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Virchows Archiv : An International... Nov 2022Pure seminomas represent the majority of testicular germ cell tumors and accurate diagnosis and staging require an accurate sampling of radical orchiectomy specimens....
Pure seminomas represent the majority of testicular germ cell tumors and accurate diagnosis and staging require an accurate sampling of radical orchiectomy specimens. The aim of our study is to find the most informative gross sampling method for orchiectomy specimens. We performed the extensive sampling of 88 radical orchiectomy specimens embedding in their entirety testicular hilum, rete testis, hilar soft tissue, and spermatic cord. We examined the impact of this procedure on tumor stage, prognostic parameters (lymphovascular invasion and infiltration of rete testis, epididymis, tunica vaginalis, and spermatic cord), and their relationship with recurrence. Eighty-eight seminomas from 88 radical orchiectomies were sampled. Seventy-seven cases (87.5%) presented as clinical stage I and 11 cases (12.5%) as clinical stage II. The follow-up period range was 18-54 months and 82 patients (93.2%) had a minimum of 2-year follow-up. Tumor size ranged from 0.4 to 16 cm (mean 3.6) requiring a mean of 7.1 sections for entire tumoral sampling. Epididymis required 2 to 8 sections (mean 3.3), and hilum and hilar soft tissues 2 to 9 sections (mean 3.4). Epididymal infiltration and lymphovascular invasion resulted significant at multivariate analysis generating a receiver operating characteristic (ROC) curve with area under curve of 0.778. All the other parameters (except for pagetoid rete testis infiltration) were significant to predict metastasis only at univariate analysis. Extensive sampling of radical orchiectomy specimens does not improve the accuracy of staging in pure seminomas. Lymphovascular invasion and epididymal infiltration are useful to predict metastasis.
Topics: Male; Humans; Seminoma; Orchiectomy; Spermatic Cord; Neoplasm Staging; Neoplasm Invasiveness; Testicular Neoplasms; Risk Factors
PubMed: 35776192
DOI: 10.1007/s00428-022-03370-z -
The Journal of Urology Jun 2016An understanding of the microsurgical anatomy of the spermatic cord and spermatic fascia is important for surgeons during microsurgical varicocelectomy and denervation....
PURPOSE
An understanding of the microsurgical anatomy of the spermatic cord and spermatic fascia is important for surgeons during microsurgical varicocelectomy and denervation. We examined the distribution of the lymphatics, and the sensory and autonomic nerves of the spermatic cord.
MATERIALS AND METHODS
We collected spermatic cords from 11 men undergoing orchiectomy for localized testicular tumors and we biopsied a third of the spermatic fascia from 36 men undergoing microsurgical varicocelectomy. Immunohistochemical staining of the pan-neuronal marker PGP 9.5 (protein gene product 9.5), the sensory nociceptor marker CPRP (calcitonin gene-related peptide), the sympathetic marker TH (tyrosine hydroxylase), the parasympathetic marker VIP (vasoactive intestinal polypeptide) and the lymphatic marker D2-40 was performed. We counted the number of nerves and lymphatics.
RESULTS
PGP 9.5 staining revealed dense nerve distributions in the spermatic cord and fascia. Sensory and autonomic nerve fibers were basically co-localized in the same nerve. Of the nerves 50% were identified near the vas deferens and 20% were identified in the spermatic fascia. Sensory and sympathetic nerve fibers represented most of the nerves but a few parasympathetic nerve fibers were observed. Of the lymphatics 36 per patient were identified in the spermatic cord but only a few were identified in the spermatic fascia.
CONCLUSIONS
Sensory and sympathetic nerves accounted for the majority of the nerves. Although the functional aspects of the nerves remain undetermined, information on the distribution of nerves and lymphatics is useful when dealing with nerves and preserving lymphatics during microsurgical varicocelectomy or denervation.
Topics: Adolescent; Adult; Autonomic Pathways; Calcitonin Gene-Related Peptide; Denervation; Humans; Immunohistochemistry; Lymphatic Vessels; Male; Microsurgery; Spermatic Cord; Testicular Neoplasms; Testis; Tyrosine 3-Monooxygenase; Ubiquitin Thiolesterase; Varicocele; Vasoactive Intestinal Peptide; Young Adult
PubMed: 26626219
DOI: 10.1016/j.juro.2015.11.041 -
Hinyokika Kiyo. Acta Urologica Japonica Jun 2017A 63-year-old man was referred to our department because of painless hard mass in the right inguinal region. Abdominal computed tomography (CT) showed right spermatic... (Review)
Review
A 63-year-old man was referred to our department because of painless hard mass in the right inguinal region. Abdominal computed tomography (CT) showed right spermatic cord mass measuring 25 mm in diameter. We performed right high orchiectomy. Histopathological diagnosis was dedifferentiated liposarcoma, which included myofibroblast components. He was alive 3 years postoperatively without recurrence.
Topics: Genital Neoplasms, Male; Humans; Immunohistochemistry; Liposarcoma; Male; Middle Aged; Orchiectomy; Spermatic Cord; Tomography, X-Ray Computed
PubMed: 28694419
DOI: 10.14989/ActaUrolJap_63_6_251 -
The Journal of International Medical... 2012This case study reports on a rare case of malignant fibrous histiocytoma arising in the right spermatic cord. An 80-year old male presented with a 2-week history of a... (Review)
Review
This case study reports on a rare case of malignant fibrous histiocytoma arising in the right spermatic cord. An 80-year old male presented with a 2-week history of a right inguinal mass, with mild pain in the same region. Ultrasonography and computed tomography showed a mass arising from the right spermatic cord. A right radical orchiectomy was performed with wide dissection of the mass; the right testicle and epididymis were found not to be grossly involved. The patient had an uneventful postoperative course and recovered well. The patient and his family refused further adjuvant radiotherapy. There was no evidence of recurrence or metastasis during 20 months of regular follow-up. The diagnosis, histological classification, treatment and prognosis of this case are presented, together with a review of the literature.
Topics: Aged, 80 and over; Cholecystolithiasis; Diabetes Complications; Genital Neoplasms, Male; Histiocytoma, Malignant Fibrous; Humans; Male; Orchiectomy; Radiotherapy, Adjuvant; Scrotum; Spermatic Cord; Treatment Refusal; Ultrasonography
PubMed: 22613448
DOI: 10.1177/147323001204000249 -
Sexual Medicine Reviews Apr 2018Post-vasectomy pain syndrome (PVPS) is a challenging problem for the practicing urologist because of its unclear pathophysiology and no clearly established protocol for...
INTRODUCTION
Post-vasectomy pain syndrome (PVPS) is a challenging problem for the practicing urologist because of its unclear pathophysiology and no clearly established protocol for evaluation or treatment. PVPS is defined as at least 3 months of chronic or intermittent scrotal content pain after a vasectomy procedure once other etiologies for the pain have been ruled out.
AIM
To systematically review the current literature on the effectiveness of micro-denervation of the spermatic cord (MDSC) for PVPS.
METHODS
A systematic literature search using PubMed, Scopus, Medline, Embase, and Cochrane databases for all reports pertaining to PVPS using the Medical Subject Heading terms post vasectomy pain syndrome and micro-denervation of spermatic cord through February 2017.
MAIN OUTCOME MEASURES
Scrotal content pain after MDSC for PVPS.
RESULTS
There were nine retrospective studies evaluating MDSC for chronic testicular pain. After omitting repeated series, there were 213 patients who underwent MDSC for chronic orchialgia. Only one study specifically reviewed the outcomes of patients who underwent MDSC for PVPS. In this study, 17 patients underwent MSDC for PVPS, with 13 (76.5%) reporting complete relief of pain at their first follow-up visit. The other four patients had significant improvement in pain and were satisfied with the results. Long-term follow-up data were not available for this study.
CONCLUSION
MDSC remains a valuable approach with high success rates and should be considered for PVPS that is refractory to medical therapy. MDSC appears to have the most success for patients who experience a temporary relief from a cord block and can significantly improve the patient's quality of life and ability to return to daily activities. Tan WP, Levine LA. Micro-Denervation of the Spermatic Cord for Post-Vasectomy Pain Management. Sex Med Rev 2018;6:328-334.
Topics: Adult; Denervation; Humans; Male; Microsurgery; Middle Aged; Pain Management; Pain, Postoperative; Spermatic Cord; Vasectomy
PubMed: 28735684
DOI: 10.1016/j.sxmr.2017.06.002 -
Hinyokika Kiyo. Acta Urologica Japonica Jul 2016A 92-year-old man had noticed enlargement of a mass in the right scrotum and inguinal region for nine months. The patient was introduced to our department for right... (Review)
Review
A 92-year-old man had noticed enlargement of a mass in the right scrotum and inguinal region for nine months. The patient was introduced to our department for right testicular tumor. Physical examination showed an over fist-sized, hard mass in the right scrotum. Magnetic resonance imaging (MRI) showed the mass, which consisted of fatty and solid contents. In addition, MRI revealed a bladder tumor simultaneously. Computed tomography revealed no distant metastases. The patient underwent right high orchiectomy with the mass resection and transurethral resection of the bladder tumor (TURBT). Pathological examination revealed well- and dedifferentiated liposarcoma of the right spermatic cord, and urothelial cancer of the bladder. Liposarcoma of the spermatic cord is a rare neoplasm. To the best of our knowledge, the present case was the 114 th reported case and oldest in Japan.
Topics: Aged, 80 and over; Cystectomy; Genital Neoplasms, Male; Humans; Liposarcoma; Magnetic Resonance Imaging; Male; Neoplasms, Multiple Primary; Orchiectomy; Spermatic Cord; Urinary Bladder Neoplasms
PubMed: 27569360
DOI: 10.14989/ActaUrolJap_62_7_393 -
BMJ Case Reports Jun 2013The authors report a case of a 53-year-old male patient who came to the urologic clinic with symptoms of a left-sided testicular mass with 4 years of evolution. A left...
The authors report a case of a 53-year-old male patient who came to the urologic clinic with symptoms of a left-sided testicular mass with 4 years of evolution. A left inguinal approach was decided for scrotal exploration. High clamping of the spermatic cord was performed with complete excision of the lesion, which was sent for pathology, preserving the spermatic cord and the testicle. The peroperative result was a well-differentiated liposarcoma of the spermatic cord. We then chose to preserve the ipsilateral testis (organ-sparing surgery). Postoperatively, the final pathology confirmed a well-differentiated spermatic cord liposarcoma, revealing negative surgical margins and no signs of local invasion, namely of the underlying structures. The patient is currently doing well, with no signs of recurrence after one and a half year of follow-up.
Topics: Genital Neoplasms, Male; Humans; Liposarcoma; Male; Middle Aged; Organ Sparing Treatments; Spermatic Cord
PubMed: 23814206
DOI: 10.1136/bcr-2013-009926 -
Hinyokika Kiyo. Acta Urologica Japonica Jan 2022A 52-year-old man was referred to our hospital for evaluation of painless right scrotal swelling persisting for 3 months. Palpation detected swelling and induration...
A 52-year-old man was referred to our hospital for evaluation of painless right scrotal swelling persisting for 3 months. Palpation detected swelling and induration centered on the head of the upper epididymis, and ultrasonography revealed a blood-filled nodular mass at the same site continuing to the spermatic cord. No abnormalities were observed in the bilateral testes. Blood tests were negative for tumor markers such as α fetoprotein and human chorionic gonadotropin-β. Right radical inguinal orchiectomy was performed, and the pathological diagnosis was dedifferentiated liposarcoma of the spermatic cord. Although the spermatic cord stump was negative, the peri-spermatic cord stump, which had an exfoliated surface, was positive. No residual tumor was found on magnetic resonance imaging, but the tumor was suspected to remain. Thus, after approximately 1month, the tissue around the spermatic cord was resected. Eight months after the initial operation, no recurrence was observed. Here, we report a case of dedifferentiated liposarcoma of the spermatic cord, which is relatively rare, and review the related literature.
Topics: Genital Neoplasms, Male; Humans; Liposarcoma; Magnetic Resonance Imaging; Male; Middle Aged; Orchiectomy; Spermatic Cord
PubMed: 35114762
DOI: 10.14989/ActaUrolJap_68_1_17 -
Clinical Anatomy (New York, N.Y.) Nov 2012Spermatic cord mobilization is a routine part of inguinal hernia repair, but the method of cord mobilization varies among surgeons. This study establishes an anatomic...
Spermatic cord mobilization is a routine part of inguinal hernia repair, but the method of cord mobilization varies among surgeons. This study establishes an anatomic plane for spermatic cord mobilization. We studied the anatomy of the superficial cremasteric fascia in 105 male patients during herniorrhaphy for primary inguinal hernias. The mean patient age was 44.8 (18-71) years and mean body mass index was 24.1 kg/m(2) (21.5-27.1 kg/m(2)). The two layers of the superficial cremasteric fascia between the spermatic cord and the inguinal falx were incised to mobilize the cord. We found that spermatic cord mobilization during herniorrhaphy can be easily approached through an anatomic plane between the spermatic cord and the conjoined tendon with subsequent division of the superficial cremasteric fascia. None of the patients experienced any hemorrhage or nerve injury during cord mobilization. We found this method to be both safe and easy to learn.
Topics: Adolescent; Adult; Aged; Fascia; Fasciotomy; Hernia, Inguinal; Herniorrhaphy; Humans; Inguinal Canal; Male; Middle Aged; Retrospective Studies; Spermatic Cord; Tendons; Young Adult
PubMed: 22308072
DOI: 10.1002/ca.22037 -
International Journal of Impotence... Jan 2021Microsurgical denervation of the spermatic cord (MDSC) can provide up to an 86% improvement in pain in patients with chronic orchialgia (CO) who have failed conservative...
Microsurgical denervation of the spermatic cord (MDSC) can provide up to an 86% improvement in pain in patients with chronic orchialgia (CO) who have failed conservative management. Failures in MDSC could be due to small diameter nerves (≤1 mm) left behind on the spermatic cord. The objective of this study was to assess if hydrodissection (HD) of the spermatic cord after MDSC could decrease the number of residual nerve fibers without compromising blood flow. Prospective blinded randomized control trial: bilateral MDSC was performed on 22 adult rats (44 cords). HD of the spermatic cord was performed on one side of each rat (side randomized) using the ERBEJET2. The contralateral cord (no HD) was the control for each animal. Blood flow through the vessels was monitored using a micro-Doppler probe. After completion a cross-section of the residual cord was sent to pathology (blinded to technique) to assess for small diameter nerves and signs of damage in vascular integrity. Blood flow had been maintained in the vessels when the ERBEJET2 was set to 6 bar (87 psi). The cord where HD had been performed had a significantly lower total median residual nerve count of 5 (0-10), compared to 8 (2-12) on the non-HD side (p = 0.007). No structural damage was seen in the vessels in the spermatic cord that had undergone HD (gross exam and histology). HD of the spermatic cord significantly decreases residual nerve density without compromising vascular integrity in a rat model.
Topics: Animals; Denervation; Male; Models, Animal; Pain Measurement; Rats; Spermatic Cord; Treatment Outcome
PubMed: 32862193
DOI: 10.1038/s41443-020-00351-1