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International Braz J Urol : Official... 2006To study the incidence and relevance of ectopic adrenal tissue in pediatric patients who underwent groin surgical explorations. (Review)
Review
OBJECTIVE
To study the incidence and relevance of ectopic adrenal tissue in pediatric patients who underwent groin surgical explorations.
MATERIALS AND METHODS
We studied 1120 patients with groin surgical explorations during a period of 8 consecutive years. Patients' clinical data and histological findings were analyzed.
RESULTS
We found ectopic adrenal tissue in 13 patients in 1120 groin surgical exploration (1.16%). Of the 13 cases, 5 were diagnosed as having undescended testes, 6 inguinal hernia and 2 communicating hydrocele. Median age at diagnosis was 5.6 years. Histological sections showed adrenal cortical tissue with no medulla present.
CONCLUSION
Based on the clinical implications of those adrenal rests it is mandatory the removal of this ectopic tissue whenever encountered during surgical interventions in the groin region in children.
Topics: Adrenal Glands; Child; Child, Preschool; Choristoma; Genital Diseases, Male; Humans; Male; Spermatic Cord
PubMed: 16650300
DOI: 10.1590/s1677-55382006000200013 -
Acta Radiologica (Stockholm, Sweden :... Dec 2007A hydrocele of the spermatic cord, which results from aberrant closure of the processus vaginalis, is an asymptomatic entity detected incidentally on computed tomography... (Review)
Review
A hydrocele of the spermatic cord, which results from aberrant closure of the processus vaginalis, is an asymptomatic entity detected incidentally on computed tomography (CT)scans performed for other clinical indications. There are two variations of a spermatic cord hydrocele: the "encysted" variety that does not communicate with the peritoneal cavity, and the "funicular" variety that does communicate with the peritoneal cavity. The encysted type can be confused with an inguinal mass (lymphadenopathy, hernias), and also primary tumors of the cord. We reviewed CT scans for all three adults and ultrasound images for one patient. Confirmation of spermatic cord hydrocele was made by surgery in one case, and CT and follow-up CT in two cases. Our findings indicate that a mass of the spermatic cord, showing fluid attenuation by CT and an avascular,anechoic appearance with sound transmission by ultrasound in an otherwise asymptomatic patient or even in those with an underlying malignancy, should prompt the radiologist to consider the diagnosis of spermatic cord hydrocele. This may eliminate the need for unnecessary, highly invasive procedures such as biopsy or surgical exploration.
Topics: Aged; Humans; Male; Middle Aged; Retrospective Studies; Spermatic Cord; Testicular Hydrocele; Tomography, X-Ray Computed; Ultrasonography
PubMed: 17963075
DOI: 10.1080/02841850701553163 -
Acta Oncologica (Stockholm, Sweden) 1999The cases of 16 adult patients with spermatic cord sarcoma were retrospectively reviewed. Patient ages had a bimodal distribution (median 57.5 years). Presentation was...
The cases of 16 adult patients with spermatic cord sarcoma were retrospectively reviewed. Patient ages had a bimodal distribution (median 57.5 years). Presentation was scrotal mass, inguinal mass or both, with an average diameter of 6.7 cm. Radical orchiectomy was performed in 9 patients, and simple tumorectomy in 7. Lymph node dissection was performed in 6 patients, including retroperitoneal dissection in 4 patients. Various types of soft tissue sarcomas were found. Embryonal rhabdomyosarcomas were evident only in young patients. Lymph node metastases were found in 2 out of 6 cases. Testicular atrophy was observed in 3 young patients, germline destruction by the tumor in 2, and partial spermatogenesis in 2 patients. The median time to first relapse in 13 patients was 5.5 months. Surgery was the primary treatment and the best salvage modality. The role of chemotherapy and radiation therapy as true adjuvant or post-salvage-surgery adjunctive treatments remains unclear.
Topics: Adult; Aged; Chemotherapy, Adjuvant; Genital Neoplasms, Male; Humans; Male; Middle Aged; Neoplasm Metastasis; Prognosis; Radiotherapy, Adjuvant; Retrospective Studies; Sarcoma; Spermatic Cord; Treatment Outcome
PubMed: 10427954
DOI: 10.1080/028418699431249 -
Annals of the Royal College of Surgeons... Sep 2023Dermoid cysts of the spermatic cord are rare, with only a few adult cases published in the literature. We report a patient with a 10cm inguinal mass referred to us for a...
Dermoid cysts of the spermatic cord are rare, with only a few adult cases published in the literature. We report a patient with a 10cm inguinal mass referred to us for a suspected paratesticular sarcoma. Imaging suggested a cyst but, due to the recent increase in size, the cyst contents were evacuated and the cyst wall was biopsied. Histopathology revealed a dermoid cyst, which is a benign variant of cystic teratomas. Histopathological examination was required here due to the uncertainty. Careful interpretation was required, as cystic teratomas very occasionally undergo a malignant transformation.
Topics: Adult; Male; Humans; Spermatic Cord; Dermoid Cyst; Biopsy; Teratoma
PubMed: 37652086
DOI: 10.1308/rcsann.2022.0102 -
Tumori 2011Spermatic cord sarcomas are rare. The therapeutic approach is based only on case reports and small series. The standard treatment is radical orchiectomy with wide local... (Review)
Review
BACKGROUND
Spermatic cord sarcomas are rare. The therapeutic approach is based only on case reports and small series. The standard treatment is radical orchiectomy with wide local resection, while the role of adjuvant therapies is not clear. We present a case of fibrosarcoma of the spermatic cord treated with surgery and adjuvant radiotherapy. A review of the literature about the role of adjuvant treatments is also discussed.
CASE REPORT
A 59-year-old man presented a right testicular mass of about 4 × 3 cm in size. Biopsy showed a high-grade polymorphous sarcoma, consistent with a diagnosis of poorly differentiated fibromyosarcoma. He underwent a right radical inguinal orchiectomy and adjuvant radiotherapy (total dose: 5940 cGy). During treatment the patient developed a G3 skin toxicity (RTOG score) in the inguinal fold. After a follow-up of 57 months, he is alive and without evidence of local or distant recurrence. No late toxicity was noted.
CONCLUSION
The optimal adjuvant management of spermatic cord sarcoma is still uncertain. Looking at the literature, it seems that adjuvant radiotherapy can improve locoregional control and disease-free survival without additional late toxicity.
Topics: Disease-Free Survival; Fibrosarcoma; Genital Neoplasms, Male; Groin; Humans; Male; Middle Aged; Orchiectomy; Radiotherapy, Adjuvant; Skin; Spermatic Cord; Treatment Outcome
PubMed: 22322854
DOI: 10.1177/030089161109700624 -
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 -
World Journal of Surgical Oncology Mar 2022Primary soft tissue sarcomas contribute to only 2% of all malignancies arising from the male genitourinary tract. Leiomyosarcoma (LMS) is a malignant soft tissue...
BACKGROUND
Primary soft tissue sarcomas contribute to only 2% of all malignancies arising from the male genitourinary tract. Leiomyosarcoma (LMS) is a malignant soft tissue neoplasm which originates from the mesenchyme and has a characteristic smooth muscle differentiation. Usually, it presents as a painless, firm, slow-growing unilateral scrotal mass. Investigations include imaging, tumor markers, and histopathology.
CASE PRESENTATION
A 65-year-old gentleman known diabetic and beta-thalassemic trait was referred to the Urology OPD at Letterkenny University Hospital. His presenting complaint was a left groin lump that appeared 1 year ago and was growing larger in size gradually. According to the patient, his lump was slightly painful (localized) initially that later became painless. He did not report any testicular trauma/infection or UTI. There was no significant history of malignancies running through his family. Clinical examination revealed a soft and lax abdomen, normal testes. There was a non-tender 2cm x 2cm well-circumscribed, mobile, firm to cystic irreducible left inguinoscrotal mass and appeared to be attached to the spermatic cord. Cough impulse was indiscernible. Ultrasound left groin showed 1.8 cm transverse x 1.4 cm AP x 1.9 cm sagittal) well-circumscribed ovoid nodular subcutaneous lesion present in the upper left inguinal area just lateral to the left pubic tubercle that appeared solid with heterogeneous internal echotexture and no internal calcification. Some internal vascularity is demonstrated with color Doppler assessment.
CONCLUSION
Because of its rareness, LMS represents a management conundrum. There is no standard protocol for treatment. We present a case and discuss the available evidence from the literature to date to help identify LMS of the spermatic cord that is highly unusual.
Topics: Aged; Genital Neoplasms, Male; Humans; Leiomyosarcoma; Male; Soft Tissue Neoplasms; Spermatic Cord; Ultrasonography
PubMed: 35337334
DOI: 10.1186/s12957-022-02539-9 -
International Surgery 2000A case of spermatic cord liposarcoma is reported in a 40-year-old man. The clinical presentation, pathogenesis and role of sonography in pre-operative diagnosis is... (Review)
Review
A case of spermatic cord liposarcoma is reported in a 40-year-old man. The clinical presentation, pathogenesis and role of sonography in pre-operative diagnosis is reviewed. The role of radical orchiectomy, retroperitoneal lymph node dissection, radiation therapy and chemotherapy in treatment of spermatic cord liposarcomas is discussed.
Topics: Adult; Biopsy; Diagnosis, Differential; Genital Neoplasms, Male; Humans; Liposarcoma; Lymph Node Excision; Male; Orchiectomy; Retroperitoneal Space; Spermatic Cord; Treatment Outcome
PubMed: 11071338
DOI: No ID Found -
BJU International Apr 2018To evaluate the outcomes of patients who underwent microdenervation of the spermatic cord (MDSC) for post-vasectomy pain syndrome (PVPS) at our institution.
OBJECTIVE
To evaluate the outcomes of patients who underwent microdenervation of the spermatic cord (MDSC) for post-vasectomy pain syndrome (PVPS) at our institution.
METHODS
A retrospective study of all patients who underwent MDSC for PVPS by a single surgeon between March 2002 and October 2016 was performed. Pain was documented using the numerical rating scale (NRS). Spermatic cord block (SCB) was performed on all patients, and success was defined as NRS score ≤1 for >4 h. All patients had failed medical therapy prior to MDSC. All previous procedures for PVPS had been performed elsewhere. Surgical success was defined as a postoperative NRS score of ≤1.
RESULTS
A total of 27 patients with 28 scrotal units underwent MDSC for PVPS. The median (1st quartile; 3rd quartile) follow-up was 10 (2; 16.5) months. The median (range) duration of pain prior to surgery was 57 (8-468) months. Pain was bilateral in 14 (52%), left-sided in eight (30%) and right-sided in five patients (19%). Data on SCB were available for 23 patients, with a success rate of 96%. The median (range) preoperative pain NRS score was 7 (2-10). The median (range) pain score after SCB on the NRS scale was 0 (0-5). The median (range) postoperative pain score on the NRS was 0 (0-9). Overall success was achieved in 20 of 28 testicular units (71%). Patients with involvement of multiple structures in the scrotum (i.e. testis, epididymis, spermatic cord) had a success rate of 81% and were more likely to have a successful surgery (P < 0.001). Five patients had failed a prior epididymectomy and three had failed a vaso-vasostomy for PVPS; this had no correlation with the success of MDSC (P = 0.89).
CONCLUSION
The MDSC procedure is a reasonably successful, durable and valuable approach for PVPS, especially when pain involves multiple structures in the scrotum (testis, epididymis, spermatic cord). MDSC was equally efficacious in patients who had previously failed a procedure for PVPS. No patient had a worsening NRS score after MDSC. This is the largest study to date evaluating MDSC for the treatment of PVPS.
Topics: Denervation; Humans; Male; Microsurgery; Pain, Postoperative; Retrospective Studies; Spermatic Cord; Treatment Outcome; Vasectomy
PubMed: 29352521
DOI: 10.1111/bju.14125 -
Journal of Visualized Experiments : JoVE May 2022Chronic orchialgia is a common disease in department of urology and andrology. The etiology is complex, and the treatment is difficult. In severe cases, orchiectomy is...
Chronic orchialgia is a common disease in department of urology and andrology. The etiology is complex, and the treatment is difficult. In severe cases, orchiectomy is even necessary. In recent years, microsurgical denervation of the spermatic cord (MDSC) is a minimally invasive and effective surgical method for the treatment of chronic orchialgia. Its greatest advantage is to preserve the testis and epididymis, avoid the possible organ resection. The key of the operation is to dissect all the fibrous tissues in the spermatic cord, while protecting the arteries (especially the testicular arteries) and several lymphatic vessels. Combined with the use of microvascular doppler in the operation, when separating the structure of spermatic cord under the microscope, the testicular arteries can be objectively and accurately protected (pulse "whistle" sound can be heard when the microvascular doppler probes the arterial surface), while artery injury and venous missed ligation can be avoided. The postoperative blood supply of the testis is also maximumly safeguarded. At the same time, we can be more fearless to cut the cremaster muscle, fatty and connective tissues surrounding the spermatic cord blood vessels and vas deferens after the arteries and lymphatic vessels being accurately protected under the microscope, finally achieve the spermatic cord completely "skeletonized" (only the testicular arteries, lymphatic vessels and vas deferens remained after the surgery). Thus we can better ensure the clinical curative effect (denervation thoroughly), avoid serious complications (testicular atrophy), and achieve better surgical results.
Topics: Denervation; Graft vs Host Disease; Humans; Male; Microsurgery; Pain; Spermatic Cord; Testicular Diseases
PubMed: 35695519
DOI: 10.3791/63780