Polyorquidism: case report comparing ultrasonography and magnetic resonance imaging / Poliorquidismo: relato de caso comparando a ultrassonografia e a ressonância magnética

Abstract Introduction: polyorchidism is an unusual pathology, about 200 cases in the world literature. Case report: we reported a case of polyorchidism in a 16-year-old male patient diagnosed by ultrasound and confirmed by magnetic resonance imaging. Discussion: most of the cases presented, there is a supernumerary testis, but there are reports on more than three, up to five testicles with supranumerical gonads on both sides of the scrotum. The diagnosis is usually performed in late puberty, incidentally, with a painless scrotal mass or at the emergency room, presenting a testicular torsion of the whole hemiscrotum or supernumerary testisalone, and the differential diagnosis should be made with epididymal cyst and spermatocele, besides other extra-testicular masses (hydroceles, varicoceles, lipomas, tumors.) and para-testicular masses (hernias, scrotal calculi). After the initial clinical evaluation, ultrasound is the first line subsidiary exam. Magnetic Resonance Imaging is very helpful, just in case the ultrasound diagnosis is uncertain. The supernumerary testishave the same Magnetic Resonance Imaging characteristics as the normal testes (intermediate signal intensity on T1- weighted images and high signal intensity on T2-weighted images).

Resumo Introdução: o poliorquidismo é uma patologia incomum, contando cerca de 200 casos na literatura mundial. Relato de caso: relatamos um caso de poliorquidismo em um paciente do sexo masculino de 16 anos, diagnosticado por ultrassom e confirmado por ressonância magnética. Discussão: na maioria dos casos apresentados, há um testículo supranumérico, mas há relatos de mais de três, até cinco testículos, com gônadas supranuméricas em ambos os lados do escroto. O diagnóstico geralmente é feito no final da puberdade, aliás, com massa escrotal indolor ou no pronto-socorro, apresentando torção de todo o hemiscroto ou somente do testículo supranumerário, e o diagnóstico diferencial deve ser feito com cisto epididimário e espermatocele, além de outros massas extratesticulares (hidroceles, varicoceles, lipomas, tumores) e massas paratesticulares (hérnias, cálculos escrotais). Após a avaliação clínica inicial, o ultrassom é a primeira linha do exame subsidiário. A ressonância magnética é muito útil se o diagnóstico por ultrassom não for certo. Os testículos supranumerários têm as mesmas características de ressonância magnética que os testículos normais (intensidade do sinal intermediário nas imagens ponderadas em T1 e alta intensidade do sinal nas imagens ponderadas em T2).

Hydrodynamic Relationship between Color Doppler Ultrasonography Findings and the Number of Internal Spermatic Veins in Varicoceles

PURPOSE: The improvement of testicular volume, testosterone levels and sperm concentration was suggested to be significantly associated with the number of internal spermatic veins (ISVs) ligated during varicocelectomy. Herein, we investigated preoperative color Doppler ultrasonography (CDU) findings as potential preoperative predictors of the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy. MATERIALS AND METHODS: In a prospective evaluation of 40 patients, maximal vein size and maximal reflux velocity were measured, while the total cross-sectional area of the affected testicular veins during a Valsalva maneuver was calculated using CDU by a single uroradiologist. Microsurgical subinguinal varicocelectomies were performed by one urologist. RESULTS: Among the semen parameters, semen morphology showed significant improvement (p=0.033), which was much clearer in the patients with a higher number of ISVs ligated than a lower number of ISVs ligated. Among the various preoperative variables, maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated (r=-0.442, p=0.004; r=0.594, p=0.000, respectively). Furthermore, univariate and multivariate linear regression analyses showed that maximal reflux velocity and total cross-sectional area on CDU were independent predictive factors of the number of ISVs ligated. CONCLUSION: Maximal reflux velocity and total cross-sectional area on CDU were related to the number of ISVs ligated. This means that the maximal reflux velocity and total cross-sectional area measured by preoperative CDU can predict the number of ISVs requiring ligation during microsurgical subinguinal varicocelectomy, which might be related to significant improvement of semen parameters after varicocelectomy.

Sonographic evaluation of the intrascrotal disease.

PURPOSE: To determine the causes of intrascrotal disease in patients who were sent for scrotal sonography at King Chulalongkorn Memorial Hospital and whether the imaging findings can help differentiate the tumor from infection of the testis. MATERIAL AND METHOD: Retrospective review was performed in 72 cases of extratesticular lesions and 48 cases of the intratesticular lesions to find out the causes of intrascrotal disease. The sonographic findings in the cases with final diagnosis of intratesticular infection and testicular tumor were analyzed according to the following criteria including the size of the testis, number, echogenicity, and margin of the mass, diffuse abnormal echogenicity of the testis, presence of fluid in the scrotal sac, epididymal lesion, scrotal skin thickening and calcification. RESULTS: Hydrocele was the most common extratesticular lesion (29.87%) and epididymitis was the second most common (14.28%). Infection was the most common intratesticular pathology (54.17%) and tumor was the second most common (31.25%). Most testicular tumors appeared as a focal mass while testicular infection usually caused diffuse abnormal echogenicity throughout the testis (p = 0.008). Epididymal lesions and skin thickening were usually detected together with intratesticular infection while they were not present in the cases of tumor (p = 0.000061 and 0.017). The number, echogenicity, margin of the mass, presence of testicular enlargement, fluid in the scrotal sac and calcification did not differ between testicular infection and tumor CONCLUSION: Hydrocele was the most common cause of extratesticular disease, followed by epididymitis. Most of the extratesticular pathology was benign entities. For intratesticular disease, the most common cause was infection, followed by intratesticular tumor Findings of a solitary intratesticular mass without epididymal lesion or skin thickening prefered malignant entity, while diffuse abnormal echogenicity of the testis with epididymal lesion and skin thickening prefered infectious process.

Role of Ultrasonography in diagnosis of acute scrotal lesions

Increasing attention has been directed to ultrasound role in evaluation of pathology of superficial organs such as the scrotum. The aim of this work is to highlight the increasing role of ultrasonography in diagnosis of acute scrotal lesions. The study was prformed on 50 patients. The apparatus used a real time, high resolution 5 MHz probe. Five cases of pyocele, 10 haematocele, 15 acute epididymitis, 16 orchitis, 2 testicular traumatic rupture and infarction and 2 testicular torsion were encountered. We conclude by saying that scrotal sonography provides rapid sensitive modality for evaluation of acute scrotal lesions

value of video-laparoscopy in the management of the impalpable testes

The management of a boy presenting with unilateral or bilateral impalpable testes presents a diagnostic and therapeutic challenge. This work describes the technique of video-laparoscopy in the diagnosis and management of such testes in 20 patients [24 testes]. The testis was absent or atrophic in 5 patients [20.8%]; it was in the inguinal canal in 12 patients [50%]; just canalicular in 5 patients [20.8%] and abdominal in 2 patients [8.3%]. We also found that the laparoscope can be used therapeutically in straightening the course of gonadal vessels and vas deferens in 3 cases and in performing fowler-stephens long loop vas orchidopexy in 2 cases. We recommended the use of video laparoscope as a routine in cases of clinically impalpable testes