to diagnose and manage scrotal emergencies such as testicular torsion, Fournier gangrene, and testicular trauma. These diagnoses are often difficult to discern from less-concerning causes. This article helps to elucidate the differences between the dangerous and the less-harmful pathologic conditions.
Topics: Acute Disease; Emergencies; Humans; Male; Scrotum; Spermatic Cord Torsion; Testicular Diseases
PubMed: 31563197
DOI: 10.1016/j.emc.2019.07.002 -
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 -
Abdominal Radiology (New York) Jun 2024To evaluate quantitative and qualitative spermatic cord CT abnormalities and presence of unilateral or bilateral symptomatic scrotal pathology (SSP) at ultrasound.
PURPOSE
To evaluate quantitative and qualitative spermatic cord CT abnormalities and presence of unilateral or bilateral symptomatic scrotal pathology (SSP) at ultrasound.
METHODS
This retrospective study included 122 male patients (mean age 47.8 years) undergoing scrotal ultrasound within 24 h of contrast-enhanced CT (n = 85), non-contrast CT (NECT, n = 32) or CT-Urogram (n = 5). CECT quantitative analysis assessed differential cord enhancement using maximum Hounsfield unit measurements. Three fellowship trained body radiologists independently assessed qualitative cord abnormalities for both CECT and NECT. Qualitative and quantitative findings were compared with the presence of SSP. Reader performance, interobserver agreement and reader confidence were assessed for NECT and CECT. Quantitative cutoff points were identified which maximized accuracy, specificity, negative predictive value, and other measures.
RESULTS
SSP was present in 36/122 patients (29.5%). Positive cases were unilateral in 30 (83.3%) and bilateral in 6 (16.6%). At quantitative assessment, 25% differential cord enhancement had the highest diagnostic accuracy (88.9%), with 90.5% positive predictive value, 88.4% negative predictive value, 96.8% specificity, and 70.4% sensitivity. At qualitative evaluation, CECT reader performance was excellent (aggregate AUC = 0.86; P < .001); NECT was poorly discriminatory, although remained significant (aggregate AUC = 0.67; P = .002). Readers had significantly higher confidence levels with CECT (P < .001). Qualitative inter-observer agreement was high for both CECT and NECT (ICC = 0.981 and 0.963, respectively).
CONCLUSION
Simple quantitative assessment of differential cord enhancement is highly accurate and specific for SSP at CECT. Qualitative abnormalities at CECT and NECT are also both predictors of SSP, however, CECT significantly out-performs non-contrast exams.
Topics: Humans; Male; Middle Aged; Retrospective Studies; Scrotum; Spermatic Cord; Tomography, X-Ray Computed; Contrast Media; Aged; Adult; Sensitivity and Specificity; Predictive Value of Tests; Ultrasonography; Aged, 80 and over; Genital Diseases, Male; Adolescent
PubMed: 38517545
DOI: 10.1007/s00261-024-04251-6 -
The New England Journal of Medicine Oct 2021
Topics: Adolescent; Humans; Male; Orchiectomy; Spermatic Cord Torsion; Testis
PubMed: 34652889
DOI: 10.1056/NEJMicm2110702 -
Morphologie : Bulletin de L'Association... Feb 2021We aim by this article to present a literature review on the anatomical risk factors for spermatic cord torsion and their involvement the different techniques of... (Review)
Review
OBJECTIVE
We aim by this article to present a literature review on the anatomical risk factors for spermatic cord torsion and their involvement the different techniques of orchidopexy.
MATERIALS AND METHODS
The literature review was conducted following PRISMA check-list, using PubMed database and the Mesh terms: testis, torsion, anomaly, orchidopexy. Techniques of surgical management provided by the EMC (French medico-surgical encyclopedia) were also used.
RESULTS
Database research identified 500 articles, and 16 mores articles were added from the review of the references lists of relevant articles. At the end, 42 articles were useful for our review including 6 reviews, 5 cross-sectional studies, 14 cohorts, 10 case reports, 1 meta-analysis, 1 letter, and 5 experimental studies. High insertion of the tunica vaginalis, a long mesorchium, deficient attachment of the epididymis to the testis, and anomalies of the gubernaculum testis are the anatomical predispositions for spermatic cord torsion. After reduction of torsion, many surgical techniques for the fixation of the testis have been suggested including: conventional technique by triangulation with or without fasciotomy, window orchidopexy, scrotal pouch, and vaginal eversion with or without dartos fixation.
CONCLUSION
The most common anatomical factor associated with spermatic cord torsion is the high insertion of the tunica vaginalis. Vaginal eversion with fixation to the dartos might be superior to other known techniques and seems promising to become standard.
Topics: Cross-Sectional Studies; Humans; Male; Orchiopexy; Risk Factors; Spermatic Cord Torsion; Testis
PubMed: 32919902
DOI: 10.1016/j.morpho.2020.06.006 -
Andrology Sep 2021Ultrasound (US) is the primary modality for the investigation of scrotal pathology, including both intra- and paratesticular abnormalities. (Review)
Review
BACKGROUND
Ultrasound (US) is the primary modality for the investigation of scrotal pathology, including both intra- and paratesticular abnormalities.
OBJECTIVE
To describe the abnormalities of the paratesticular space.
MATERIALS/METHODS
The paratesticular space contains the epididymis, spermatic cord and the tunica vaginalis cavity and is affected by a variety of inflammatory or tumoral entities. Differential diagnosis based on US criteria is frequently problematic, as the findings are non-specific.
RESULTS
Some general rules apply: (i) unlike testicular lesions, extra-testicular entities are usually benign in the adult, (ii) the first steps to accurate diagnosis include careful localization of the lesion and assessment of its consistency (solid or cystic) and (iii) magnetic resonance imaging can be useful for further tissue characterization of lesions suspected to contain fat, but surgical biopsy will often provide the definite diagnosis. Contrast-enhanced ultrasound (CEUS) has been applied with limited experience indicating a narrow role, primarily for the differential diagnosis of echogenic cystic entities and the delineation of a necrotic abscess from a solid neoplasm.
DISCUSSION
The various abnormalities are discussed and illustrated.
CONCLUSION
This manuscript summarizes the literature on paratesticular lesions and the value of US in diagnosis.
Topics: Adult; Contrast Media; Diagnosis, Differential; Epididymis; Genital Diseases, Male; Humans; Male; Scrotum; Spermatic Cord; Testicular Diseases; Testis; Ultrasonography
PubMed: 33864338
DOI: 10.1111/andr.13021 -
Sarcoma 2021Paratesticular sarcomas are defined as tumors that arise within the scrotum and include the subsites of epididymis, spermatic cord, and tunica vaginalis and represent...
INTRODUCTION
Paratesticular sarcomas are defined as tumors that arise within the scrotum and include the subsites of epididymis, spermatic cord, and tunica vaginalis and represent the most common type of GU sarcoma. The mainstay of treatment is often surgical resection, combined with histology specific chemotherapy and radiotherapy. Due to the rare nature of the disease, there are limited data to guide management. We present our single-institution retrospective experience regarding the management and treatment of paratesticular sarcomas.
MATERIALS AND METHODS
We queried our oncology registry database for patients treated for testicular, spermatic cord, and scrotal soft tissue sarcomas between 1971 and 2017. Patients in this series had pathological confirmation of a sarcoma diagnosis by a sarcoma-specialized pathologist. Only patients with localized disease were included in this analysis with the exception of patients with a diagnosis of rhabdomyosarcoma where patients with both localized and metastatic disease were included on this study.
RESULTS
A total of 34 patients were included in this retrospective analysis. The median was 24 (range, 5-78), and the median tumor size was 6.25 cm. Twenty-six patients had localized disease (76.6%) at the time of diagnosis. A predominance of patients had tumors involving the spermatic cord (45.5%), and the most common histology was rhabdomyosarcoma (35.3%), leiomyosarcoma (26.5%), and well-differentiated liposarcoma (23.5%). The median follow-up was 71.0 months (range, 2.5-534.4 months). A total of 7 patients experienced an isolated local failure (20.6%), four patients developed distant metastatic disease (11.8%), and one patient (2.9%) with synovial sarcoma of the spermatic cord experienced a regional recurrence. The median progression-free survival (PFS) was 99.6 months, 95% CI (45.8-534.3 months), with a three-year PFS rate of 71%, 95% CI (53%-83%), and a 5-year PFS rate of 64% (range, 46%-78%). We did not find any statistically significant associations based on surgery type (=0.15), the use of chemotherapy, (=0.36), or final margin status (=0.21). Two patients who were treated with preoperative radiotherapy had significant wound healing complication with chronic sinus tracts, though these patients did not experience a local recurrence.
CONCLUSIONS
We provide a characterization of the natural history and treatment patterns of paratesticular sarcomas. While effective at reducing a local recurrence, preoperative radiotherapy was associated with significant toxicity. As a result, we prefer the use of postoperative radiotherapy in patients as clinically indicated. We did not find any specific treatment patterns associated with an improvement in clinical outcomes.
PubMed: 33746565
DOI: 10.1155/2021/8824301 -
Japanese Journal of Radiology Jun 2024Scrotal masses, whether cystic or solid lesions, are routinely evaluated using ultrasonography. Magnetic resonance imaging (MRI) may be used for further investigation in... (Review)
Review
Scrotal masses, whether cystic or solid lesions, are routinely evaluated using ultrasonography. Magnetic resonance imaging (MRI) may be used for further investigation in cases with atypical findings, difficult diagnoses, large masses, and/or unclear relationships with the surrounding tissues. Scrotal solid masses are divided into intra- and extra-testicular masses. A staggering 90% of the intratesticular masses are malignant, whereas 75% of extratesticular masses are benign. Extratesticular masses are less common than intratesticular masses; however, some extratesticular masses present characteristic MRI findings. Familiarity with these specific MRI features of extratesticular masses is beneficial to radiologists, as appropriate diagnoses can help avoid unnecessary invasive treatments such as orchiectomy. In this review, we describe fibrous pseudotumors, polyorchidism, adenomatoid tumors, and scrotal leiomyoma as benign paratesticular masses, focusing on their characteristic imaging features on MRI. Although these tumors are extremely rare, their MRI findings are distinctive, and accurate diagnoses can prevent unnecessary orchiectomy. In addition, to demonstrate the pitfalls of diagnosing extratesticular masses, we present a case of seminoma misidentified as extratesticular masses due to large extensions outside the testis. Spermatic cord sarcoma, including rhabdomyosarcoma, leiomyosarcoma, and liposarcoma, and metastasis to the spermatic cord are described as malignant extratesticular masses. This review focused on extratesticular masses and elaborates the imaging findings that can aid in the accurate diagnosis using MRI.
PubMed: 38836965
DOI: 10.1007/s11604-024-01605-4