Traumatisme des bourses : aspects cliniques et thérapeutiques au service d'urologie du CHU Gabriel Toure

Objectif : Notre travail avait pour but de décrire les aspects épidémiologiques, cliniques, paracliniques et thérapeutiques des traumatismes des bourses dans le service d'urologie ­ andrologie du CHU Gabriel Touré de Bamako au Mali. Matériel et Méthode : Il s'agissait d'une étude rétrospective portant sur 13 dossiers de patients qui ont été pris en charge au service d'Urologie-Andrologie l'hôpital Gabriel Touré du Mali pour traumatisme des bourses durant la période allant de Février 2006 à Janvier 2013. Les paramètres suivants ont été étu dié : la fréquence, l'âge, les étiologies, le motifet le délai de consultation, les résultats de l'examen clinique, le protocole de traitement adopté et l'évolution. Résultats : La moyenne d'âge était de 28 ans avec des extrêmes de 1an et 46 ans. Les circonstances de survenue étaient dominées par les accidents de la voie publique (12 cas), une agression par armes à feu. Le délai de consultationvariait entre 1heure à 1jour. La grosse bourse douloureuse était le motif de consultation le plus fréquent (n=12). A l'examen physique le traumatisme était fermé dans 10 cas, et ouvert dans 3 cas. Sur le plan thérapeutique, 7 de nos patients ont subi une intervention chirurgicale et 6 un traitement conservateur (surveillance + anti-inflammatoire).Les gestes chirurgicales ont consistés; à une plastie des enveloppes scrotales et péniennes (n=2), une orchidopexie, une uretroplastie (n=1), un parage et drainage de la vessie, une orchidectomie. Le séjourmoyen en hospitalisation a été de 5 jours avec des extrêmes d'un jour et 1mois. Les suites opératoires immédiates ont été simples chez tous les patients sauf deux. Conclusion : Une exploration chirurgicale doit être réalisée en cas d'hématocèle ou de rupture de l'albuginée testiculaire à l'échographie. Une prise en charge précoce permet de préserver la fonction gonadique

La prise en charge de l'ectopie testiculaire a l'hopital central de Yaounde : a propos de 171 cas

INTRODUCTION:L'ectopie testiculaire est frequente. Le diagnostic et la prise en charge precoces sont necessaires a cause des risques d'atrophie; de cancerisation; de subfertilite; et les consequences psychologiques en rapport avec l'absence d'un testicule dans une bourse. Cette prise en charge est tardive dans notre milieu. Le but de ce travail etait d'etudier les facteurs interferant avec cette prise en charge. MeTHODOLOGIE Nous avons revu 172 dossiers des patients operes d'ectopie testiculaire de 1999 a 2012. Nous avons etudie l'age au moment de l'operation; la qualification de la personne ayant assure l'accouchement; les facteurs interferant avec la prise en charge et les resultats de cette prise en charge. ReSULTATS L'age des patients au moment de la chirurgie variait de 1 a 48 ans; avec une moyenne de 8 ans. Seuls 21 patients avaient ete operes dans les delais recommandes. L'information medicale avait ete erronee ou insuffisante dans 93 cas. L'on retrouvait la peur de l'operation dans 42 cas; les problemes financiers dans 14 cas; l'ignorance des parents dans 7 cas. CONCLUSION Le manque d'information des soignants ou des parents; la peur de l'operation et le manque de moyens financiers sont les principales causes de delai dans la prise en charge de l'ectopie testiculaire. Ce travail fait ressortir la responsabilite du personnel de sante dans le la prise en charge precoce de l'ectopie testiculaire

Diagnostic value of high resolution ultrasound in localisation of the undescended testis in children

Background: The use of ultrasonography in the pre-operative localisation of undescended testes has become controversial due to fears about its accuracy. This study was designed to ascertain the accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography in the localisation of the undescended testes in children. Patients and Methods: A prospective evaluation of all boys undergoing operation for undescended testes at the Lagos University Teaching Hospital, Idi-Araba, Lagos, over a 12 month period was performed. The pre-operative clinical and ultrasound findings were compared with the findings on surgical exploration. Results: Forty boys with 52 undescended testes were studied. The mean age of the boys at the time of surgery was 4.0 ± 0 years (range 1-11 years). Forty-six (88.5%) testes were localised pre-operatively by ultrasound- 20 of 22 (90.9%) palpable testes and 26 of 30 (86.7%) non-palpable testes. Intra-operatively, 49 (94.2%) of the undescended testes were found while 3 (5.8%) were absent/vanishing testes. Ultrasound evaluation had an accuracy of 86.5%, sensitivity of 89.8%, and specificity of 33.3%, PPV of 95.7% and a NPV of 16.7%. Conclusion: Ultrasound assessment is beneficial in pre-operative evaluation of children with undescended testes

Testicular Biopsies of Azoospermic Men at The Lagos State University Teaching Hospital

Objectives: This study was conducted to evaluate the histological findings from testicular biopsies in azoospermic men seen at the Lagos State University Teaching Hospital; Ikeja - Lagos; Nigeria. Patients and Methods: A retrospective study of testicular biopsies of azoospermic men who presented to our institution from 2005 to 2006 was performed. The patient's age; type of infertility and histopathological diagnosis were evaluted. All biopsies were preserved in 10formaldehyde solution. Results: Of the 51 azoospermic men (mean age 30 years; range 25 - 46 years) 25 (49.0) had primary infertility; 11 (21.6) had secondary infertility and 15 (29.0) were not specified. Five (9.8) patients had normal spermatogenesis. Abnormal histological parameters occurred in 46 (90.2) patients: testicular atrophy in 30 (58.8); maturation arrest in 14 (27.5) and hypospermatogenesis in 2 (3.9) patients. Conclusion: The presence of normal spermatogenesis in azoospermic men; which would suggest an obstructive lesion; is not common in our practice; in contrast to previous studies from our country. This may indicate a changing pattern in the aetiology of male infertility in our environment. Identification of the possible causes of testicular damage resulting in non-obstructive azoospermia in our environment may help to prevent male infertility

Accuracy of ultrasound diagnosis after blunt scrotal trauma (10 years experience)

Objectives:To evaluate the role of ultrasonography (US) and its accuracy; sensitivity and specificity for the diagnosis of testicular rupture after blunt scrotal trauma. Moreover; tunica albuginea breach; testicular hematoma; testis avulsion; epididymal injuries and hematocele are particularly examined. Patients and Methods: Between 1998 and 2008; 24 patients presented to Suez Canal University Hospital after blunt scrotal trauma and underwent surgical exploration. All patients had an emergency scrotal US examination with the use of a 7.5-10 MHz linear transducer. US findings were compared with the surgical findings to calculate the sensitivity and specificity of US for each type of lesion. Results: Out of 24 patients; 12 were diagnosed as having testicular rupture and tunica albuginea breach was visualized on US in 6 patients. Sensitivity and specificity of US were 92and 50for testicular rupture; 85and 75for hematocele; 80and 79for testicular hematoma; and 100 and 96 for testicular avulsion; respectively. US diagnosis of epididymal injuries was poor as it failed to detect 3 out of 5 epididymal lesions. Conclusion: US was highly sensitive in the diagnosis of testis rupture. This can provide information on the integrity of the scrotal contents that can help the physician to determine the optimal treatment

Primary Plasmacytoma of the Testis with no Evidence of Multiple Myeloma: a New Case Report and Literature Review

Plasmacytomas of the testis are extremely rare tumours; especially when occurring in the absence of a previous or concurrent diagnosis of multiple myeloma. We report a new case of solitary testicular plasmacytoma; with immunohistochemical studies showing monoclonal cytoplasmic production of IgG lambda light chains; in a 51-year-old man who had no evidence of multiple myeloma 3 years after the orchiectomy

Evaluation of Sexual Maturity among Adolescent Male Sickle Cell Anaemia Patients: the Usefulness of Testicular Volume Estimation

Use of Tanner stages i.e. Sexual Maturity Rating; (SMR); in evaluation of sexual maturity has gained widespread acceptance. Tanner staging assesses pubic hair growth and increase in genital sizes; the latter of which is best reflected by the increase in testicular size. Testicular volume increases is thought to be the most sensitive clinical indication of onset and progress of puberty. It has been argued that the initial stage of sexual development may be missed if testicular volume is not assessed. We explored usefulness of testicular volume estimation for assessing sexual maturity among adolescent male sickle cell anaemia (SCA) patients. Methods: We conducted a cross-sectional case-control study evaluating sexual maturation of male patients with sickle cell anaemia and those with HbAA genotype. Tanner staging and testicular volume assessment were both used as models for evaluating stages of sexual maturation among SCA patients and their normal counterparts matched for age and socioeconomic status. Results: SCA patients demonstrated delay in onset and completion of sexual maturation. Testicular volumes (TV) of subjects were smaller than those of controls but when related to stages of sexual maturity; there was no statistically significant difference between both groups. The correlation coefficients between various stages of sexual maturity and TV suggest strong associations. Conclusion: Testicular volume increase is shown as a reasonably good predictor of onset and progression of sexual maturity in both SCA subjects and their healthy controls

Les traumatismes des bourses

Objectif: Evaluer les caracteristiques epidemiologiques; cliniques; paracliniques et therapeutiques des traumatismes des bourses dans le service d'urologie - andrologie du CHU de Brazzaville Patients et methodes: Etude retrospective portant sur 18 patients hospitalises pour un traumatisme des bourses entre janvier 1990 et decembre 2006. Les parametres analyses ont ete: la frequence; l'age; les etiologies; le motif et delai de consultation; les resultats de l'examen clinique; les donnees echographiques; le protocole de traitement adopte et l'evolution. Resultats: Les traumatismes des bourses representaient 0;4des hospitalisations au CHU de Brazzaville. L'age moyen des patients etait de 34;6 ans (extremes 9 et 64 ans). Les traumatismes par accident de la voie publique (8 cas) et ceux du travail (5 cas) etaient les principales causes. Le delai moyen de consultation etait de 3 jours pour les traumatismes fermes (12 cas) et une heure pour les traumatismes ouverts (6 cas). Le principal motif de consultation etait la douleur scrotale (n=10). L'echographie realisee chez 8 patients a mis en evidence: 4 cas de rupture de l'albuginee; 2 cas d'hematomes intra testiculaires et 2 cas d'hematocele. Le traitement a ete medical dans 6 et chirurgical dans 12 cas. Les interventions ont consiste en la resection de la pulpe exteriorisee et suture de l'albuginee (n=4); une orchidopexie (n=1); une orchidectomie (n=3); une evacuation d'un hematocele (n=2) et un drainage d'un hematome testiculaire (n=2). A long terme; des douleurs testiculaires residuelles ont ete observees chez 3 patients; une ligoasthenozoospermie chez 3 patients; une atrophie testiculaire chez 2 patients et un cas de dysfonction erectile. Conclusion: Une exploration chirurgicale doit etre realisee en cas d'hematocele. L'echographie; entre des mains entrainees; peut faire le diagnostic de rupture de l'albuginee testiculaire cependantcet examen ne doit pas retarder la prise en charge au bloc operatoire

Undescended testes in a developing country: a study of the management of 71 patients

BACKGROUND: A testis located outside the scrotum is prone to a lot of complications but early detection and correction give good result. The purpose of this study was to determine the pattern of presentation, complications recorded, the surgical treatment offered and outcome in a developing country. PATIENTS AND METHODS: A retrospective study of patients that presented with undescended testes at the University of Benin Teaching Hospital between January, 1997 and December, 2006. RESULTS: A total of 76 orchidopexies and 10 orchidectomies were done on 71 patients with undescended testes during the period. They were aged 9 months and 47 years (mean 8.3 +/- 7.9 years) at surgery. Only 31 (43.7%) patients presented at age 5 years and below while 40 (56.3%) presented after 5 years. Seventy-two (83.7%) testes were palpable, ultrasound scan was used to locate 10 (11.6%), while 4 (4.7%) could only be located during groin exploration. Intraoperative assessment of the testes were 54 (62.8%) normal testicular volume, 22 (25.6%) reduced volume and 10 (11.6%) atretic. All those aged 5 years and below had normal/reduced testicular volume and all had orchidopexy whereas those above 5 years with normal/reduced testicular volume had orchidopexy and those with atretic testis had orchidectomy. Post operatively, testicular growth was recorded only among the pre/pubertile boys, the testes retracted in two patients, scrotal skin infection in one, and intra scrotal haematoma in two. CONCLUSION: Delayed presentation resulted in morphological changes, increased complications, number of orchidectomy and reduced chance of testicular growth post orchidopexy

Pseudotumeurs fibreuses inflammatoires du cordon spermatique chez l'enfant

Les pseudotumeurs fibreuses inflammatoires du cordon spermatique observe chez l'enfant sont rares. Les auteurs rapportent un cas observe chez un garcon de 9 ans presentant une tumefaction paratesticulaire gauche. L'examen echographique du scrotum revele un nodule hypoechogene du cordon spermatique gauche. A partir de cette observation et d'une revue de la litterature; nous discutons les aspects diagnostiques et therapeutiques de ces tumeurs

Changes in Testes Lipid Profile in Rats Fed on Thermally-Oxidized Soya bean Oil-Based Diets

The effect of thermally-oxidized soyabean oil-based diets on the lipid profile of the testes of rats was studied. For 35 days; two groups of male weanling rats were fed a basal diet containing unoxidised and oxidized soyabean oil. Rats fed the thermally oxidized soyabean oil diets displayed typical signs of essential fatty acids (EFA) deficiency and had their testes weights reduced to about 81 of fats fed unoxidised soyabean oil diets. There was a significant decrease (p0.05) in phosphatidylcholine and diphosphatidylglycerol content and increase in cholesterol (p0.005) content of the testes of rats fed oxidized soyabean oil-based diet compared to those fed unoxidised oil diets

Toxicological Effects of Paraquat on the Histology of the Stomach; Small Intestine and Testis of Male Albino Rat (Rattus Norvegicus)

Background: Paraquat is a herbicide; commonly used by farmers in agriculture to prevent weed infestation. The non-target organic toxicity effect of this chemical motivated this study.Methods: Utilizing male albino rats of 0.2 kg average body weight; the LD100(lethal dose that gave 100death) for Paraquat was obtained as 1g/kg body weight Furthermore LD50 (median lethal dose of paraquat; ip) was obtained as 0.45 g/kg body weight using arithmetic method of karber. Six dose levels of paraquat 0; 0.09; 0.18; 0.35; 0.70; 1.00 g/kg body weight were administered intraperitoneally into the various groups of the male rats. Within 24hrs; histopathological examination in the stomach; in the small intestine and testis of the rats were performed.Results: Histopathological examination of the organs studied revealed that the stomach had mild mucosal ulceration; muscular coat atrophy; stromal oedema and tubular hyalinization which were dose- dependent. The small intestine showed mucosal ulceration; loss of villi; luminal and stromal oedema and glandular necrosis which were also dose dependent. Furthermore; the testis had classical central fibrosis; cellular polarization; tubular disorganization; necrosis and lack of mitotic figures (no cell division); oligospermia; azoospermia and hyperchromasia which were dose dependent.Conclusion: Paraquat; a notable herbicide used in agricultural weed control; had deleterious effects on such organs as stomach; small intestine and testes. Need therefore arises for caution in the handling of these chemicals as the danger of impairment of the gastrointestinal tract and indeed the reproductive system in males is a possibility

Rupture of the Testes From Blunt Trauma

Background: Traumatic rupture of the testis is rare. Methods: Two patients with the condition are discussed in this article. The first; a 32 year old father; presented with post traumatic swelling and pain in the scrotum. He was a passenger on a motorcycle which was hit by a car. He was thrown up and landed on the windscreen of the car. He complained of pain in the scrotum and was quickly taken to a near-by clinic where a scrotal laceration was sutured. He continued to have severe pain from the swollen testes and was transferred to another clinic for urological attention. The second patient; a 26 year old man; was hit on the scrotum with a police handcuff. He presented with lower abdominal pain; scrotal and left testicular swellings. Results: The scrotum was explored in each patient. In the 32 year-old; the two testes ruptured transversely but were viable. Each was debrided and closed with chromic catgut. The patient was commenced on antibiotics. The following morning; the testes were much less swollen. The wound healed primarily in one week. At three weeks after injury; he claimed to have satisfactory erections but declined investigation of semen analysis as well as serum testosterone. In the 26 year old; exploration revealed a transverse rupture of the left testis. This was sutured. The wounds healed primarily. Conclusion: It is suggested that blunt trauma resulting in testicular swelling indicates testicular exploration and ultra sound investigation for diagnosis may not be necessary

Assessment of the antioxidant potential of alcoholic extract of Garcinia Kola seed in alcohol induced testicular oxidate stress in Sprague-Dawley rat

The action of alcoholic extract of Garcinia kola (G. kola) seed as an antioxidant was investigated in alcohol induced testicular oxidative stress. 40 adult Sprague-Dawley rats weighing 100 - 150g were used for the study. These were divided into a control and 7 experimental groups of 6 rats each. These were fed one of alcohol; G. kola or alcohol and G. kola combined daily by gastric gavage. At the end of eight weeks of experiment; the animals were sacrificed after anaesthesia; Histological study (H et E); sperm count; assay for testicular Malondialdehyde (MDA) and Catalase activity were determined. Results obtained revealed testicular lesion in the groups that received 500mg/kgw of extract; and 500mg/kgw with 2g of ethanol (concurrently) for 8 weeks.Slightly reduced sperm count was observed in ethanol/ extract (500mg/kg) combined group. There was increased testicular MDA and increased catalase activity in the groups that received 2g of ethanol only and 2g of ethanol concurrently with 500mg/kg extract. G. kola seed extract has a dose dependent antioxidant activity but may not be effective in alleviating alcohol induced testicular oxidative stress

Assessment of the antioxidant potential of alcoholic extract of Garcinia kola seed in alcohol induced testicular oxidative stress in sprague-dawley rat

The action of alcoholic extract of Garcinia kola (G. kola) seed as an antioxidant was investigated in alcohol induced testicular oxidative stress. 40 adult Sprague-Dawley rats weighing 100 - 150g were used for the study. These were divided into a control and 7 experimental groups of 6 rats each. These were fed one of alcohol; G. kola or alcohol and G. kola combined daily by gastric gavage. At the end of eight weeks of experiment; the animals were sacrificed after anaesthesia; Histological study (H et E); sperm count; assay for testicular Malondialdehyde (MDA) and Catalase activity were determined. Results obtained revealed testicular lesion in the groups that received 500mg/kgw of extract; and 500mg/kgw with 2g of ethanol (concurrently) for 8 weeks. Slightly reduced sperm count was observed in ethanol/ extract (500mg/kg) combined group. There was increased testicular MDA and increased catalase activity in the groups that received 2g of ethanol only and 2g of ethanol concurrently with 500mg/kg extract. G. kola seed extract has a dose dependent antioxidant activity but may not be effective in alleviating alcohol induced testicular oxidative stress

The value of testicular biopsy in male infertility : experience with 63 Nigerians

Objectives: The subject of male infertility is large and complex. While testicular biopsy has been condemned in the diagnosis of patients with testicular tumors; it has a well established place in the investigation of the sub-fertile male. This study was conducted to examine the role of testicular biopsy in patients with male infertility seen at the University of Ilorin Teaching Hospital; Ilorin; Nigeria. Patients and Methods: A retrospective histopathological study of slides and request forms of 63 cases of testicular biopsies of patients with male infertility seen over a fourteen year period (1990-2003) was carried out. They were evaluated based on age; type of infertility and histopathological diagnosis. Result: Thirty-one (49.2) patients suffered from primary infertility and 14 (22.2) of secondary infertility; 18 (28.6) were not specified. Testicular atrophy (55.6) was the commonest histopathological diagnosis with the age range of 25 - 34 years as its peak age of occurrence. Normal testicular histology was found in 14.3of cases; maturation arrest in 25.4and hypospermatogenesis in 4.8of cases. Conclusion: The greatest value of testicular biopsy and its clinical correlation lies in its ability to differentiate curable from irremediable cases so that appropriate action can be taken. It should never be undertaken as an isolated investigation but as part of a planned study of sub-fertile male patients

Tumeurs malignes du testicule en Côte d'Ivoire: aspect anatomo-pathologique à propos de 54 cas

Objectif : Le but de cette étude est d'étudier les caractéristiques histologiques du cancer du testicule en Côte d'Ivoire. Matériel et méthodes : Cette étude rétrospective porte sur les dossiers de 54 patients âgés en moyenne de 23,41 ans (extrêmes 13 mois et 68 ans) avec des tumeurs malignes du testicule, colligés en 25 ans dans les services d'Anatomie pathologique de Côte d'Ivoire. Les renseignements suivants ont été évalués: l'âge, l'origine géographique des patients ainsi que les caractéristiques cliniques des tumeurs telles leur localisation, leur nature et leur type histologique. Certaines données telles que les marqueurs tumoraux et la stadification de la maladie n'ont pas été prises en compte. Résultats : En moyenne deux tumeurs ont été diagnostiquées par an. Sur le plan histologique, 87% des tumeurs sont primitives. On y distingue: 46,3% de tumeurs germinales parmi lesquelles les tumeurs germinales non séminomateuses sont prédominantes avec un taux de 24.07% de l'ensemble des cas et les séminomes 22.22% des cas; et 40.74% de tumeurs non germinales avec 18,5% de rhabdomyosarcomes. Les tumeurs secondaires représentent 13,9% des tumeurs du testicule de notre série. Il s'agit essentiellement de localisations secondaires des lymphomes de Burkitt (5 cas sur 7). Enfin, l'atteinte bilatérale est importante. La tumeur est bilatérale, d'emblée dans 31% des cas. Conclusion : Il ressort que les tumeurs du testicule sont rares en Côte d'Ivoire, avec une incidence annuelle d'environ deux cas. Elles surviennent chez l'adulte jeune âgé en moyenne de 23 ans et sont souvent de mauvais pronostic à cause de la bilatéralité de leur atteinte. En effet, 31% des tumeurs testiculaires atteignent simultanément les deux testicules

Testicules impalpables : approche diagnostique et therapeutique; apport de la coelioscopie

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