Management of the Torsion of Spermatic Cord in the Urology-Andrology Department of the Ignace Deen National Hospital in Conakry

Introduction: Torsion of the spermatic cord is an emergency whose delay in treatment conditions the functional prognosis of the testicle. The aim of this study was to analyze the management of spermatic cord torsion in the Urology Andrology Department of the Ignace Deen National Hospital in Conakry. Material and methods: This was a ten-year retrospective descriptive study from January 1, 2012 to December 31, 2021. It involved all patients admitted for torsion of the spermatic cord, confirmed at surgical exploration. Results: We identified 21 cases of torsion of the spermatic cord. The mean age of the patients was 17.9 ± 4.4 years. The average consultation time was 19.2 ± 21.4 hours with extremes of [2 h and 98 h]. Only 6 patients (28.6%) consulted before the sixth hour. All patients presented with scrotal swelling. At scrototomy, all torsions were intravaginal with two turns of spiral in 13 cases and three turns in 8 cases. Orchiectomy followed by contralateral orchidopexy was performed in 6 cases. In the other cases, bilateral orchidopexy was performed after detorsion. The average hospital stay was 4.5 days. We recorded 4 cases of testicular atrophy after orchidopexy. Conclusion: Spermatic cord torsion is an infrequent emergency in our department. The delay in consultation remains the main predictive factor of testicular necrosis. Emergency exploratory scrotomy should be the rule.

Immunohistopathology of the contralateral testis of rats undergoing experimental torsion of the spermatic cord

Aim： To evaluate the immunohistopathological changes in the contralateral testis of rats after an experimental spermatic cord torsion. Methods： Male Sprague-Dawley rats of 45-50 days old were subjected to a 720° unilateral spermatic cord torsion for 10, 30 and 80 days （experimental group, E）, respectively or sham operation （control group, C）. Histopathology of the contralateral testis as well as germ cell apoptosis were studied using the Terminal Deoxynucleotidyl Transferase Biotin-dUTP Nick End Labeling （TUNEL） technique. The number of testicular lymphocytes, mast cells and macrophages, and the expression of tumor necrosis factor-α （TNF-α） and its receptor （TNFR1） in testicular cells of the contralateral testis were quantified by histochemistry and immunohistochemistry. TNF-α concentration in testicular fluid was determined by ELISA. Results： In the contralateral testis of rats from the E group, the maximal degree of damage of the germinal epithelium was seen 30 days after torsion. At this time we observed in the E group vs. the C group increases： （i） the number of testicular T-lymphocytes; （ii） the number of testicular mast cells and macrophages; （iii） the percentage of macrophages expressing TNF-α; （iv） TNF-α concentration in testicular fluid; （v） the number of apoptotic germ cells; and （vi） the number of TNFR1^＋ germ cells. Conclusion： Experimental spermatic cord torsion induces, in the contralateral testis, a focal damage of seminiferous tubules characterized by apoptosis and sloughing of germ cells. Results suggest humoral and cellular immune mediated testicular cell damage in which macrophages and mast cells seem to be involved in the induction of germ cell apoptosis through the TNF-α/TNFR1 system and in the modulation of the inflammatory process.

Microanatomy of the spermatic cords during microsurgica inguinal varicocelectomy： initial experience in Asian met

The microanatomy of the inguinal spermatic cords has never been reported in Asia. The purpose of this study was to describe the number and relationship of the veins, arteries and lymphatics in the spermatic cord and to clarify the location of the vas deferens in Asian men. Fifty-one patients receiving 79 primary microsurgical varicocelectomies performed by a single surgeon from April 2011 to July 2012 were studied. The number of internal and external spermatic veins, testicular arteries and lymphatic channels preserved during the inguinal microsurgical varicocelectomy were recorded. The relationship between the right and left vascular anatomy during bilateral varicocelectomies was evaluated. The data showed that mean numbers of 1.5±0.9 arteries, 5.6±2.2 spermatic veins and 3.6±1.9 lymphatics were identified during the repairs. The internal spermatic arteries were surrounded by a dense complex of adherent veins in 81.2% of the cases. The external spermatic vein or veins were found in 60.8% of the cases. The vas deferens may be contained within the internal spermatic fascia. The results suggest that the number of veins may be highly variable and less than those reported in the English literature, but there is some similarity in the inguinal microanatomy of the right and left spermatic cords, Further research is warranted to clarify our results.

Krukenberg tumor with concomitant ipsilateral hydronephrosis and spermatic cord metastasis in a man: A case report

BACKGROUND Tumors of the spermatic cord are rare,and approximately 25%are malignant neoplasms.Metastatic spermatic cord tumors are even rarer.Several studies have revealed that the most frequent primary tumors metastasizing to the spermatic cord and peritesticular tissues are neoplasms of the stomach and prostate.Furthermore,metastasis to the spermatic cord or epididymis may occur via retrograde lymphatic and hematic routes.We present the case of a man with gastric cancer that metastasized to the spermatic cord and epididymis,with concomitant ipsilateral hydronephrosis after surgical resection and chemotherapy for his primary tumor.CASE SUMMARY A 71-year-old man underwent total gastrectomy for pT4aN2 poorly differentiated gastric adenocarcinoma in December 2016.Two months after surgery,he received adjuvant chemotherapy with TS-1 from February 2017 to February 2018.Surveillance computed tomography(CT)was performed in June 2018,which did not reveal any sign of tumor recurrence.In November 2019,he presented with left lower quadrant abdominal pain and a palpable left inguinal-scrotal mass.CT revealed left mild hydronephrosis and a left scrotal mass measuring 4.0 cm×1.7 cm.Tumor biomarkers,including alpha-fetoprotein(AFP),lactate dehydrogenase(LDH),beta-human chorionic gonadotropin(βHCG),carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9(CA19-9)were all normal.Renal and testicular echography showed left hydronephrosis and a left peritesticular soft tissue lesion with blood flow.Diagnostic ureteroscopy showed left lower ureter narrowing without an intraluminal lesion.A biopsy was obtained for the indurated spermatic cord and epididymis,which showed poorly differentiated adenocarcinoma.Immunohistochemical staining demonstrated that the tumor was diffusely and strongly positive for homeobox protein CDX2.The features were consistent with metastatic adenocarcinoma of a primary gastric tumor.CONCLUSION In patients with a history of primary cancer,an inguinal mass of unknown cause with accompanying ipsilateral hydronephrosis may be a sign of distant metastasis from a primary tumor,especially of gastrointestinal origin.

Pleomorphic rhabdomyosarcoma of the spermatic cord and a secondary hydrocele testis:A case report

BACKGROUND Pleomorphic rhabdomyosarcoma(RMS)of the spermatic cord is a group of rare neoplasms,and a secondary hydrocele testis occasionally occurs.The misdiagnosis of paratesticular mass may lead to a therapeutic delay.CASE SUMMARY A 79-year-old man presented to our clinic complaining of a 1-mo history of painless scrotal swelling.Physical examination revealed approximately a 15 cm×10 cm×5 cm inguinal mass with limited mobility.Contrast-enhanced magnetic resonance imaging showed a hydrocele testis,several enlarged inguinal lymph nodes,and a heterogeneously enhanced lesion with a relatively well-defined margin in the left inguinal region.Due to the imaging findings,he was diagnosed with pleomorphic RMS and received a wide resection of the mass,an inguinal incision with a high section of the left spermatic cord,and a left radical orchiectomy.He experienced local relapse 1 mo postoperatively and received radiotherapy and anlotinib hydrochloride-based immunotherapy as adjuvant therapy.The patient died 3 mo after the surgery.CONCLUSION The optimal interventions for advanced-stage pleomorphic RMS patients should be investigated by more preclinical studies and clinical trials.Physicians need to be aware of the occurrence of pleomorphic RMS in unusual locations,especially when accompanied by a hydrocele testis.

Bilateral occurrence of sperm granulomas in the left spermatic cord and on the right epididymis:A case report

BACKGROUND Sperm granuloma is a rare disease in clinical andrology and its incidence is still unclear worldwide.According to the existing literature,sperm granuloma often occurs unilaterally.Clinical and ultrasound features are similar to epididymal tuberculosis,chronic epididymitis and other diseases.Sperm granuloma is usually diagnosed based on postoperative histopathological and immunohistochemical examination.CASE SUMMARY A 46-year-old man was admitted to the hospital due to the presence of a left scrotal mass for 3 mo and aggravation of pain for 1 wk.The lesions at both sites were surgically resected.Postoperative pathological examination showed that the left spermatic cord mass and the right epididymal mass were consistent with sperm granuloma.The sperm granulomas then recurred 3 mo after surgery.There is little change in the local mass so far.CONCLUSION The case report is helpful for our understanding of this disease.In clinical diagnosis,it should be distinguished from epididymal tuberculosis,chronic epididymitis and other diseases.Color Doppler ultrasound can be used as a preferred examination method but postoperative pathological examination is still needed for diagnosis.

Twisting of the Spermatic Cord in an Elderly Subject at the Yaounde Central Hospital: About a Case

Introduction: Twisting of the spermatic cord is part of urological emergencies. It can occur at any age with a predilection for children and adolescents. There is no literature on spermatic cord torsion in octogenarians, probably due to its rarity. The majority of recent studies show spermatic cord torsion in patients under 55 years of age. This is why we present a case of spermatic cord torsion in an 80 years old subject. Case Presentation: We present a case of torsion of the spermatic cord in an 80-year-old subject. The diagnosis was made on anamnestic and clinical grounds. The patient presented with scrotal pain, unilateral, of sudden onset, violent intensity without urinary signs with an ascended testicle. The urine dipstick was unremarkable. Management was done surgically and as an emergency. The postoperative course was satisfactory. Conclusion: Spermatic cord torsion in octogenarians is exceptional and should be suspected in the first instance in the presence of any sudden onset, severe testicular pain without urinary signs with an ascended testicle and a negative urine dipstick.

Fibrous histiocytoma of the spermatic cord 1 case and review of the literature

Objective:The diagnosis and treatment of this disease were discussed based on the relevant literature and the clinical data of spermatic fibrous histiocytoma in our hospital.Methods:The clinical data of 1 case of spermatic cord fibrous histiocytoma admitted to urology department were retrospectively analyzed,combined with relevant literature review and discussion.Results:After surgical radical treatment,the pathological result was fibrous histiocytoma.Conclusion:Spermatic cord fibrous histiocytoma is a rare tumor of genitourinary system.The diagnosis is mainly based on pathological results.Surgery is the first choice for treatment.Adjuvant radiotherapy and chemotherapy are not effective and the prognosis is poor.Regular postoperative review is required.

Microsurgical denervation of the spermatic cord for treatment of idiopathic chronic orchialgia

A patient referred to our hospital, diagnosed with left idiopathic chronic orchialgia, was evaluated with a thorough medical and psychiatric history, physical examination, scrotal ultrasound and magnetic resonance imaging. Conservative management failed. The patient had temporary pain relief after undergoing outpatient cord block three times. Microsurgical denervation of the left spermatic cord was operated in March, 2011. A pain questionnaire was used to determine efficacy before and after operation, and complete pain relief was noted at one week after operation. The follow up period was 12 months, at the end of which the pain score was still zero. No complications, including testicular atrophy and hydrocele, occurred. Microsurgical denervation of the spermatic cord can be a minimally invasive, safe and effective management option for treatment of idiopathic chronic orchialgia.

Torsion of the spermatic cord in adults:a multicenter experience in adults with surgical exploration for acute scrotal pain with suspected testicular torsion

Acute scrotal pain(AsP)requiring surgical exploration is common in the pediatric population,but little has been reported on this subject with regard to the adult population.The aim of this study was to investigate the demographic and clinical characteristics and outcomes of scrotal explorations performed on adult patients.Patients over 21 years of age who underwent surgical exploration for ASP with suspected testicular torsion(TT)at 14 French hospitals between January 2005 and December 2019 were included in this study.The main outcome measures were demographic characteristics,pathology found during scrotal exploration,and perioperative outcomes.Logistic regression was used to perform univariate and multivariate analyses to identify predictors of TT.Data for 1329 men were analyzed.The median age was 30(interquartile range[IQR]:25-35;range:21-89)years.Regarding the clinical examination,867(65.2%)patients presented with an elevation of the testicle,613(46.1%)patients with scrotal edema or erythema,and 211(15.9%)patients with nausea or vomiting.Operative findings identified TT in only 684(51.5%)patients,epididymo-orchitis in 112(8.4%)patients,a tumor in 16(1.2%)patients,and no causes in 475(35.7%)patients.Orchiectomy for nonviable testes was required in 101(7.6%)patients.In multivariate analysis,an elevation of the testicle,erythema/swelling,and the presence of nausea/vomiting were found to be associated with the occurrence of TT.Testicular torsion is not exclusive to children and adolescents,so must be considered in males of any age with acute scrotal findings.However,one-third of scrotal explorations in adults did not lead to a diagnosis.

Large Painful Bursae at Abeche Hospital: Epidemiological, Clinical, Therapeutic and Evolutionary Aspects

Introduction: Acute large bursae (ALB) are a frequent reason for emergency consultations. The aim of this study was to investigate the prevalence, clinical course, treatment and evolution of ALB at Abeche University Hospital. Patients and Method: This was a 45-month cross-sectional study from January 2020 to September 2023. Male patients of any age who had been admitted to and treated for acute large bursae at the Abeche University Hospital were included. Sociodemographic, clinical and therapeutic variables were studied. Results: Acute large bursae accounted for 7.92% of emergency admissions. The average age was 39.40 years. 60.27% of patients came from rural areas. The average consultation time was 4 days, ranging from a few hours to 18 days. The main reason for consultation was pain. Strangulated inguino-scrotal hernia was the most common, followed by acute orchi-epididymitis, accounting for 41.8% and 26% of cases respectively. Traditional treatment prior to consultation was attempted in 13.7% of cases. All patients were treated as emergencies, 41 of whom had received medical treatment. Of the patients treated surgically, orchidopexy was performed in all. Parietal suppuration and anaemia occurred in 6.2% and 4.8% of cases respectively. Conclusion: A accounts for a significant proportion of our emergency care activity. However, patients are seen with a delay, which jeopardises the functional prognosis of the testicle and intestine.

Outpatient varicocelectomy performed under local anesthesia

Aim： To report a series of varicocelectomy performed under pure local anesthesia. Methods： From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale （VAS） was used to assess whether the pain level was acceptable. Results： The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % （567/575） of men could go back to work by the end of the first post-operative week and only 8 （1.4 %） men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of （18.5 ± 11.3） mm that was regarded as tolerable. Conclusion： This study has shown varicocelectomy under local anesthesia to be possible, simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.

Morphological and microcirculatory evaluation of the rat testis after detorsion with or without a capsular release with a tunica vaginalis flap

Testicular torsion may lead to serious ischemia, and the viability depends on the duration of torsion and the effect of ischemia-reperfusion. Testicular decompression and tunica vaginalis flap application technique were introduced in 2008 by Kutikov et al. We aimed to examine the impact of this method on the testicular microcirculation and hemorheological parameters in a rat model. Six adult rats underwent bilateral scrotal exploration. Intravaginal torsion of the testis was created by 720° rotation on both sides for 2 h. After detorsion, the right testes underwent tunica albuginea incision and tunica vaginalis flap application. Testicular microcirculation was monitored and hematological parameters, erythrocyte deformability, and aggregation were determined. Measurements were performed before and after torsion, directly after detorsion, on the 1^st-2^nd and 8^th postoperative day. After the last sampling, testicles were removed to determine their volume for histological examinations. The microcirculatory parameters demonstrated slight differences between testicles. Apical zone of the left （nondecompressed） testicles had elevated compared to the middle zone （P 〈 0.05）. On the 2^nd and 8^th day, the microcirculation of the testes normalized but not equally. The erythrocyte aggregation and deformability decreased by the 8^th day. Both testicles underwent atrophy and epithelial necrosis, but the volume of the decompressed ones was lower （1.07±0.08 vs 1.25 ± 0.31）. Histologically, there was no significant difference in epithelial damage score between decompressed and nondecompressed testes. In conclusion, 2-h ischemia led to alteration in testicular microcirculation, reduction in volume, changes in hemorheological parameters and serious epithelial necrosis both in decompressed and nondecompressed testicles without remarkable differences.