Research status of related factors and recent advances in the diagnosis and treatment of testicular atrophy after orchiopexy in children / 中华泌尿外科杂志

Cryptorchidism is one of the common diseases in children’s genitourinary system. Surgery is the first choice for clinical treatment. Testicular atrophy is a serious complication after operation. The related risk factors of testicular atrophy include the age of operation, the position of testis before operation and the mode of operation. At present, the possible treatments for testicular atrophy are hormone therapy, stem cell therapy and so on. This article reviews the related risk factors, fertility, diagnosis and treatment of testicular atrophy after orchiopexy in children.

Mesenteric abscess presents as left iliac fossa mass in postoperative case of inguinal hernia surgery with undescended testis

An abscess is a collection of pus (dead and dying neutrophils plus proteinaceous exudate) that has built up within the tissue of the body. Mesenteric abscess is a rare, usually accounts for small percentage of intra-abdominal abscess after inguinal hernia surgery which is presented as left iliac fossa mass in postoperative period of open inguinal hernia surgery of left side and also presented with undescended testis of left side which is actual cause of formation of inguinal hernia of same side. Late onset mesh infection and post-operative peritonitis are very common in case of open hernia surgery. Intra-abdominal abscess cause significant morbidity and mortality. Surgery disturb the equilibrium between coagulation and fibrinolysis in the abdominal cavity in favour of coagulation system. Diminished fibrin degradation is a common pathway for the formation of abscess. We present a case of 40 years of male came with pain in left iliac fossa and lower abdomen for last 2 months with a swelling at LIF and hypogastric region for last 3 months with a previous history of hernia surgery of left side 2 month back which was  diagnosed as mesenteric abscess and  treated with exploratory laparotomy under general anaesthesia and abscess was drained.

Laparoscopic orchidopexy and its outcome in the management of nonpalpable testis

Background: Management of impalpable testis represents a significant diagnostic and operative challenge. The aim of this work was to present the superior value of laparoscopy as a single tool for the diagnosis and treatment of impalpable testis.Methods: 51 patients with 58 nonpalpable were included in our study. Study design was case series. We have conducted this study at Surat Municipal Institute for Medical Education and Research, Surat. For each patient laparoscopy orchidopexy was performed and either testis or blind ending cord structure are searched for. The testis either brought down to the scrotum or removed depending on the condition. The patients were followed up for 12 months.Results: On diagnostic laparoscopy the number of testis found normal 54, followed by 3 hypoplastic and 1 atrophic. There were 8 testis found to be present at high intraabdominal (>2 cm from deep ring), 46 were present at low intra-abdominal (<2 cm from deep ring), intracanalicular 4. Postoperative complication included minor wound infection in one patient, none of them were diagnosed scrotal hematoma, port site hernia, and testicular atrophy.Conclusions: Laparoscopy seems to offer a safe and reliable diagnostic and therapeutic option to patients with nonpalpable testis. Intraabdominal dissection allows more testis to be brought down to scrotum. Laparoscopy clearly demonstrate the anatomy and provide visual information upon which a definitive decision can be made.

Deviation of paradigmatic mutations found in Shprintzen-Goldberg syndrome

Shprintzen-Goldberg (S-G) Syndrome known as rare congenital connective tissue disorder where craniosynostosis and marfanoid habitus found to be the usual presentation. Craniofacial dysmorphism with multi-organ involvement documented to be amongst prominent features of this syndrome. Case characteristics is five-month-old male infant with craniosynostosis, and motor developmental delay was evaluated for congenital connective tissue disorder. Dysmorphic craniofacial features like dolichocephaly, triangular forehead, ocular hypertelorism, micrognathia and retrognathia were noticed besides congenital umbilical hernia, empty scrotal sac, clinodactyly with long slender fingers, hyper-mobile joints, hypotonia. Subsequent investigations revealed normal male karyotype (46, XY) while genetic analysis depicted missense mutations in six different genes. Conventionally, mutation in SKI gene reported for its' associated with S-G syndrome where dysregulation of TGF-? signaling was discussed as the primary reason. In the present case discussed here, it was found to have polygenic mutational association where few novel genetic mutations were seen.

Clinicopathological study of testicular lesions

Background: Testis is affected by both neoplastic and non neoplastic conditions. Non neoplastic lesions of the testis include epididymo-orchitis, testicular atrophy, undescended testis, testicular abscess etc. Testicular tumors are relatively rare. They constitute the 4th most common cause of death from neoplasia in the young males. This study was undertaken to study the histopathological spectrum, age wise distribution and clinical symptoms of testicular lesions.Methods: This is a retrospective study of three years conducted in the department of pathology, Aurangabad from June 2015 to May 2018. It included all the orchidectomy specimens received from the department of surgery and excluded the orchidectomy specimens sent for infertility and prostatic carcinoma. A detail clinical history was taken. Histopathological examination was done after routine processing and staining with H and E. The data collected was tabulated, analysed and compared to other similar studies.Results: We studied 70 cases. Non neoplastic testicular lesions were 57 and 13 were neoplastic. Non neoplastic testicular lesions were more common than the neoplastic ones. Non neoplastic testicular lesions presented most commonly in the 2nd decade. Most common non neoplastic lesion was epididymo-orchitis followed by torsion, atrophy and testicular abscess. Most common neoplasm was malignant mixed germ cell tumor. Most of the patients of neoplasms presented in the 3rd decade. The most common complaint was testicular swelling and pain.Conclusions: Majority of testicular lesions are non neoplastic. Neoplastic lesions are rare. Non neoplastic lesions mimic neoplastic ones clinically, as testicular swelling is the most common complaint. So histopathological diagnosis is necessary for an accurate diagnosis of testicular lesions.

Crossed testicular ectopia in a patient presenting with undescended testis

@#Crossed Testicular Ectopia (CTE), is a rare congenital anomaly in which both gonads migrate towardthe same hemiscrotum. This may be due to a deviation of testicular descent resulting in unilaterallocation of both testes. Reported is a case of crossed testicular ectopia in a 1-year-old boy whopresented with undescended testis. On exploration, both testes were present in the right hemiscrotum.Subsequently, transseptal orchidopexy was performed. CTE should be considered in patientspresenting with undescended testis, unilateral hernia and concurrent cryptorchidism of the contralateralside. In suspected cases, laparoscopy and ultrasonographic evaluation may be helpful in diagnosingthis condition.

Undescended testis varying presentation – Clinical research study.

Background: This study focus on the varying presentation, hormonal influence, and biochemical marker for a series of patient with undescended testis and their influence over descend and imaging modality and various diagnostic approaches towards the undescended testis. Materials and methods: Patients who had attended vinayaka mission medical college, karaikal with the complaints of absence of testis and infertility included in this study and it is a prospective clinical study which was carried from 2014 – 2016 June. All treatment modality were carried out according to the diagnosis confirmed by both clinically and imaging after obtaining concern from the patients. Results: all hormonal and bio chemical marker were taken for all the patients and they were evaluated. In that testosterone showed little on lower side with patients with infertility, insulin like 3 peptide was on lower side for more than fifty percent of patient mainly who were in adolescent age. In patients whose presentation of testis can’t be assessed by either clinical and ultrasonography diagnostic laparoscopy was done and testis were found out. Conclusion: Testosterone has significant effect in descend of the testis and mainly in the patients with infertility. Insulin like peptide 3 can be used as a prognostic marker to assess the viability of the testis and diagnostic laparoscopy remains gold standard invasive diagnostic tool where the testis is not seen clinically and imaging.

Single scrotal-incision orchidopexy without ligation of processus vaginalis for palpable undescended testis / 中华男科学杂志

Objective@#To determine the feasibility and short-term effect of single scrotal-incision orchidopexy (SSIO) without ligation of the processus vaginalis (PV) in the treatment of palpable undescended testis (PUDT).@*METHODS@#This retrospective study included 109 cases of PUDT (125 sides) and 15 cases of impalpable undescended testis (IUDT). The former underwent SSIO without PV ligation (group A, n = 53) or standard inguinal orchidopexy with PV ligation (group B, n = 56) while the latter received laparoscopic exploration (group C). We analyzed the success rate of SSIO in the management of PUDT, postoperative complications, and incidence rates of hernia and hydrocele, and compared the relevant parameters between groups A and B.@*RESULTS@#The median age of the PUDT patients was 1.4 (0.6－11.0) years. Group A included 24 cases of left PUDT (2 with hydrocele), 20 cases of right PUDT (1 with hydrocele), and 9 cases of bilateral PUDT, the success rate of which was 95.1%. Group B consisted of 27 cases of left PUDT, 22 cases of right PUDT (3 with hernias), and 7 cases of bilateral PUDT. The rate of PV patency in the PUDT patients was 80.8% (101/125). Laparoscopic exploration of the 15 IUDT patients revealed 2 cases of congenital testis absence, 6 cases of testis dysplasia, all treated by surgical removal, 3 cases of staying around the inner ring, descended by inguinal orchidopexy, and the other 4 treated by laparoscopic surgery. The incisions healed well in all cases, with no testicular atrophy, inguinal hernia or hydrocele.@*CONCLUSIONS@#Single scrotal-incision orchidopexy without PV ligation is a safe and feasible procedure for the treatment of palpable undescended testis, which avoids the risk of inguinal hernia or hydrocele.

Peters anomaly with post axial polydactyly, ocular hypertelorism, a low nasal bridge, retrognathia, undescended testis, microphthalmia, and club foot in an Indian neonate: A case report

A case of Peters anomaly with bilateral post axial polydactyly, convex soles, ocular hypertelorism, a low nasal bridge, retrognathia, undescended testis, microphthalmia and club foot was examined in a neonatal Indian baby girl who had been delivered in the hospital and admitted to the newborn unit. She died aged five days. There were no cases of Peters anomaly recorded in India according to a literature search. In addition, available data point to the majority of the principal associations in Peters anomaly to be genitourinary anomalies, making this case a rare one in its isolated collection of musculoskeletal associations. A Indian baby girl of who was born through a Cesarean section presented in the new born unit of our hospital with bilateral corneal opacities, bilateral polydactyly, camptodactyly and club foot. This is a rare case of Peters anomaly and its association with Patau syndrome makes it special

The Evaluation of Laparoscopic Orchiopexy on the Treatment of Non-palpable Undescended Testes .

Objectives: Cryptorchidism is the most frequent birth anomaly in boys with 2-5% prevalence in full term infants. This anomaly is associated with an increased risk of testicular cancer and infertility as well as hernia, testicular torsion, and psychological distress. Surgery is the main treatment for this anomaly. This study aimed to evaluate the therapeutic efficacy of laparoscopic orchiopexy in the treatment of non-palpable undescended testis. Methods: Forty patients with a non-palpable testis were evaluated by laparoscopic orchiopexy in a hospital in Hamedan city, Iran, during 2006 to 2009. The average age of patients was 19±12.16 months old. The patients were followed up after the surgery and three months later to assess the response to treatment and the testicular atrophy. Results: Thirteen patients did not have a testis in the laparoscopic investigation and six patients had testis located in the inguinal canal. So they were excluded from the analysis. Seventeen patients were treated by one-staged laparoscopic orchiopexy while four patients were treated by two-staged Fowler-Stephens laparoscopic orchiopexy. The success rate for the treatment was 100%. Conclusion: Laparoscopic orchiopexy is a safe and effective method for the treatment of non-palpable undescended testis.

Undescended testicle: An update on fertility in cryptorchid men.

Cryptorchidism or undescended testis is one of the most common anomalies encountered in paediatric urology and is estimated to affect 1 to 4 per cent of full term and upto 30 per cent of preterm male neonates. The associated problems of sub-fertility or infertility and malignant transformation have been recognized for long. Fertility is impaired after both unilateral and bilateral cryptorchidism. The reported paternity rates in adults are about two-third for unilateral undescended testis and less than one-third for bilateral disease. Over the last five decades, the concepts related to cryptorchidism have changed dramatically as knowledge about its effects has accrued from research conducted worldwide. The recommended age of orchidopexy has fallen progressively from adolescence to less than one year. The realization that the infantile testes are not in a state of ‘suspended animation’ and the recognition of the defect in the androgen dependent transformation of gonocytes into adult dark spermatogonia in cryptorchidism have been recognized as the primary cause of sub-fertility in these patients. This has paved the way for hormone therapy in an attempt to simulate the ‘post-natal gonadotropin surge’ or ‘mini-puberty’. This review summarizes the current knowledge about the various factors affecting the fertility status in cryptorchidism with a particular focus on the derangements in the development and maturation of the germ cells and the role of surgery, hormone therapy and antioxidants in reversing these changes.

Multiple sequences MRI in diagnosis of non-palpable undescended testis / 中华内分泌外科杂志

Objective To evaluate the role of multiple sequences MRI in diagnosis and preoperative evaluation of non-palpable undescended testis.Methods 58 patients with unilateral or bilateral non-palpable undescended testis underwent abdominal and pelvic MRI 2 weeks before surgery.Multiple sequences MRI included diffusion-weighted imaging(DWI)with b values of 400 and 800 s/mm2,T1 and T2-weighted sequence,and T2-weighted fat-suppressed sequence.Preoperative images including the conventional MRI images,DWI images,and the conventional-MRI and DWI images together.ADC value was detected.Pathological findings were used as the gold standard to evaluate the diagnostic accuracy of multiple sequences MRI in detection of non-palpable undescended testis and its differential diagnosis with lymph nodes.Results The combination of DWI and conventional MRI was the most sensitive method in detection of non-palpable undescended testis,with the sensitivity,specificity and accuracy of 96.5％,87.5％,and 95.3％,respectively.Malignant non-palpable undescended testes were all detected.The ADC value of the non-palpable undescended testis,lymph nodes and malignant non-palpable undescended testis was(1.18 ± 0.17) × 10-3 mm2/s,(1.49 ± 0.27) × 10-3 mm2/s,and (0.84 ± 0.20) × 10-3mm2/s,respectively.The difference had statistical significance (P ＜ 0.05).Conclusion Multiple sequences MRI improves the diagnostic accuracy of non-palpable undescended testis,which can be routinely used in preoperative evaluation of non-palpable undescended testis.

Undescended Testes: Embryological and Clinical Importance.

During the routine dissection of abdomen, two adult male cadavers, aged 55 & 67years, presented with unilateral and the bilateral undescended testes respectively. One of them presented with unilateral and the other with bilateral undescended testes. In both cases the testes were found at the superficial inguinal ring. The histological examinations indicated normal testicular tissue. Undescended testis is the inability of the testis to reach the scrotum. In living, it has to be differentiated from testicular agenesis, ectopic testis and retractile testis. The genetic sex of the male is determined at the time of fertilization but the phenotypical sex starts as early as 4th month of intrauterine life and completed along with the descent just before birth. The embryological basis and clinical significance has been explained.

Perineal Ectopic Testis- A Rarity In Pediatric Surgical Practice.

Perineal ectopic testis (PET) is a rarity in pediatric surgical practice seen in less than 10% cases of maldescended testis. An eighteen months old boy presented with empty right scrotum and a palpable soft mass in the perineum which on preoperative ultrasonography was consistent with testicular morphology. Orchidopexy was performed by standard operative technique and testis was placed in Dartos Pouch. The case is reported to highlight the importance of examination of ectopic sites in a cryptorchid child and the need for long term follow-up of patient.

Anomalias da migração testicular em Pediatria / Anomalies of testicular migration in Pediatrics

Há consenso de opinião entre os cirurgiões pediátricos no sentido de que, no ser humano, a migração do testículo é um evento complexo e mediado por dois fatores, hormonal e mecânico; e também, que a cirurgia precoce (antes de dois anos de idade), em oposição à operação mais tardia, é benéfica para manter a fertilidade. Todavia, o hormônio gonadotrófico coriônico (HGC) induz ao aumento da gônada e do escroto, alongamento e espessamento das estruturas do cordão espermático e a migração parcial do testículo; tudo isto pode fazer com que a cirurgia se torne simplificada. Destarte, aqueles pacientes com testículo alto poderão apresentar melhor resultado ao tratamento cirúrgico, se o HGC for administrado no peri ou pré-operatório, ou quando o resultado cirúrgico não for satisfatório, poderá ser melhor valendo-se da aplicação de HGC no pós-operatório. Desde que a hormonioterapia com HGC tem provado ser eficiente, de alguma forma facilitando a subsequente cirurgia, entendo que seja o tratamento coadjuvante de escolha para pacientes com distopia do testículo. Em decorrência desta discussão apresentei as finalidades da cirurgia e meu modo de tratar o problema clinicamente. Por outro lado, sempre existiu a necessidade de uma classificação, a qual é sugerida aqui, a fim de assegurar que todos tenham as mesmas definições. Minha expectativa é que não levemos mais outras décadas em debates, para conseguir respostas mais bem fundamentadas para este tipo de questão...

Mixed gonadal dysgenesis with normal karyotype : A rare case report.

Mixed gonadal dysgenesis (MGD) presents as a unilateral testis, usually intraabdominal, a streak gonad on contralateral side, and persistent mullerian structures. 45X/45XY karyotype is most frequent in such cases with predominance of 45X cells in both peripheral lymphocytes and gonads. We present a rare case of a left undescended testis, normally descended right testis, with penoscrotal hypospadias, who had a normal karyotype and whose histopathological findings were endometrial tissue and fallopian tube in left testicular biopsy. Gonadal dysgenesis should always be kept a possibility in patient with undescended testis and proximal hypospadias. If karyotype reveals a 46XY gonadal dysgenesis, these patients need all the more careful follow-up to screen for gonadoblastoma in remaining normal testis. Subjecting the patients to prophylactic orchidectomy with hormone replacement can be an additional option in such patients.

Torsion of an Undescended Testis in the Inguinal Canal Diagnosed with Doppler Ultrasound: A Report of Two Cases

We report here on two cases of testicular torsion in the inguinal canal, and there have been only rare published reports on this condition. Doppler ultrasound was used for making the diagnosis in the present two cases, which were initially considered to be inguinal hernia.

Diagnosis and Management of Cryptorchidism

Cryptorchidism or an undescended testis is one of the most common congenital anomalies found at birth and affects about 3% of full-term male newborns. A cryptorchid testis can be located anywhere between the abdominal cavity and just outside the scrotum, and 80% of undescended testes are palpable. Approximately three-fourths of cryptorchid testes will spontaneously descend, usually by 3 months of age. Children with retractile testes require annual follow-up until puberty or the testis is no longer retractile. Determination of whether the testis is present on physical examination is critically important because it guides further workup and treatment. Although radiological evaluation does not have a relevant role in the assessment of undescended testes and would not influence surgical management, many physicians have been performed it to verify the location and condition of cryptorchid testis. The efficacy of hormonal treatment is less than 20% and is significantly dependent on pretreatment testicular location. Therefore, surgical repositioning of the testis within the scrotal sac, i.e., orchiopexy, remains the gold standard for the management of undescended testes and it should be performed between 6 and 12 months of age because spontaneous descent occurs uncommonly thereafter, and in order to prevent the complications and long-term sequelae of cryptorchidism, such as testicular torsion, trauma, infertility, and testicular cancer. Recently, laparoscopy has attained its greatest degree of general acceptance, both diagnostically and therapeutically, in the realm of pediatric urology for the management of a nonpalpable testis.

Giant Seminoma Arising in Intraabdominal Undescended Testis Treated with Initial Chemotherapy: A Case Report / 대한비뇨기과학회지

Seminoma arising in an abdominally located undescended testis is uncommon, accounting for only 5% of all seminomas. It tends to be relatively advanced at the time of diagnosis and usually treated with surgery followed by radiation and/or chemotherapy. We report a case of 61-year- old man who had a giant seminoma arising in the right testis of bilateral intraabdominal undescended testes with retroperitoneal lymph node metastasis, which was successfully treated with initial BEP chemotherapy. Excision of residual masses revealed complete necrosis of the tumor without viable cancer cells. The patient has been free of recurrence for 5 years after surgery.