A Rare Case Report of Undescended Testis: Both on One Side.

Undescended Testis is a medical term that uses for any testis which is not in its normal place (bottom of the scrotum). UDT can be classified as unilateral and bilateral. Unilateral UDT is more common than bilateral UDT. There is a very rare condition in which both testicles are on the same side and have not descended.We report in this article a 3 years old boy by a chief complaint of bilateral testicular mass absence. Diagnostic evaluation has been done but testes was abcent in scrota.  Exploring laparoscopy has been done and rare cases of UDT diagnosed, in which both testicles was on left side of the pelvis by two separate spermatic cord. The shorter spermatic cord fixed in the left scrotum and the longer one fixed on the right side. The testis was normal in follow up examinations.

The prevalence of bell clapper anomaly in the solitary testis in cases of prior perinatal torsion.

PURPOSE: Bell clapper anomaly is associated with an increased risk of intravaginal testicular torsion. However, perinatal torsion is thought to be secondary to an extravaginal process. We quantified the contralateral prevalence of bell clapper anomaly in children found to have atrophic testicular nubbins secondary to presumed torsion during gestation to better define the subsequent risk of metachronous testicular torsion. MATERIALS AND METHODS: Inspection results for the presence of contralateral bell clapper anomaly was recorded by a single surgeon in 50 consecutive cases in which exploration for nonpalpable testes revealed a testicular nubbin. For comparison data were collected in 27 consecutive cases of acute testicular torsion. Anatomy of the normal contralateral testis was compared between the 2 groups. RESULTS: Average age at surgery in the perinatal torsion group was 15 months vs 12.7 years in the acute torsion group. One case of partial contralateral bell clapper anomaly was discovered in the perinatal torsion group but no complete anomaly was found. In contrast, in older boys with acute testicular torsion complete bell clapper anomaly was found in 21 of the 27 contralateral testes (78%). CONCLUSIONS: In older boys with acute testicular torsion contralateral bell clapper anomaly is highly prevalent, supporting the standard practice of contralateral testicular fixation in this clinical situation. However, the prevalence of contralateral bell clapper anomaly is exceedingly small in cases of monorchism after perinatal torsion, substantiating an insufficient risk of subsequent torsion to justify routine fixation of the solitary testis.

Splenogonadal fusion and sex reversal.

Splenogonadal fusion is a rare congenital malformation where an abnormal union occurs between the spleen and gonad or mesonephric derivatives. Although it occurs in females it is much less prevalent than in males (male:female ratio, 16:1), but this may partly be because of the inaccessibility of the female gonads leading to under-diagnosis. To our knowledge this is the first case of splenogonadal fusion associated with sex reversal reported in the literature.

Scrotal nubbins associated with blind-ending spermatic vessels and a normal vas deferens on laparoscopy.

OBJECTIVES: To determine whether a scrotal nubbin is present in children with unilateral non-palpable testis when diagnostic laparoscopy demonstrates blind-ending vessels and a normal vas deferens entering a closed internal ring. METHODS: Eighty consecutive patients with a unilateral nonpalpable testis were retrospectively reviewed. Patients underwent initial diagnostic laparoscopy, and, if needed, subsequent inguinal exploration was performed. On inguinal exploration, any testicular remnant or nubbin-like tissue was removed and evaluated histologically. Patients with a patent processus vaginalis were excluded from this analysis. RESULTS: Overall, 60 of the 80 patients had neither an abdominal testis nor a patent processus vaginalis. Of these 60, 34 patients had both a vas deferens and spermatic vessels entering a closed internal ring, and all of these underwent inguinal exploration. A total of 17 patients had both a blind-ending vas deferens and blind-ending spermatic vessels; no inguinal exploration was attempted. In nine patients, laparoscopy revealed blind-ending vessels with a normal vas deferens entering the closed internal ring. Of these nine, six underwent inguinal exploration, and a scrotal nubbins was found in three. At histological examination, hemosiderin deposit and calcification were seen in the nubbin tissue. No viable germ cell was detected in these specimens. CONCLUSIONS: A laparoscopic finding of blind-ending vessels above the closed internal ring does not mean intra-abdominal vanished testis, regardless of the appearance of the vas deferens.

Liposarcoma del cordón espermático: Nuestra experiencia y revisión de la literatura / Liposarcoma of the espermatic cord: Our experience and review of the literature

Introduccion: Los tumores paratesticulares representan del 7-10% de las masas intraescrotales. Los sarcomas abarcan el90% de las lesiones malignas del cordón espermático y de estas aproximadamente el 3-7% son liposarcomas. Material y métodos: Presentamos nuestra experiencia con dos casos de liposarcomas paratesticulares. Resultados: Hasta la fecha hay reportados cerca de 161 casos de liposarcoma paratesticular. Debido a lo raro de esta patologíaes difícil conocer la historia natural y llegar a conclusiones acerca de los resultados del tratamiento, el cual hasta el momento sigue siendo la orquiectomía radical, con excisión amplia de los tejidos locales y el papel de la radio y quimioterapia aún es controversial. Conclusiones: Los sarcomas del cordón espermático son neoplasias raras, su manejo inicial es quirúrgico, recomendamos la valoración transoperatoria de los bordes quirúrgicos para tratar de disminuir la frecuencia de reincidencias (AU)

Introduction: The paratesticular tumors represent 7-10% of the intraescrotales masses. Sarcomas includes 90% of the espermatic cord malignant lessons and approximately the 3-7% are liposarcomas. Material and methods: We presented our experience with two cases of paratesticular liposarcomas. Results: Actually it has been reported near 161 cases of paratesticular liposarcoma. Due to the rarely of this pathology it is difficult to know its natural history and to reach conclusions of the treatment results, which one until the moment continues being radical orchiectomy with wide local resection of the surrounding soft tissues, the value of adjuvant radiation and chemotherapy is even controversial. Conclusions: Sarcomas of the espermatic cord are rare, their initial treatment is surgical, we recommended the transoperatory valuation of the surgical edges to try to diminish the recurrence frequency (AU)

Cryptorchidism with short spermatic vessels: staged orchiopexy preserving spermatic vessels.

PURPOSE: Patients with cryptorchidism can have such short spermatic vessels that it is impossible to place the testicle in a satisfactory scrotal position using conventional orchiopexy. In these cases the most commonly used operation is 1 to 2-stage Fowler-Stephens orchiopexy. We present our surgical experience using staged inguinal orchiopexy without section of the spermatic vessels in patients with short spermatic vessels. MATERIALS AND METHODS: We used 2-stage inguinal orchiopexy in 38 children with intra-abdominal testis or testis peeping through the internal ring and short spermatic vessels (7 bilateral). Spermatic vessels were not sectioned, but were lengthened through progressive traction of the spermatic cord wrapped in polytetrafluoroethylene pericardial membrane (Preclude). In the first stage we mobilized the spermatic cord in the retroperitoneal space and then wrapped it in the polytetrafluoroethylene membrane. We subsequently attached the testis to the invaginated scrotal bottom. At 9 to 12 months we performed the second stage, which involved removing the polytetrafluoroethylene membrane. RESULTS: From the first to the second stage we observed progressive descent of the testicle toward the scrotum. At 1 to 8-year followup after the second stage all 45 testicles were palpable in a satisfactory scrotal position with stable or increased testicular volume. CONCLUSIONS: This technique represents an alternative to Fowler-Stephens orchiopexy, which can be associated with a greater risk of testicular ischemia.

[Present state of studies on anatomical anomalies in cryptorchidism].

Cryptorchidism is a clinically common congenital deformity of the genital organ, the etiological factors of which are still not clarified up to now. Undescended testis is frequently accompanied with the anomalies of the spermatic cord, gubernaculum testis, processus vaginalis, and epididymis. Because these anatomical anomalies act as terminal factors or the ending in the links of the cause of cryptorchidism, it is of important directive significance for the clinical treatment of the problem to seek evidence of anatomical anomalies at orchiopexy to demonstrate the etiological factors of cryptorchidism.

[Polyorchidism: a case report and review of the literature]. / Poliorquidismo: aportación de un caso y revisión de la literatura actual.

Polyorchidism is an uncommon congenital defect. In fact, less than one hundred cases have been reported in the medical literature worldwide. This problem should be considered in the differential diagnosis of all scrotal masses. It is associated with multiple other urologic entities including malignancy. It is for this reason that it is important to be familiar with potential diagnostic and therapeutic strategies. This diagnosis is usually documented by imaging, specifically doppler ultrasound (US) and magnetic resonance imaging (MRI). The risk of malignancy approaches 6% in Polyorchidism and therefore several authors have advocated surgery as the most appropriate therapeutic approach. However, recent reports suggest that asymptomatic patients with normal imaging could be observed. We present a 14 year old boy with polyorchidism which was diagnosed clinically and confirmed with imaging. His treatment and a review of the literature are presented as well.

Partial duplication of the vas deferens at the level of inguinal canal.

A case of partial duplication of vas deferens is reported. The reports relevant to this malformation are reviewed and the embryologic etiology is discussed.

Clinical and histological significance of the testicular remnant found on inguinal exploration after diagnostic laparoscopy in the absence of a patent processus vaginalis.

PURPOSE: We reviewed the histological findings of cord structures excised at inguinal exploration after diagnostic laparoscopy in patients with a nonpalpable testis with the vas deferens and spermatic vessels exiting the internal inguinal ring in the absence of a patent processus vaginalis. MATERIALS AND METHODS: A retrospective review of 809 laparoscopic explorations for nonpalpable testes between 1981 and 2003 was conducted. The histological findings of the excised remnants of those patients with a closed processus vaginalis were reviewed. RESULTS: A total of 110 patients underwent excision of a testicular remnant at inguinal exploration in association with a closed processus vaginalis. Of the specimens 31 (28%) were on the right side and 79 (72%) were on the left side. The incidence of viable germ cell elements was 8 of 110 (7%). The presence of hemosiderin, calcification and fibrosis was identified in all 8 remnants with viable germ cell elements. CONCLUSIONS: The incidence of viable germ cell elements in the excised remnant when the vas deferens and spermatic vessels are identified exiting a closed internal ring in patients with a nonpalpable testis is 7%. To our knowledge no prior study has evaluated the incidence of viable germ cell elements in remnants associated with a closed internal inguinal ring. Based on these findings, we advocate inguinal exploration and excision of testicular remnants in these patients.

[The characteristics of improving the prevention of male infertility]. / Deiaki osoblyvosti udoskonalennia profilaktyky cholovichoho bezpliddia.

The author analyzes major shortcomings in the administration of male infertility prophylaxis. An association has been found out between the late onset of surgical correction of congenital abnormalities of the testis and spermatic cord and displeasing results of treatment. An outline is submitted of prophylactic management of children presenting with this pathology. Its implementation into the practical activities of outpatient physicians will, we believe, help in achieving better results with treatment of children having testis malformation and in perfecting the administration of male sterility prophylaxis.

[Laparoscopic intervention in pediatric urology]. / Laparoszkópos beavatkozások a gyermekurológiában.

The authors summarise the short history of the laparoscopy, and main steps of its use in international and Hungarian practice of urological surgery. They evaluate the possibility of laparoscopy in paediatric urological practice. Finally, they present their experience with this minimally invasive technique from 1995. Between October 1995 and September 1998, 83 laparoscopic procedures were performed. In 59 patients the vena testicularis were ligated by laparoscopy and in 22 patients 24 non palpable testes were diagnosed and operated. In 9 of the cases laparoscopic orchidopexy was performed. The authors demonstrate their operative technique. All laparoscopic interventions were tolerated well by children and they were treated without any complication. Postoperative pain medication were given for 5 children. The operative time for varix ligation ranged from 15 and 20 minutes, and for laparoscopic orchidopexy from 30 and 40 minutes. The recurrence rate of varicocele was found to be 1.5%, and postoperative hydrocele developed in one patient (1.5%).