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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 -
Translational Andrology and Urology Feb 2024Inflammatory myofibroblastic tumor (IMT) is a rare entity that is described in several organ systems. This comprehensive review aims to identify IMTs occurring at... (Review)
Review
BACKGROUND AND OBJECTIVE
Inflammatory myofibroblastic tumor (IMT) is a rare entity that is described in several organ systems. This comprehensive review aims to identify IMTs occurring at various genitourinary (GU) organ sites and describe patterns of clinical management in adult and pediatric patients.
METHODS
A comprehensive search of PubMed and Web of Science was conducted according to the Preferred Reporting Items for Systematic Review and meta-analyses statement. Two reviewers performed independent initial screening of abstracts. Eligible articles underwent full review and data extraction. The clinical features, diagnostic tests, treatment, and outcomes at each GU organ site were analyzed individually and summarized into a comprehensive review.
KEY CONTENT AND FINDINGS
Of the 270 articles identified, 112 met inclusion criteria. Articles primarily consisted of case reports or small series describing a total of 167 cases, of which 30 (18%) occurred in children. Most patients (96%) were symptomatic at presentation. The most frequently involved sites included bladder (106 cases) and kidney (n=33) followed by epididymis (n=6), urachus (n=6), ureter (n=5), prostate (n=4), testis (n=4), and spermatic cord (n=3). Complete surgical excision of the mass including partial or total removal of involved organs provided excellent outcomes. Incomplete excision was associated with early local recurrence and progression. Late recurrence or metastatic transformation was rarely noted (<2%).
CONCLUSIONS
IMTs exhibit locally invasive, symptomatic and progressive phenotypes that affect all urologic organs in adults and children. Clinical features and imaging results are similar to those noted with urologic cancers. These tumors require complete surgical excision since incomplete resection increases the risk of symptomatic recurrence.
PubMed: 38481869
DOI: 10.21037/tau-23-471 -
PloS One 2024Testicular torsion is a severe urological emergency caused by the twisting of the spermatic cord. The nationwide incidence of testicular torsion in Japan has not been...
Testicular torsion is a severe urological emergency caused by the twisting of the spermatic cord. The nationwide incidence of testicular torsion in Japan has not been previously reported. Accordingly, we aimed to estimate the nationwide incidence of testicular torsion using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) and examine the orchiectomy rate. This cross-sectional study was based on data from the NDB. We extracted data of patients aged < 21 years with documented testicular torsion and relevant treatment from January 2018 to December 2020. Testicular torsion was identified based on the Japanese standardized disease codes. The national incidence rate between 2018 and 2020 was calculated and assessed according to age and region of origin. Orchiectomy rates were evaluated according to age. The nationwide incidence rates of testicular torsion were 14.46, 15.09, and 15.88 per 100,000 males aged < 21 years in 2018, 2019, and 2020, respectively. The orchiectomy rate was 7.1%. Testicular torsion was most frequently observed during winter. A similar trend was observed nationwide. To the best of our knowledge, this study is the first to report the nationwide incidence of testicular torsion in Japan.
Topics: Male; Humans; Spermatic Cord Torsion; Japan; Cross-Sectional Studies; Retrospective Studies; Orchiectomy
PubMed: 38457468
DOI: 10.1371/journal.pone.0297888 -
Urology Case Reports Mar 2024Cystic dysplasia of the testis is characterized by the presence of multiple cysts within the testicular parenchyma. It is a rare benign tumor. It is often accompanied by...
Cystic dysplasia of the testis is characterized by the presence of multiple cysts within the testicular parenchyma. It is a rare benign tumor. It is often accompanied by kidney malformations. There is no consensus on treatment. We report here the case of testicular dysplasia revealed by a torsion of the spermatic cord in an adult. The diagnosis of cystic dysplasia of the testis was made intraoperatively and confirmed by pathology. An orchiectomy was performed. Serum testicular cancer markers were normal postoperatively.
PubMed: 38414816
DOI: 10.1016/j.eucr.2024.102674 -
Journal of Medical Case Reports Feb 2024Testicular tumors have many different manifestations. The majority of these cases are presented as an incidental finding during hydrocelectomy. Malignant mesotheliomas...
BACKGROUND
Testicular tumors have many different manifestations. The majority of these cases are presented as an incidental finding during hydrocelectomy. Malignant mesotheliomas are uncommon tumours that can arise from the coelomic epithelium of the pleura, peritoneum, pericardium, and tunica vaginalis.
CASE PRESENTATION
We present a 51-year-old South Asian (Indian) male patient with a rare case of mesothelioma, presenting with right hydrocele, to whom a right hydrocelectomy was performed. Any history of trauma or asbestos exposure was not present. Histopathological and immunohistochemistry reports revealed a malignant mesothelioma of tunica vaginalis. There was no invasion of the tumour to the epididymis and spermatic cord. Imaging studies showed no signs of metastasis. 1 month later, a high inguinal orchidectomy was performed. The patient underwent adjuvant chemotherapy thereafter and is still on follow-up.
CONCLUSION
Although hydrocele is common, detailed evaluation is mandatory to rule out certain rare tumours-testicular and paratesticular variants.
Topics: Male; Humans; Middle Aged; Mesothelioma, Malignant; Mesothelioma; Testicular Hydrocele; Testicular Neoplasms
PubMed: 38409016
DOI: 10.1186/s13256-024-04348-y -
Polski Przeglad Chirurgiczny Oct 2023Testicular and scrotal abnormalities can occur in children, adolescents, and adults. The lesions, often accompanied by pain and swelling/enlargement of the scrotum, can...
Testicular and scrotal abnormalities can occur in children, adolescents, and adults. The lesions, often accompanied by pain and swelling/enlargement of the scrotum, can cause anxiety in patients and their parents. Regardless of age, proper diagnosis is based on adequate anamnesis and physical examination. Color Doppler ultrasound is the first-line test in the differential process of testicular and scrotal diseases. Testicular and scrotal lesions require differentiation for benign and malignant processes as well as therapeutic management, including urgent surgical intervention. The aim of this paper is to present the most common causes of testicular and scrotal abnormalities in pediatric and adult patients and to outline the symptoms and diagnostic and therapeutic management.
Topics: Male; Adolescent; Humans; Child; Genital Diseases, Male; Scrotum; Spermatic Cord Torsion
PubMed: 38348982
DOI: 10.5604/01.3001.0053.9349 -
Scientific Reports Feb 2024Twisted testicular appendages had difficult differential diagnosis with testicular torsion. The objective of this paper is to evaluate the number, shape, size and...
Twisted testicular appendages had difficult differential diagnosis with testicular torsion. The objective of this paper is to evaluate the number, shape, size and determine the laterality pattern of the testicular and epididymal hydatids and evaluate the correlations between the length and width of the testicular and epididymal hydatids with testicular measurements. We analyzed 60 fixed cadavers and 16 patients with prostate cancer without previous hormonal treatment undergoing bilateral orchiectomy, totalizing 76 units and 152 testicles. In relation to the testicular appendices, we analyzed the following situations: absence of testicular and epididymis appendages, presence of a testicular appendix, presence of epididymis appendix, and presence of testicular and epididymis appendix. We measured the length, width and thickness of the testis and classified the appendages as sessile or pedicled. Chi-square test was used to verify associations between categorical variables. McNemar Test was used to verify differences between the percentages of right and left appendages. Correlations between quantitative measures were evaluated using the Pearson Correlation Coefficient (p < 0.05). In 50 cases (65.78%) we observed the presence of some type of appendices, in 34 cases (44.72%) we observed the presence of testicular appendices and in 19 cases (25%) the presence of epididymal appendices. We observed the presence of pedicled appendices in 39 cases (51.32%), with 25 of the cases (32.89%) of pedicled testicular appendices and 14 of the cases (18.42%) of pedicled epididymal appendages, with a significant association between the occurrence of appendices on the right and left sides (p < 0.001). Testicular hydatids were present in around two thirds of our sample being pedunculated in almost half of the cases with bilateral similarity. There is a significant chance in cases of twisted appendices that the same anatomical characteristics are present on the opposite side, which is a factor that tends to indicate the need for contralateral surgical exploration in cases of torsion, however studies with larger samples are needed to confirm these findings.
Topics: Male; Humans; Testis; Epididymis; Spermatic Cord Torsion; Pelvis; Orchiectomy
PubMed: 38332206
DOI: 10.1038/s41598-024-52734-9 -
Journal of Pediatric Urology Jun 2024Staged laparoscopic management of intra-abdominal testes using pedicular section is recognized as gold standard technique, successful in 85 % of cases for scrotal... (Comparative Study)
Comparative Study
BACKGROUND
Staged laparoscopic management of intra-abdominal testes using pedicular section is recognized as gold standard technique, successful in 85 % of cases for scrotal testicular position with less than 10 % testicular atrophy. Recently, Shehata proposed a new technique without pedicular division for these testes, using spermatic vessels traction, but did not provide a comparative study of the two techniques.
OBJECTIVE
To evaluate the laparoscopic spermatic pedicular traction (Shehata technique, ST) for the treatment of intra-abdominal testis, as an alternative to gold standard pedicular section (2-stage Fowler-Stephens, FS).
STUDY DESIGN
Intra-abdominal testes of 129 patients in two tertiary pediatric urology centers were managed laparoscopically (2011-2019) either by 2-stage FS orchidopexy or ST according to the surgeon preference. Testicular position and size were statistically compared.
RESULTS
A total of 147 testes were pulled down by 80 ST and 67 FS, including 18 bilateral cases. Median (IQR) age at surgery was 24.2 (15.6-46.4) months (ST) and 18.3 (13.1-38.2) months (FS) (p = 0.094). Scrotal pulling-down of the testis was performed after a median (IQR) period of 2.3 (1.6-3.4) months (ST) and 6.1 (4.7-8.3) months (FS), respectively (p < 0.005). Although ST had collapsed in 17 cases (21.3 %), only one (1.3 %) redo procedure was required. After a median (IQR) follow-up of 22 (12-40) and 19 (8.75-37) months (p = 0.59), the testis was in the scrotum in 85 % and 81 % of ST and FS cases, respectively (p = 0.51). Testicular atrophy occurred in 10 % of ST and 13.4 % of FS (p = 0.61). Multivariate analysis using the propensity score analysis did not identify any difference between the two techniques.
DISCUSSION
Our results seem to confirm that FS and ST achieve the same results regarding final testicular position and testicular atrophy rate, with a long-term follow-up. Our study supports pediatric surgeons to favor laparoscopic spermatic pedicular traction (ST) which preserves the testicular vascularization and may ensure better spermatogenesis after puberty. More details on the size and position of the testicle at the beginning of the first laparoscopy seem however essential to assess more accurately the outcomes of each surgical technique. Our outcomes will also be re-evaluated when our patients have reached puberty, from an exocrine and endocrine points of view.
CONCLUSIONS
This study showed similar results after laparoscopic traction or section of spermatic vessels for intra-abdominal testis in a long-term follow-up, providing more evidence for the use of ST as a valuable alternative to FS.
Topics: Male; Humans; Laparoscopy; Orchiopexy; Cryptorchidism; Infant; Child, Preschool; Retrospective Studies; Testis; Spermatic Cord; Traction
PubMed: 38310033
DOI: 10.1016/j.jpurol.2024.01.017 -
Journal of Minimal Access Surgery Jan 2024This study aimed to investigate the feasibility of applying laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia in...
INTRODUCTION
This study aimed to investigate the feasibility of applying laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia in children.
PATIENTS AND METHODS
From December 2017 to November 2018, we recruited 20 children, who were aged 1-6 years old, with indirect inguinal hernia. At the time of admission, the participants had already developed an indirect inguinal hernia for 6 months to 1 year. A simple transection and partial resection of hernia sac was performed at the internal ring on each of the recruited children. The procedure was conducted under laparoscopy. Two 5-mm trocars were placed on either side of the umbilicus, one for the camera and the other for a surgical instrument. Another trocar was placed on the right abdomen. Laparoscopic camera curved forceps, and scissors were placed. Along the unclosed internal ring, the peritoneum was cut in a circular fashion to transect the hernia sac and dissociate it from the distal end. About 1-2 cm of the hernia sac was resected.
RESULTS
The operation was successfully completed in all 20 cases, who did not experience any complications, such as the absence of spermatic cord, vas deferens injury, scrotal swelling and incision infection. The children were discharged 1 day after the operation. In the post-operative follow-up for the first 3-4 years, recurrence and testicular atrophy did not occur in the study participants.
CONCLUSION
The short-term results obtained from this study showed that the application of laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia is feasible. Long-term results and further observation are needed for validation.
PubMed: 38289023
DOI: 10.4103/jmas.jmas_78_23