Images in clinical urology. Floating balls appearance in testicular cystic teratoma.

Fourteen cases of a "floating balls" appearance on imaging studies in a mature ovarian cystic teratoma have been reported in published studies since 1991. Past investigators could not provide an explanation for the true mechanism of the formation of the balls. However, the floating balls occurred in rather large cysts. Because of self-examination, patients with testicular teratoma are usually referred to the hospital when the tumor is of a smaller size than that seen in patients with ovarian teratoma. We report the first case of a floating balls appearance in a testicular teratoma.

[Laparoscopic examination of the nonpalpable testis].

We evaluated the results and advantages of laparoscopic examination in 28 patients with 32 nonpalpable testes. Between April 1991 and May 2006, 28 patients, 12 months to 12 years old, with 32 nonpalpable testes underwent diagnostic laparoscopy under general anesthesia before surgical management of the testes. If the blind end of the vas deferens and/or spermatic vessels was observed, the diagnosis of vanishing testis was made, and no further examination or treatment was performed. If intra-abdominal testis was observed, laparoscopic orchiectomy or open orchiopexy was performed. If the internal spermatic vessels and vas deferens entered into the internal inguinal ring, the diagnosis of intra-canalicular testis was made so that the inguinal canal was opened for surgical interventions. Of the 32 nonpalpable testes 10 were on the right side and 22 were on the left side (4 patients had bilateral undescended testes). There were 7 (21.8%) vanishing, 5 (15.6%) intra-abdominal and 20 (62.5%) intra-canalicular testes. There were no complications related to laparoscopy. Laparoscopy can be safely performed to assess the location of the non-palpable testes. Another advantage of the laparoscopic examination is that orchiopexy or orchiectomy can be immediately performed after the examination to avoid a second surgery.