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European Review For Medical and... Apr 2024Testicular ischemia-reperfusion induced by testicular torsion-detorsion increases the level of reactive oxygen species, leading to testicular damage. Allicin, one of the...
OBJECTIVE
Testicular ischemia-reperfusion induced by testicular torsion-detorsion increases the level of reactive oxygen species, leading to testicular damage. Allicin, one of the most active ingredients in garlic, is a significant exogenous antioxidant. In the research, the efficacy of allicin in treating testicular ischemia-reperfusion injury was assessed.
MATERIALS AND METHODS
The study included sixty Sprague-Dawley male rats. Three groups with 20 rats per group were created as follows: control group, testicular ischemia/reperfusion-induced group, and testicular ischemia-reperfusion plus treatment with allicin group. The control group underwent a sham operation of the left testis without other interventions. In the testicular ischemia/reperfusion-induced group, rat left testis was subjected to 720° torsion for two hours and then detorsion. In the allicin-treated group, in addition to testicular ischemia-reperfusion, 50 mg/kg of allicin was injected intraperitoneally, starting immediately following detorsion. Testicular tissue samples were obtained to measure the protein expression of xanthine oxidase, which is a major source of reactive oxygen species formation, malondialdehyde level (a reliable marker of reactive oxygen species), and testicular spermatogenic function.
RESULTS
Testicular ischemia-reperfusion significantly increased the expression of xanthine oxidase and malondialdehyde levels in ipsilateral testes while reducing testicular spermatogenic function. The expression of xanthine oxidase and malondialdehyde levels were significantly lower in ipsilateral testes, whereas testicular spermatogenic function in the allicin-treated group was significantly higher compared with those in the testicular ischemia-reperfusion group.
CONCLUSIONS
Our findings indicate that allicin administration improves ischemia/reperfusion-induced testicular damage by limiting reactive oxygen species generation via inhibition of xanthine oxidase expression.
Topics: Rats; Male; Animals; Humans; Spermatic Cord Torsion; Rats, Sprague-Dawley; Xanthine Oxidase; Reactive Oxygen Species; Testis; Reperfusion Injury; Antioxidants; Ischemia; Malondialdehyde; Disulfides; Sulfinic Acids
PubMed: 38639521
DOI: 10.26355/eurrev_202404_35910 -
International Journal of Surgery Case... May 2024Encysted spermatic cord hydrocele is a rare anomaly characterized by obstruction of processus vaginalis closure. Clinically, it presents as a swelling in the inguinal...
INTRODUCTION AND IMPORTANCE
Encysted spermatic cord hydrocele is a rare anomaly characterized by obstruction of processus vaginalis closure. Clinically, it presents as a swelling in the inguinal region extending to the upper scrotum and does not communicate with the peritoneal cavity. It is often mistaken for indirect inguinal hernias, inguinal lymphadenopathy, undescended testis, and primary tumors of the cord in infants and children, making the diagnosis challenging.
CASE PRESENTATION
We report the cases of five male patients aged nine months to 12 years who presented with painless swelling on the right side of the scrotal region. Physical examination revealed firm masses in the right inguinal region with positive transillumination, negative cough impulse tests, and irreducibility. Inguinal and scrotal ultrasonography showed an anechoic cystic lesion with thin walls, without any signs suggestive of a hernia. Patients were diagnosed with encysted spermatic cord hydrocele and advised to undergo cyst excision. The postoperative periods were uneventful, and expected recovery was observed at one-week and one-month follow-ups.
CLINICAL DISCUSSION
Encysted spermatic cord hydroceles are rare causes of painless inguinal swelling. The medical history and clinical findings can be used to establish a diagnosis, which can be confirmed using ultrasonography. Management depends on differentiating between spermatic cord hydrocele and scrotal hydrocele and involves considering the type. Treatment options range from conservative measures to surgery, particularly for non-communicating hydroceles that persist beyond 12-18 months or enlarge in size.
CONCLUSION
Encysted hydrocele of the cord is rare and is often mistaken for indirect inguinal hernias in infants and children. This similarity makes the diagnosis challenging and necessitates vigilance from clinicians. Surgical intervention results in optimal outcomes, especially in cases where the hydrocele persists beyond 12-18 months or with size progression.
PubMed: 38626639
DOI: 10.1016/j.ijscr.2024.109619 -
Journal of Clinical Medicine Apr 2024Intra-abdominal testes are located in a variety of intra-abdominal positions, most less than 2 cm from the internal ring. Various surgical techniques of laparoscopic...
The Safety and Effectiveness of Single-Stage, Vessel-Preserving, Laparoscopic Orchiopexy for Intra-Abdominal Testes in Pediatric Patients: A 10-Year Single-Center Experience.
Intra-abdominal testes are located in a variety of intra-abdominal positions, most less than 2 cm from the internal ring. Various surgical techniques of laparoscopic orchiopexy have been described to date. The aim of this study was to evaluate the safety and long-term efficacy of a single-stage, vessel-preserving, laparoscopic orchiopexy for intra-abdominal testes in pediatric patients. A retrospective search of the medical records of 32 children (34 testes) who underwent single-stage, vessel preserving, laparoscopic orchiopexy for intra-abdominal testes between 1 January 2014 and 31 December 2023 was performed. Single-stage laparoscopic orchiopexies were performed in all patients for whom sufficient length of the spermatic cord was achieved during the procedure. The volume of each patient's testes was measured using ultrasound before and 6 months after laparoscopic orchiopexy. The main outcome of this study was testicular volume before and after the procedure. The secondary outcomes were the occurrence of early and late complications, the duration of surgery, and the length of hospital stay. The median age at the time of surgery was 10 months (interquartile range-IQR 9, 13). The majority of the children ( = 24; 75%) were less than 12 months old at the time of surgery. A normal testis was found in 24 patients (70.6%), while a hypotrophic testis was visible in 10 cases (29.4%). The majority of the testes were located near the internal ring ( = 19; 55.9%), while in the remaining cases, the testes were located near the iliac blood vessels. The median duration of the surgical procedure was 37.5 min (IQR 33, 42.5). The duration of hospitalization was one day for all the children. No intraoperative complications were observed. One child had a wound infection at the site of the umbilical trocar, which was treated conservatively. In two cases (5.5%), testicular atrophy was detected during long-term follow-up. In three cases, the testis was found in a higher position in the scrotum during the follow-up period, but in two cases, the position was normal during the follow-up period, while in one case, the position in the scrotum remained unchanged. At long-term follow-up with a median of 35 months (IQR 19, 60.5), the overall success rate was 94.5%. The median testicular volume at 6-month follow-up increased from 0.31 mL (IQR 0.28, 0.43) to 0.40 mL (IQR 0.33, 0.53) ( = 0.017). Single-stage, vessel-preserving, laparoscopic orchiopexies for intra-abdominal testes are safe and effective in pediatric patients in whom adequate spermatic cord length can be achieved during the procedure.
PubMed: 38610810
DOI: 10.3390/jcm13072045 -
SAGE Open Medical Case Reports 2024Testicular epidermoid cysts, accounting for 1%-2% of all testicular masses, present a diagnostic challenge often identified post-orchiectomy. Conservative surgery is...
Testicular epidermoid cysts, accounting for 1%-2% of all testicular masses, present a diagnostic challenge often identified post-orchiectomy. Conservative surgery is recommended, emphasizing the need for accurate preoperative diagnosis. A 28-year-old patient with acute left scrotal pain, initially suggestive of testicular torsion, underwent intraoperative exploration revealing extra-vaginal torsion with an incidentally discovered 2-cm intra-testicular mass. Due to suspected malignancy, a total orchiectomy was performed. Pathological analysis confirmed an epidermoid cyst with normal postoperative tumor markers. The patient had a good postoperative outcome and underwent testicular prosthesis placement 3 months after the surgery. Epidermoid cysts, often identified incidentally during urgent scenarios, underscore the importance of accurate preoperative diagnosis. Conservative surgery remains the preferred approach, emphasizing the consideration of benign factors to prevent unnecessary orchiectomies.
PubMed: 38595943
DOI: 10.1177/2050313X241245286 -
Urology Case Reports May 2024Primary rhabdomyosarcoma of the testis is an exceptionally rare and highly malignant sarcoma. To date, there are only 23 reported cases in the literature. We report a...
Primary rhabdomyosarcoma of the testis is an exceptionally rare and highly malignant sarcoma. To date, there are only 23 reported cases in the literature. We report a 17-year-old male patient presented with massive scrotal swelling that had been progressively enlarging over seven-months. Scrotal ultrasound and contrast-enhanced CT revealed a 10 × 10cm left testicular heterogeneously enhancing mass that extends into the spermatic cord. A left inguinal orchiectomy was performed, and histopathological examinations showed findings consistent with Rhabdomyosarcoma, Embryonic-type. Primary embryonal testicular rhabdomyosarcoma has poor prognosis, particularly for adolescents, and tumour size greater than 10cm. Early diagnosis and radical orchiectomy improve the prognosis.
PubMed: 38571549
DOI: 10.1016/j.eucr.2024.102723 -
Journal of Equine Science Mar 2024Equine testicular arteritis commonly occurs as a consequence of the migration of nematode larvae or equine arteritis virus (EAV) infection. However, testicular arteritis...
Equine testicular arteritis commonly occurs as a consequence of the migration of nematode larvae or equine arteritis virus (EAV) infection. However, testicular arteritis without evidence of these infections has been reported, and the underlying pathogenesis remains unclear. We encountered testicular arteritis without evidence of nematode or EAV infection in a 3-year-old male heavy draft horse with scrotal enlargement. Grossly, the volume of the pampiniform plexus was markedly increased due to edema. Histologically, non-suppurative and necrotizing testicular arteritis, characterized by lymphocyte infiltration and fibrinoid necrosis of the arterial walls, was diffusely observed in the spermatic cord, pampiniform plexus (most severe), testis, and epididymis. We were unable to identify the cause of arteritis, such as a viral infection or autoimmune abnormality.
PubMed: 38524753
DOI: 10.1294/jes.35.15 -
International Journal of Surgery Case... Apr 2024Inguinal hernia is common, but the groin area can host various pathologies. Distinguishing clinically between hernias and rare conditions like torsion of funiculocele...
INTRODUCTION
Inguinal hernia is common, but the groin area can host various pathologies. Distinguishing clinically between hernias and rare conditions like torsion of funiculocele poses challenges due to similar presentations.
CASE PRESENTATION
A 50-year-old man, with a 10-year-history of a groin mass, presented with a painful groin mass, initially diagnosed as a strangulated hernia. In surgery, a torsion of a cyst was identified, and it was attached to the spermatic cord. A detorsion of the cyst and an excision were successfully performed. The patient recovered well with no recurrence.
DISCUSSION
The most common causes of acute groin pain are injury, incarcerated hernia, kidney stone and bone fracture. Additionally, funiculocele can cause groin pain or discomfort. Funiculocele, a rare congenital anomaly, typically affects pediatric patients. A torsion of funiculocele is easily confused with an incarcerated hernia. Ultrasonography plays a crucial role in confirmation. Although unusual, a torsion of a cyst can occur, necessitating surgical excision.
CONCLUSION
Funiculocele in adults, mimicking hernias, is rare but requires timely surgical intervention to prevent complications. Awareness of this anomaly is vital for accurate diagnosis and appropriate management.
PubMed: 38522305
DOI: 10.1016/j.ijscr.2024.109547 -
Cureus Feb 2024Splenogonadal fusion is a rare, benign congenital malformation characterized by the association of splenic tissue and gonads (typically testicles). It is a condition of...
Splenogonadal fusion is a rare, benign congenital malformation characterized by the association of splenic tissue and gonads (typically testicles). It is a condition of male predominance and can be classified into two types: continuous, if the spleen and gonad are united by a splenic cord or fibrous tissue, or discontinuous. Splenogonadal fusion is often associated with other congenital anomalies such as cryptorchidism, limb defects, and micrognathia. Differential diagnosis can be difficult and includes inguinal hernia, spermatic cord cyst, cryptorchidism, or testicular mass. Due to little knowledge of the pathology, unnecessary orchidectomies are often performed. A previously healthy five-year-old boy was sent to a pediatric surgery appointment due to testicular asymmetry. The physical examination showed a painless, nodular mass adhering to the upper pole of the left testicle, without any palpable inguinal masses. Tumor markers were negative, and a testicular ultrasound with Doppler revealed a mass suggestive of an accessory testicle. Left inguinal surgical exploration revealed the presence of a mass joined by fibrous tissue to the upper pole of the testicle, but no connection to the native spleen was found. Total excision was performed with the testicle's preservation. The anatomopathological analysis revealed morphological aspects compatible with splenic tissue with normal characteristics. The diagnosis of splenogonadal fusion is rare and complex, requires several differential diagnoses, and is often made intraoperatively.The prognosis is excellent as long as there are no associated malformations. A high level of suspicion for this pathology, with recognition of the anatomical structures, can avoid unnecessary orchidectomy.
PubMed: 38510865
DOI: 10.7759/cureus.54454 -
The Tokai Journal of Experimental and... Apr 2024Transverse testicular ectopia (TTE) is a rare congenital malformation where both testes descend through the same inguinal canal and are located in the same hemiscrotum....
Transverse testicular ectopia (TTE) is a rare congenital malformation where both testes descend through the same inguinal canal and are located in the same hemiscrotum. It is usually treated with transseptal orchiopexy. In this article, we report the case of a 1-year-old boy diagnosed with TTE who was successfully treated with laparoscopically assisted orchiopexy by going through the anatomical conventional route. A four-month-old boy was referred to our department with bilateral empty scrotum. On the physical examination, the left testis was palpable in the left groin region and the right testis was impalpable. A follow up ultrasonography was performed after 4 months, and an oval-shaped testis-like structure was detected in left internal inguinal ring near the left testis. Right side TTE was suspected in the initial diagnosis. Laparoscopic surgery was performed at age one. The left testis was observed in the inguinal canal, and the right testis was ectopically located in the left opening inguinal canal above the left testis. Two spermatic cord and testes were separated respectively, and the right testis was pulled into abdominal space laparoscopically and brought down to the right hemiscrotum via the right inguinoscrotal canal. Bilateral orchiopexy was performed via the normal anatomical route. The postoperative course was uneventful, and testes were in the scrotum bilaterally one year after orchiopexy.
Topics: Male; Humans; Infant; Orchiopexy; Testis; Laparoscopy; Ultrasonography
PubMed: 38509010
DOI: No ID Found -
Pediatric Surgery International Mar 2024Ultrasound as a diagnostic tool in suspicion of testicular torsion is still highly debated. In this investigation, we aimed to evaluate whether time spent on scrotal...
PURPOSE
Ultrasound as a diagnostic tool in suspicion of testicular torsion is still highly debated. In this investigation, we aimed to evaluate whether time spent on scrotal ultrasonography had a negative impact on testicular loss.
METHODS
Patients' records containing a scrotal ultrasound and/or surgical procedure codes for testicular interventions on suspicion of testicular torsion were examined. Patients aged 0-15 years admitted during 2015-2019 at Copenhagen University Hospital, Rigshospitalet were included.
RESULTS
In total, 1566 patients underwent an ultrasound and 142 of these proceeded to surgery while 13 patients proceeded directly to surgery without an ultrasound. The rate of testicular loss with a preceding ultrasound was 23% versus 42% without (p = 0.18). Four cases of testicular torsion were misdiagnosed by ultrasound resulting in a sensitivity of 95.4% and specificity of 95.6%. The mean diagnostic delay from ultrasound examination was 55 ± 39 min, and the mean time from ultrasound to surgery was at 169 ± 76 min versus 171 ± 72 min without ultrasound.
CONCLUSION
In a clinical setting, ultrasound provided a reliable tool for the diagnosis of testicular torsion and did not seem to increase the orchiectomy rate.
Topics: Child; Male; Humans; Spermatic Cord Torsion; Delayed Diagnosis; Retrospective Studies; Testis; Ultrasonography
PubMed: 38507099
DOI: 10.1007/s00383-024-05663-7