Testicular arteries anatomy applied to fowler-sthephens surgery in high undescended testis - a narrative review

ABSTRACT Objectives: In this review we will describe the testicular vessels anatomy and the implications of these vessels in surgical treatment of high undescended testis. Material and Methods: We performed a narrative review of the literature about the role of the testicular arteries anatomy in the treatment of high undescended testis. We also studied two human testes to illustrate the testicular vascularization. Results: Each testis is irrigated by three arteries: testicular artery (internal spermatic artery), a branch of the right aorta; deferential artery (vasal artery), a branch of the inferior vesicle artery that originates from the anterior trunk of internal iliac artery and cremasteric artery (external spermatic artery), a branch of the inferior epigastric artery. There are important communications among the three arteries with visible anastomotic channels between the testicular and deferential arteries. Conclusions: Laparoscopic transection of the testicular vessels by dividing the spermatic vessels (Fowler-Stephens surgery) is safe in patients with high abdominal testis due to the great collateral vascular supply between testicular, vasal and cremasteric arteries; also, two-stage Fowler-Stephens orchiopexy appears to carry a higher rate of success than the single stage approach.

Microsurgical subinguinal varicocelectomy with spermatic cord double traction and vein stripping / 亚洲男科学杂志(英文版)

We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General Hospital (Shanghai, China). In this surgical approach, the testis was delivered, and the gubernacular and external cremasteric veins were stripped. In addition, the spermatic cord was delivered downward with continuous double traction away from the external ring. The remaining procedure was similar to the conventional approach. We followed patients for at least 3 months and evaluated postoperative semen parameters, pain symptoms, and complications. We excluded data for 32 men due to inadequate follow-up (<3 months). Of the remaining 254 patients, 73 had oligoasthenospermia, 121 had nonobstructive azoospermia, and 60 had symptomatic varicoceles. Total progressive sperm counts increased in the oligoasthenospermic patients from a median preoperative value of 9.15 × 106 ml-1 to 25.33 × 106 ml-1 (n= 34), and 35.6% (26/73) initially oligoasthenospermic men contributed to unassisted pregnancies. Sperm returned to the ejaculate in 12.4% (15/121) azoospermia patients. In patients with scrotal pain (n = 60), 43 (71.7%) reported complete resolution of pain, 16 (26.7%) reported partial resolution, and 1 (1.7%) reported no change. No patients experienced varicocele recurrence. This double-traction strategy avoids opening the external oblique aponeurosis, and results in less damage and faster recovery. In addition, the stripping strategy eliminates potential damage to the testis caused by the varicose veins. Our results showed that microsurgical subinguinal varicocelectomy using spermatic cord double traction in conjunction with testicular delivery for vein stripping is a safe and effective approach for varicocele repair.

Pancreatic Cancer Presents as Inguinal Mass: A Case Report and Literature Review / 中国医学科学杂志(英文版)

A 70-year-old male presenting with a mass in the right inguinal area was treated with surgery, and was diagnosed pathologically as spermatic cord metastasis of pancreatic cancer. He was given systemic chemotherapy. Unfortunately, he died of ascites and cachexia three months later.

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats

Abstract Purpose To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels. Methods Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh — cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured. Results The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05). Conclusion Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.

Denervación de cordón espermático asistida con lupas para el tratamiento del dolor testicular crónico idiopático / Spermatic cord denervation assisted with magnifying glasses in the treatment of idiopathic cronic testicular pain

Presentar una serie clínica de doce pacientes sometidos a denervación de cordón espermático asistida con lupas como tratamiento del Dolor Testicular Crónico ldiopático (DTCI). Pacientes y métodos: Diecisiete pacientes (rango de edad 18 a 70 años) con DTCI no respondedores a analgésicos orales fueron enrolados prospectivamente en la primera etapa del estudio. Se realizó un bloqueo del cordón espermático con Bupivacaína a todos los pacientes. Aquellos pacientes que respondieron al bloqueo (n= 12) fueron sometidos a denervación del cordón espermático asistida con lupas (magnificación 3. 5x) por via subinguinal. El seguimiento incluyó un ecodoppler testicular a los siete días post cirugía y Escala Visual Análoga (EVA) del dolor a los 3 y 6 meses. Resultados: La duración promedio de la cirugía fue de 70 minutos (rango: 50 a 90 minutos). En el control de los siete días los doce pacientes presentaron un ecodoppler normal sin evidencias de isquemia en ninguna de las unidades testiculares sometidas a cirugía (n= 13). Respecto de la EVA a los tres y seis meses, nueve pacientes (75 por ciento) estaban completamente libres de dolor con un EVA igual a O. Tres pacientes persistían con molestias, dos con un EVA de 1 que no requerían analgésicos, y uno con EVA de 2 que requería analgésicos de manera intermitente. Dos pacientes fueron reoperados 6 y 8 semanas después de la cirugía primaria, uno por un hematocele y el segundo por un linfocele, ambos evolucionaron de manera favorable con ecodoppler normal después de la segunda cirugía. Conclusión: La denervación de cordón espermático asistida con lupas es una alternativa eficaz para el tratamiento del DTCI y puede constituirse en una buena alternativa terapéutica para el manejo de estos pacientes...

To present a clinical series of twelve patients that underwent loupe assisted spermatic cord denervation as a treatment for idiopathic Chronic Testicular Pain (ICTP). Patients and methods: Seventeen non responders to oral analgesics patients (age range 18 - 70 years) with ICTP were prospective/y enrolled in the first stage of the study. A spermatic cord block with bupivacaine was performed in all patients. Twelve patients who responded to the bupivacaine cord block underwentloupe assisted (3. 5x magnification) spermatic cord denervation through a subinguinal/ approach. Postoperative follow-up included color doppler ultrasound of the testes seven days after surgery and Visual Analog Scale (VAS) pain questionnaire at 3 and 6 months. Results: The median operation time was 70 minutes (range 50 - 90 min). Seven days after surgery all patients had a normal color Doppler ultrasound without evidence of ischemia in any of the operated testes (n=13). At three and six months after surgery nine patients (75 percent) were absolutely pain free (VAS=O). Three patients remained with pain; two had a VAS 1 that did not interfere with daily activities and required no analgesics, the third patient had a VAS 2 and occasionally required analgesics to manage pain. Two patients needed reoperations, 6 and 8 weeks after primary surgery, one for hematocele and another for lymphocele, both had a favorable outcome and normal color doppler ultrasounds after the second surgery. Conclusion: Loupe assisted spermatic cord denervation is an efficient alternative for the management of ICTP and may become a good therapeutic option for these patients...

Pseudotumor fibroso calcificado del cordón espermático / Calcified fibrous pseudotumor of spermatic cord

Los tumores paratesticulares son infrecuentes y la mayoría benignos. Se presenta el caso de un paciente de 24 años de edad, con antecedentes de buena salud que asistió a la consulta por notarse en el escroto derecho un tumor de aproximadamente 4 cm de diámetro, de consistencia dura e indoloro, de unos 6 meses de evolución. El ultrasonido escrotal reveló una lesión heterogénea y bien circunscrita, independiente del epidídimo y del testículo. La biopsia aspirativa con aguja fina fue infructuosa por la dureza del tumor. Se realizó una inguinotomía y la exéresis total del tumor con biopsia por congelación, negativa de malignidad. El informe histopatológico definitivo fue: pseudotumor fibroso calcificado del cordón espermático. La evolución del paciente ha sido satisfactoria. Se confirma la importancia de la inguinotomía para el abordaje de los tumores paratesticulares, más aún cuando la biopsia aspirativa con aguja fina no es concluyente para el diagnóstico(AU)

Paratesticular tumors are infrequent and most are benigns. This a case presentation of a patient aged 24 with a history of good health coming to our consultation by presence of a hard and painless 4 cm tumor in right scrotum with a 6 months course. Scrotal ultrasound (US) showed a well circumscribed heterogeneous lesion separate of epididymis and the testis. Fine needle aspiration biopsy (FNAB) was not possible by hardness of tumor. A inguinal surgery was performed and the total tumor exeresis using freezing biopsy negative of malignancy. Final histopathological report was: calcified fibrous pseudotumor of spermatic cord. Patient's course has been satisfactory. Significance of inguinal surgery was confirmed for the paratesticular tumor approach, even more when FNAB it is not conclusive for diagnosis(AU)

Ipsilateral testicular necrosis and atrophy after 1.080-degree torsion of the spermatic cord in rats / Necrose e atrofia do testículo ipsilateral após torção de 1080 graus do cordão espermático em ratos

PURPOSE: To assess the incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord, and 60 days after detorsion of the spermatic cord. METHODS: 42 rats were divided in 7 groups. Except for the control group, surgical torsion of the right spermatic cord was performed in all groups (T0). After 1, 2, or 4 hours of torsion, each group underwent either ipsilateral orchiectomy (groups OT1, OT2, and OT4), or detorsion of the spermatic cord and observation for 60 days (groups DT1, DT2, and DT4), before they were evaluated for the presence of testicular necrosis/atrophy. RESULTS: Only one rat (5.5%) in groups OT1, OT2, and OT4 had testicular necrosis, in comparison with six rats (33.3%) in groups DT1, DT2, and DT4 (p=0.04). The incidence of testicular necrosis/atrophy was not different between subgroups T1, T2, and T4, and the control group (p>0.05). There was, however, a tendency toward greater incidence of necrosis/atrophy in the rats in group DT4. CONCLUSION: The incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord is 5.5%, in comparison with 33.3% sixty days after detorsion of the spermatic cord.

OBJETIVO: Avaliar a incidência de necrose/atrofia testicular imediatamente após 1 a 4 horas de torção de 1080 graus do cordão espermático e 60 dias após a destorção do cordão espermático. MÉTODOS: 42 ratos foram separados em 7 grupos. Exceto para o grupo controle, todos os animais foram submetidos à torção operatória do cordão espermático direito (T0). Após 1, 2 ou 4 horas de torção, cada grupo foi submetido a orquiectomia ipsilateral (grupos OT1, OT2 e OT4), ou destorção do cordão espermático e observação por 60 dias (grupos DT1, DT2 e DT4), antes de serem avaliados para a presença de necrose/atrofia testicular. RESULTADOS: Somente um rato (5,5 por cento) nos grupos OT1, OT2 e OT4 apresentou necrose testicular em comparação com 6 ratos (33,3%) nos grupos DT1, DT2 e DT4 (p=0,04). A incidência de necrose/atrofia testicular não foi diferente entre os subgrupos T1, T2 e T4 e o grupo controle (p>0,05). Houve, no entanto, uma tendência a maior incidência de necrose/atrofia nos ratos do grupo DT4. CONCLUSÃO: A incidência de necrose/atrofia testicular imediatamente após 1 a 4 horas de torção de 1080 graus do cordão espermático é de 5,5% em comparação com 33,3% sessenta dias após a destorção do cordão espermático.

Embolization of testicular vein for treatment of recurrent varicocele

To assess the efficacy of embolization of testicular vein for the treatment of recurrent varicocele. Between January 2002 and December 2005, a total of 64 patients with a mean age of 28 [18-40 years] were treated by embolization of testicular vein for management of recurrent varicocele at Prince Hussein Bin Abdullah II Center in King Hussein Medical Center. Indication for treatment was as either infertility or presence of dragging pain in the left testicle. Embolization was accomplished successfully in 53 patients [82.8%], whereas it was difficult in eleven patients because of venous spasm and anomalous collaterals which could not be cannulated. One patient required transfusion of blood due to bleeding from the internal spermatic vein. Embolization technique for internal spermatic vein for treatment of recurrent varicocele is a safe technique with low morbidity. It is also minimally invasive with high success rate

Microsurgical testicular denervation for the treatment of chronic testicular pain initial results

INTRODUCTION: Chronic testicular pain remains an important challenge for urologists. Currently, the treatment plan is primarily empirical, with the first approach consisting of clinical measures. However, some patients remain in pain despite a conservative treatment protocol and, for them, it is possible to perform a surgical procedure that involves severing the scrotal and spermatic branches of the genitofemoral and ilioinguinal nerve fibers. METHODS: In our institution, 60 patients were evaluated and treated for idiopathic chronic testicular pain between January 2003 and July 2007. Priority was give to clinical treatment, which evolved from simple to more complex measures. Microsurgical treatment was performed on those who experienced no considerable pain relief (10 individuals in our study). RESULTS: Over a twenty-four-month follow-up period, 70 percent of patients showed complete remission and 20 percent exhibited partial relief from pain.

Ectopic adrenal tissue in the spermatic cord in pediatric patients: surgical implications

OBJECTIVE: To study the incidence and relevance of ectopic adrenal tissue in pediatric patients who underwent groin surgical explorations. MATERIALS AND METHODS: We studied 1120 patients with groin surgical explorations during a period of 8 consecutive years. PatientsÆ clinical data and histological findings were analyzed. RESULTS: We found ectopic adrenal tissue in 13 patients in 1120 groin surgical exploration (1.16 percent). Of the 13 cases, 5 were diagnosed as having undescended testes, 6 inguinal hernia and 2 communicating hydrocele. Median age at diagnosis was 5.6 years. Histological sections showed adrenal cortical tissue with no medulla present. CONCLUSION: Based on the clinical implications of those adrenal rests it is mandatory the removal of this ectopic tissue whenever encountered during surgical interventions in the groin region in children.

Paratesticular leiomyosarcoma treated by enucleation

Spermatic cord leiomyosarcomas are rare tumors and standard treatment consists of radical orchiectomy and high cord ligation. We report a case of a paratesticular leiomyosarcoma successfully treated by enucleation. A 22-year-old man presented with a 6-months history of inguinal pain. Physical examination revealed a right paratesticular nodule about 0.5 cm in diameter. Inguinal exploration and nodule biopsy were performed. It was thought to be a benign epididymal nodule on a quick section and the tumor was enucleated and sent for paraffin section. Histology and immunohistochemistry were compatible with leiomyosarcoma. The patient was advised to undergo radical orchiectomy with high cord ligation. However, he refused surgery. An alternative approach with clinical, biochemical and radiological follow-up was adopted. The patient has been followed up for thirteen years and shows no evidence of disease.

Spermatic cord block: a safe technique for intrascrotal surgery

In this study, 48 patients underwent operative procedures on the testes, epididymis or the spermatic cord using the technique of spermatic cord block anesthesia. There were no complications attributable to the technique. The procedures were tolerated well and most of the patients were treated on a day case basis