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Systems Biology in Reproductive Medicine Jun 2020The aim of the study was to investigate the micro-structures of the spermatic cord using histological examination with three-dimensional (3D) reconstruction of the...
UNLABELLED
The aim of the study was to investigate the micro-structures of the spermatic cord using histological examination with three-dimensional (3D) reconstruction of the serial tissue sections of the cord for clinical application in microscopic varicocelectomy. Human spermatic cord specimens obtained from 13 adult male cadavers were used to prepare serial transverse sections. The sections were stained to allow observation of the spermatic cord microstructures. The 3D reconstruction was performed with digitized serial sections by Mimics software. The microscopic varicocelectomy was performed based on the anatomical results of 3D reconstruction of the spermatic cord. The results showed the number of small spermatic veins, large spermatic veins, arteries, lymphatics or nerves were not markedly different between the subinguinal and inguinal regions or between the right and left sperm cord. The number of medium spermatic veins in the subinguinal region was obviously higher than at the inguinal level. The internal spermatic vessels and the vas deferens together with other associated vessels within the cremaster were separately enclosed by two thin and translucent sheaths, the internal spermatic fascia and the vas deferens fascia. We conclude that internal spermatic vessels and the vas deferens together with the associated neurovascular vessels are wrapped by two distinct sheaths separating them from the surrounding tissues. Microscopic varicocelectomy based on the anatomical results of 3D reconstruction of the spermatic cord is feasible.
ABBREVIATIONS
3D: three-dimensional; ISF: internal spermatic fascia; ESF: external spermatic fascia; MHIV: High inguinal microsurgical varicocelectomy; MSIV: subinguinal microsurgical varicocelectomy; CAAD: computer-assisted anatomic dissection; HE: hematoxylin-eosin.
Topics: Biopsy; Humans; Imaging, Three-Dimensional; Male; Spermatic Cord; Varicocele
PubMed: 32202917
DOI: 10.1080/19396368.2020.1741723 -
Cureus Apr 2023Emphysematous epididymo-orchitis is a rare and potentially fatal infection marked by the presence of gas in the epididymis and testicular tissue. Here, we describe the...
Emphysematous epididymo-orchitis is a rare and potentially fatal infection marked by the presence of gas in the epididymis and testicular tissue. Here, we describe the case of a 49-year-old male with a known past medical history of diabetes and hypertension who presented with right inguinoscrotal swelling and severe tenderness. An urgent scrotal ultrasound was obtained and revealed a fluid-filled avascular mass. Moreover, the non-contrast CT scan showed a mixture of air and fluid density in the right epididymis, perineum, and spermatic cord course. The medical team confirmed the diagnosis of emphysematous epididymo-orchitis. The patient refused the management plan at first, but later came back and accepted the procedure. A right orchidectomy with spermatic cord removal was performed without complications.
PubMed: 37266058
DOI: 10.7759/cureus.38358 -
Current Urology Reports Jan 2021Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment... (Review)
Review
PURPOSE OF REVIEW
Chronic scrotal content pain (CSCP) is a complex condition with multiple etiologies that requires a thorough understanding of its pathophysiology, workup, and treatment options. We performed a comprehensive and contemporary review to augment our current understanding of CSCP.
RECENT FINDINGS
We discuss new advances in CSCP-specific pain questionnaires, modern studies of microscopic spermatic cord denervation and its variations, and novel techniques including electric nerve stimulation and cryoablation in addition to randomized control trials with significant negative findings. We also present literature focusing on the prevention of CSCP secondary to surgical iatrogenic causes. The constantly evolving literature of CSCP has led to the significant evolution in its diagnosis and treatment, from oral medications to salvage options after microscopic spermatic cord denervation. With each advance, we come closer to developing a more thorough, evidence-based algorithm to guide urologists in treatment of CSCP.
Topics: Algorithms; Chronic Pain; Cryosurgery; Denervation; Electric Stimulation Therapy; Genital Diseases, Male; Humans; Iatrogenic Disease; Male; Microsurgery; Pain Measurement; Pelvic Pain; Randomized Controlled Trials as Topic; Scrotum; Skin Diseases; Spermatic Cord; Testicular Diseases
PubMed: 33447905
DOI: 10.1007/s11934-020-01026-6 -
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 -
The Journal of Dermatology Nov 2020
Topics: Humans; Male; Spermatic Cord; Tuberculosis, Cutaneous
PubMed: 32783197
DOI: 10.1111/1346-8138.15540 -
Research and Reports in Urology 2023Spermatic cord torsion (SCT) is a rare urological emergency that can jeopardize the fertility of the patient. Our study aimed to investigate the epidemiological,...
INTRODUCTION
Spermatic cord torsion (SCT) is a rare urological emergency that can jeopardize the fertility of the patient. Our study aimed to investigate the epidemiological, diagnostic and therapeutic aspects of SCT in Souro Sanou University Teaching Hospital.
MATERIALS AND METHODS
This was a descriptive cross-sectional study with retrospective data collection from January 1, 2017, to December 31, 2021, in the emergency surgical and urology division of Souro Sanou University Hospital.
RESULTS
The annual frequency of SCT was 4.4 patients/year. The mean age of the patients was 17.82 ± 6.74 years. Painful swelling of the hemi-scrotum was the main presenting symptom. The torsion involved the left spermatic cord in 50% of cases and both spermatic cords in 5% of cases. The mean time of symptoms before presentation was 78.8 hours ± 153 hours. Only 27.3% of patients presented before the 6th hour after the onset of pain. The average time from presentation to surgical intervention was 5.6 hours ± 5 hours. Orchiectomy was performed in 11 patients (47.8%). The average hospital stay was 3.1 ± 1.4 days.
CONCLUSION
SCT is a rare urological emergency. The prognosis depends on the duration and degree of torsion. A high orchidectomy rate can be observed with a delay in presentation.
PubMed: 37615011
DOI: 10.2147/RRU.S419786 -
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 -
FP Essentials Apr 2021Scrotal and testicular conditions include benign masses, infections, testicular torsion, and testicular cancer. Common palpable benign scrotal masses include...
Scrotal and testicular conditions include benign masses, infections, testicular torsion, and testicular cancer. Common palpable benign scrotal masses include spermatocele, varicocele, and hydrocele. Most patients with these masses require no treatment. Some varicoceles are associated with impaired fertility, probably due to an increase in scrotal temperature that leads to testicular hyperthermia, oxidative stress, and reduced spermatogenesis. Patients with documented infertility or scrotal pain should be referred to a urology subspecialist for consideration of surgical management. Epididymitis and epididymo-orchitis are caused by infection with , , or enteric bacteria. Antibiotics and supportive measures (eg, scrotal elevation, bed rest) are recommended for management of acute epididymitis. Testicular torsion is a urologic emergency that requires rapid surgical exploration and orchidopexy to reduce the risk of testicular loss due to ischemia. Salvage rates exceed 90% when surgical exploration is performed within 6 hours of symptom onset. Testicular cancer commonly manifests as a painless, incidentally discovered mass in a single testis. Ultrasonography is recommended to confirm the diagnosis. The recommended primary intervention for a suspected malignant testicular tumor is radical inguinal orchiectomy.
Topics: Humans; Male; Men's Health; Scrotum; Spermatic Cord Torsion; Testicular Neoplasms
PubMed: 33856180
DOI: No ID Found -
Seminars in Ultrasound, CT, and MR Feb 2022Ultrasonography (US) is the primary imaging modality for the evaluation of pediatric scrotal disease. The ability to obtain exceptional anatomical detail and testicular...
Ultrasonography (US) is the primary imaging modality for the evaluation of pediatric scrotal disease. The ability to obtain exceptional anatomical detail and testicular perfusion information without ionizing radiation makes it the essential tool for evaluating scrotal pain and palpable masses. Challenges arise in both the performance and interpretation of scrotal US in the child. Optimizing imaging parameters and recognizing key differentiating US features help minimize misinterpretations that can lead to poor patient outcomes. Key pearls and pitfalls in pediatric scrotal ultrasound methods and diagnoses are reviewed. Knowledge of what is normal for the various ages of childhood from neonate through adolescence is necessary for accurate US analysis. Imaging evaluation of key causes of the acute painful scrotum including testicular appendage torsion, epididymitis, and testicular torsion are discussed. Sonographic features for the diagnosis of benign and malignant scrotal masses, microlithiasis, and cryptorchidism are reviewed.
Topics: Adolescent; Child; Epididymitis; Genital Diseases, Male; Humans; Infant, Newborn; Male; Scrotum; Spermatic Cord Torsion; Ultrasonography
PubMed: 35164905
DOI: 10.1053/j.sult.2021.05.011