Epididymal disjunction anomalies in undescended testis - a factor associated with spermatic obstruction

ABSTRACT Background: To analyze the incidence of epididymal anomalies (EAs) associated to spermatic obstruction in patients with undescended testis (UT) according to testicular position and age. Materials and Methods: We studied 87 patients (110 testis) with cryptorchidism and analyzed the presence of EAs correlated with the testicular position, age and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis we considered three situations: (a) Normal pattern: the epididymis was attached to the testis at the head and tail and epididymis totally attached to the testis; (b) EAs: when the epididymis was attached to the testis only at the head (Figure-1A) and (c) EAs associated to spermatic obstruction: epididymis was attached to the testis only at the tail (Figure-1B) and when there are no visible connection between testis and epididymis (Figure-1C). We used the Wilcoxon-Mann-Whitney test and the Chi-square test for contingency analysis (p <0.05). Results: The mean age of the patients was 5.18 years (SD=2.867). Of 110 testes analyzed, 14 were abdominal (12.72%); 83 inguinal (75.45%) and 13 suprascrotal (11.81%). Normal relationships between testis and epididymis were observed in 54 patients (62.1%) with no significant differences in relation to the patient's age (p=0.666). Epididymal tail disjunction was observed in 23 patients (26.44%), with no significant differences in relation to age (p=0.59). EAs associated to spermatic obstruction were observed in 16 patients (18.4%), also with no significant differences in relation to age (p=0.684). We did not observe significant correlation between the testis position and the incidence of EAs (p=0.119). We did not observe significant correlations between patency of the PV (64.7%) and incidence of EAs (p=0.742). Conclusions: Epididymal anomalies associated with spermatic obstruction are present in almost 20% of undescended testes, without significant correlation with age, testicular position and patency of the PV. This information needs to be correlated to the infertility risk of this congenital anomaly.

Do retractile testes have anatomical anomalies?

ABSTRACT Objectives: To assess the incidence of anatomical anomalies in patients with retractile testis. Materials and Methods: We studied prospectively 20 patients (28 testes) with truly retractile testis and compared them with 25 human fetuses (50 testes) with testis in scrotal position. We analyzed the relations among the testis, epididymis and patency of the processus vaginalis (PV). To analyze the relations between the testis and epididymis, we used a previous classification according to epididymis attachment to the testis and the presence of epididymis atresia. To analyze the structure of the PV, we considered two situations: obliteration of the PV and patency of the PV. We used the Chi-square test for contingency analysis of the populations under study (p <0.05). Results: The fetuses ranged in age from 26 to 35 weeks post-conception (WPC) and the 20 patients with retractile testis ranged in ages from 1 to 12 years (average of 5.8). Of the 50 fetal testes, we observed complete patency of the PV in 2 cases (4%) and epididymal anomalies (EAs) in 1 testis (2%). Of the 28 retractile testes, we observed patency of the PV in 6 cases (21.4%) and EA in 4 (14.28%). When we compared the incidence of EAs and PV patency we observed a significantly higher prevalence of these anomalies in retractile testes (p=0.0116). Conclusions: Retractile testis is not a normal variant with a significant risk of patent processus vaginalis and epididymal anomalies.

Bilateral isolated Epididymal Agenesis in a 32 year old man

Epididymal agenesis is defined as the absence of the epididymis totally or segmentally, unilateral or bilateral, which is secondary to the Wolffian duct malformation (1). Rete testis, epididymis, vas deferens and seminal vesicle are believed to develop from Wolffian ducts.

Structural analysis of testicular appendices in patients with cryptorchidism

Objectives Report the incidence and structure of testicular appendices (TAs) in patients with cryptorchidism, comparing their incidence with epididymal anomalies (EA) and patency of the vaginal process (PVP) and analyzes the structure of TAs. Material and Methods We studied 72 testes of patients with cryptorchidism (average of 6 years), and 8 testes from patients with hydroceles (average of 9 years). We analyzed the relations among the testis, epididymis and PVP and prevalence and histology of the TAs. The appendices of 10 patients with cryptorchidism and 8 with hydrocele were dissected and embedded in paraffin and stained with Masson trichrome; Weigert and Picro-Sirius Red with polarization and immunohistochemistry analysis of the collagen type III fibers to observe collagen. The stereological analysis was done with the software Image Pro and Image J, using a grid to determine volumetric densities (Vv). Means were statistically compared using the ANOVA and unpaired T test (p < 0.05). Results Of the 72 testes with cryptorchidism, 20 (27.77%) presented EA, 41 (56.9%) had PVP and 44 (61.1%) had TAs. Of the 44 testes with cryptorchidism and appendices, 30 (68.18%) presented PVP and 11 (25%) presented EA. There was no alteration of the epithelium in the appendices of patients in both groups. Stereological analysis documented the prevalence of ESFs (mean of 1.48%), prevalence of veins (mean of 10.11%) and decrease (p = 0.14) of SMCs in the TAs of patients with cryptorchidism (mean = 4.93%). Collagen III prevailed in the TAs of patients with cryptorchidism. Conclusion The testicular appendices presented significant structural alteration in the patients with cryptorchidism, indicating that TAs present a structural remodeling. .

Findings concerning testis, vas deference, and epididymis in adult cases with nonpalpable testes

In this study, we aimed to state the relationship between testis, epididymis and vas deference, in adult cases with nonpalpable testis. Between January 1996 and December 2009, we evaluated 154 adult cases with nonpalpable testes. Mean age was 23 years (20-27 years). Explorations were performed by open inguinal incision, laparoscopy, and by inguinal incision and laparoscopy together on 22, 131 and 1 patient, respectively. Of all the unilateral cases, 32 were accepted as vanishing testis. In five of these cases, vas deference was ending inside the abdomen, and in the others, it was ending inside the scrotum. In the remaining 99 unilateral and 22 bilateral cases, 143 testes were found in total. Testes were found in the inguinal canal as atrophic in one case, at the right renal pedicle level with dysmorphic testis in one case, and anterior to the internal ring between the bladder and the common iliac vessels at a smaller than normal size in 119 cases. One (0.69 percent) case did not have epididymis. While epididymis was attached to the testis only at the head and tail locations in 88 (61.53 percent) cases, it was totally attached to the testis in 54 (37.76 percent) cases. There is an obviously high incidence rate of testis and vas deference anomalies, where epididymis is the most frequent one. In cases with abdominal testes, this rate is highest for high localised abdominal testes.

Paratesticular embryonal rhabdomyosarcoma; report of a case

Paratesticular rhabdomyosarcoma is the most common pediatric soft-tissue sarcoma, often presenting in the first two decades after birth. Paratesticular embryonal rhabdomyosarcoma [RMS] is a rare tumor arising from the mesenchymal tissues of the spermatic cord, epididymis, testis and testicular tunics. It represents only 7% of all patients entered in the Intergroup Rhabdomyosarcoma Study [IRS] and 17% of all malignant intrascrotal tumors in children less than 15 years old. We report a case of a 14-year-old boy with a left paratesticular tumor, who undergone inguinal surgery and misdiagnosed as being inguinal hernia. During operation, the surgeon realized that the mass was not an inguinal hernia, it seemed like a testicular tumor. A urologist was consulted. The patient underwent left high inguinal orchiectomy. His serum markers for oc-fetoprotein, [3-human chorionic gonadotropin and lactate dehydrogenase were normal. In the result of further investigation, the patient was diagnosed as having paratesticular embryonal rhabdomyosarcoma with retroperitoneal lymph node mass. We referred him to the oncology department. The patient was followed up post-operatively with chemotherapy. Vincristine, doxorubicin and cyclophosphamide [VAC] regimen was used. One year after completion of chemotherapy there was no evidence of the disease. In the patients with testicular and paratesticular mass, ultrasound should be considered the imaging modality of choice for evaluating intra-scrotal pathologies in adolescents

Unilateral renal agenesia associated with partial epididymis and vas deferens agenesia in a patient with abdominal testicle

This study considers a unilateral renal agenesia associated with agenesia of the epididymis body and tail and the vas deferens and non-palpable left testicle in a 20-month-year-old patient. During laparoscopic procedure, the testicle was positioned at approximately 5 cm above the inguinal ring. The size was appropriate for the age and the head of the epididymis was situated in its normal position. The decision was made to perform the first step of the Fowler-Stephens’ surgery and the patient presented a good evolution. The association of male duct system agenesia with unilateral renal agenesia in a patient with cryptorchidism diagnosed by laparoscopy is an extremely rare event, however generally in these cases the testicle is of normal size, presents unaltered hormonal function, and must be preserved.

Study on the incidence of testicular and epididymal appendages in patients with cryptorchidism

OBJECTIVE: To study the incidence of testicular and epididymal appendages in patients with cryptorchidism. MATERIALS AND METHODS: We studied 65 patients with cryptorchidism, totalizing 83 testes and 40 patients who had prostate adenocarcinoma and hydrocele (control group), totalizing 55 testes. The following situations were analyzed: I) absence of testicular and epididymal appendages, II) presence of testicular appendage only, III) presence of epididymal appendage, IV) presence of testicular and epididymal appendage, V) presence of 2 epididymal appendages and 1 testicular appendage and VI) presence of paradidymis or vas aberrans of Haller. RESULTS: In patients with cryptorchidism we found testicular appendages in 23 cases (41.8 percent), epididymal appendages in 9 (16.3 percent), testicular and epididymal appendage in 8 (14.5 percent), 2 epididymal appendages and 1 testicular in 1 (1.8 percent) and absence of appendages in 14 (25.4 percent). In the control group, we found testicular appendages in 29 (34.9 percent), epididymal appendages in 19 (22.8 percent), testicular and epididymal appendage in 7 (8.4 percent), and absence of appendages in 28 (33.7 percent), we did not find 2 epididymal appendages in this group, and none of the patients in the 2 groups presented paradidymis or vas aberrans of Haller. CONCLUSION: The occurrence of testicular and epididymal appendages is quite variable. There was no statistically significant difference in the incidence and distribution of the testicular and epididymal appendages between patients with cryptorchidism and those from the control group.

Complete separation of the testis and epididymis presenting as inguinal hernia

Complete separation of the epididymis from the testis is a rare phenomenon. In all reported cases, both structures remained undescended. We recently managed a 2-month-old boy with bilateral inguinal hernia and complete dissociation of the epididymis from the testis on the left side. At exploration, a right indirect inguinal hernia was confirmed while on the left side, an indirect inguinal hernia was associated with an undescended abdominal testis completely separated from a normally descended epididymis. This could reflect an essential role of the epididymis in the process of testicular descensus. The diversity of congenital abnormalities possibly encountered in the inguinoscrotal region during infancy and childhood necessitates the acquisition of insightful knowledge in the pathological anatomy of this area and adequate surgical skill to avoid undesirable intraoperative confusion with its negative impact on proper diagnosis and appropriate management

Epididymal Anomalies Associated with Patent Processus Vaginalis in Hydrocele and Cryptorchidism

The epididymal anomalies and patent processus vaginalis are frequently seen in patients with cryptorchidism or hydrocele. We performed a prospective study on the relationship between the epididymal anomalies and the patency of the processus vaginalis in boys with hydrocele (190 cases) or cryptorchidism (89 cases) who were treated from August 1997 to February 2000 (mean age, 51 months; range, 12 to 152 months). The epididymal anomalies were observed with an overall frequency of 48%. Closed, partially closed, and open processus vaginalis were associated with an epididymal anomaly in 14, 38, and 65% of cases, respectively. The epididymal anomalies were more common in association with undescended (61%) than with descended (43%) testes without statistical significance (p=0.415). Incomplete attachment of the caput epididymis was the most common anomaly (35%), followed by detachment of caput and cauda epididymis (31%), cauda epididymis (24%), and long looping epididymis (10%). These data showed that the epididymal anomalies were strongly associated with the patency of the processus vaginalis irrespective of testicular descent (p<0.001), and they provide further evidence for the hypothesis that a common stimulus, possibly androgens, may be required for the epididymal development and obliteration of the processus vaginalis.

Criptorquidia y malformaciones de epidídimo / Cryptochidism and epidymis malformations

Se realizó un estudio retrospectivo en 28 pacientes operados de criptorquídia,incluyendo 6 casos de bilateralidad,o sea se analizaron 34 testículos para identificar malformaciones del epidídimo.8 testículos tenían anatomía anormal del epidídimo,2 eran testículos evanescentes y 24 normales.La presencia del conducto peritoneo vaginal permeables resultó más frecuente en los testes anómalos.Es importante constatar estas anomalías que tendrían relación con el pronóstico de fertilidad testicular

Anomalias congênitas macroscópicas do epidídimo em crianças com criptorquia unilateral / Macroscopic congenital anomalies of the epydidymis in children with unilateral cryptorchidism

Em estudo caso-controle, com análise transversal, clínico-cirúrgica, verificou-se a incidência geral e a incidência dos grupos e dos tipos das anomalias congênitas macroscópicas do epidídimo (ACME) em crianças com criptorquia unilateral, correlacionando-as com a sua idade e cor, a lateralidade da criptorquia, a presença de hérnia inguinal/hidrocele associadas à criptorquia, a localizaçäo do testículo críptico e a representaçäo anatômica do conduto peritônio-vaginal. A casuística compöe-se de 95 crianças com criptorquia unilateral, com idade média de cinco anos e três mêses. O grupo-controle consta de 44 crianças do sexo masculino, com idade média de três anos e 11 meses, sem criptorquia, submetidas ao tratamento cirúrgico de hérnia inguinal/hidrocele. Durante o ato operatório, identificou-se a localizaçäo do testículo críptico, a representaçäo anatômica do conduto peritônio-vaginal, as anomalias congênitas macroscópicas do epidídimo, quando presentes, e confirmou-se o diagnóstico pré-operatório de hérnia inguinal/hidrocele. As ACME foram observadas em 59 crianças com criptorquia unilateral (62,1 ñ 9,74 por cento) e em apenas duas crianças do grupo-controle ( 4,5 ñ 6,19 por cento), sendo esta diferença estatisticamente significativa. A incidência geral das ACME é estatisticamente maior quando o conduto peritônio-vaginal estava aberto (67,5 por cento) que quando fechado ou ausente (33,3 por cento). A correlaçäo da incidência geral destas anomalias com a idade e a cor das crianças, a lateralidade da criptorquia, a presença de hérnia inguinal/hidrocele associadas à criptorquia, e a localizaçäo anatômica do testículo críptico näo têm significaçao estatística. As anomalias da fusäo testículo-epididimária constituem o grupo de maior frequência (71,2 ñ 11,5 por cento), seguido pela anomalia de alongamento do epidídimo (18,6 ñ 9,9 por cento) e pelas anomalias obstrutivas do epidídimo (10,2 ñ 7,7 por cento). As anomalias obstrutivas do epidídimo têm incidência estatisticamente maior na criptorquia esquerda (17,7 por cento) que na direita (0,0 por cento). Considerando-se a elevada incidência das ACME em crianças com criptorquia, é relevante pesquisá-las durante a orquiopexia, uma vez que o epidídimo anômalo teria participaçäo na etiologia da criptorquia e no prognóstico da futura fertilidade da criança, além de implicaçöes cirúrgicas durante o ato operatório da criptorquia.

Embarazo logrado con espermatozoides obtenidos de la cabeza epididimaria en una agenesia de vías espermáticas / Pregnancy with spermatozoa from the head of the epididymis in a spermatic ducts agenesis

De un hombre afectado de agenesia de cuerpo y cola de epidídimos y conductos deferentes, se obtuvieron espermatozoides mediante la aspiración microquirúrgica del contenido epididimario. Los espermatozoides móviles se separaron de las muestras aspiradas mediante centrifugación a través de un gradiente discontínuo de Percoll, y se procedió a la fertilización in vitro de los oocitos obtendios de la esposa con la técnica habitual. La inseminación se realizó a las 8 horas de la recolección de los oocitos. Veinte hora después se examinaron los oocitos para detectar signos de fertilización transferiéndolos a medio de cultivo fresco. De 23 oocitos preovulatorios, sólo fertilizó uno, el cual fue transferido a la trompa de Falopio al alcanzar el estadío de 6 células. A los 14 días de la transferencia se detectó en sangre una subunidad HCG de 320 mU/ml y el día 29 se visualizó por ecografía transvaginal un saco fetal de 5 mm con actividad cardíaca. Después de una gestación de 38 semanas se produjó el parto de una niña normal de 2 800 g de peso

Estudo das malformaçöes de epidídimo encontradas em testículos retidos e sua provável significaçäo clínica / Epididymal abnormalities in undescended testis and its probable clinic significance

Os testículos de 66 pacientes com criptorquidia e ectopia testicular, compreendendo 82 órgäos, foram dissecados cirurgicamente e fotografados durante orquidopexia, para observar e classificar as alteraçöes de epidídimo e anexos encontrados. As modificaçöes anatômicas encontradas foram classificadas em alteraçöes do comprimento do epidídimo, separaçäo testículo-epididimal, angulaçäo do epidídimo, atresia do mesmo ou do vaso deferente e presença de alteraçäo no mesórquio. Encontraram-se apenas 20,7% dos testículos com aspecto normal. Os demais apresentavam uma ou mais malformaçöes de epidídimo, sendo de modo geral mais sérias e comuns nos testículos criptorquídicos do que nos ectópicos. Parece haver nos testículos retidos importantes anomalias no sistema de conduçäo espermática que poderia, em boa parte dos pacientes, comprometer a contribuiçäo desses testículos para a fertilidade

Anomalia da junçäo testículo-epididimária na síndrome de Alport / Anomaly of testicle-epididymaria junction in Alport's syndrome

Os AA. descrevem o caso de um paciente de 12 anos, do sexo masculino, afetado pela síndrome de Alport (nefropatia hereditária, surdez de percepçäo e anomalias do cristalino). Como apresenta-se quadro clínico de subtorçöes do testículo E., foi submetido à exploraçäo das bolsas escrotais onde se evidenciou uma afecçäo extremamente rara. O paciente era portador de uma falência embriológica na uniäo entre o testículo e o derivado mesonéfrico, ou seja, o epidídimo, desenveolvendo-se tais órgäos separadamente. Um quadro de infertilidade, semelhante ao encontrado na síndrome de predominância das células de Sertoli, foi achado ao exame anatomopatológico. Até 1971, haviam sido descritos somente 29 casos desta malformaçäo. Discutem-se normas sobre se tal achado poderia vir a tomar parte na síndrome de Alport